When 56-year-old Mrs Saroja was diagnosed with breast cancer, her biggest concern and worry was regarding chemotherapy as she had heard about the side effects and was scared about undergoing this part of the treatment. After her cancer surgery, she was counselled about the probable need for chemotherapy. However, as she had early-stage good risk hormone positive disease, she was advised to undergo prognostic testing that would help to decide whether chemotherapy was actually needed or not. This was a life-changing decision for her. She decided to proceed to take the recurrence test that could determine the probability of recurrence. This test is done on the tumour tissue that was removed during surgery. She was able to avoid chemotherapy as the recurrence test classified her as low risk of recurrence. Her doctors, therefore, advised her to not undergo chemotherapy and proceed with the next part of her treatment that was oral hormonal therapy.
There was a time when most early-stage breast cancer patients had to undergo chemotherapy to decrease the chances of cancer recurrence. This approach has significantly changed over the last decade due to the advent of recurrence tests also referred to as 'prognostic tests'. These tests can determine the probability of recurrence of cancer. The test classifies the patient into a low or high-risk zone for recurrence. Based on the test results, clinicians can then plan an appropriate treatment for each patient.
Recurrence risk prediction is an important step towards personalized cancer treatment. In up to 3 out of 4 patients with early-stage hormone receptor-positive breast cancer, the risks of chemotherapy are outweighed by its benefits. Therefore, it is essential that chemotherapy is given to only those patients who will benefit from it, thereby preventing overtreatment in the majority of the patients. A prognostic test aids in identifying those patients that have a high risk of cancer recurrence and will gain the maximum benefit from chemotherapy.
A prognostic test is a boon to patients as well as clinicians. Breast cancer patients with ER+(Estrogen positive), HER2-/neu disease, if diagnosed at an early stage, have a very good prognosis with a high survival rate. Prior to the advent of molecular tests, the clinicians would gauge the prognosis of patients based on clinical factors such as tumor size, tumor grade, age of the patient, number of positive nodes and other factors. Based on these risk factors, patients would be prescribed chemotherapy followed by radiation therapy (if required) and endocrine therapy. But these conventional clinical parameters individually do not look at the disease on an individual molecular level and thus lack in providing insights into how each individual patient will fare with the disease. Therefore, a prognostic test provides assistance to clinicians for personalised decision-making in each individual patient and helps to select the patient who will most benefit from chemotherapy and avoid it in those who will not gain much benefit.
Chemotherapy is an aggressive treatment with many side effects such low blood counts, infections, fatigue, loss of appetite, etc It destroys healthy cells in its course while targeting the fast-growing cancer cells. By taking a prognostic test, patients with a low risk of cancer recurrence can avoid chemotherapy along with all the toxic side effects.
The importance of prognostic tests is evident by the fact that they are a part of major international cancer treatment guidelines such as NCCN (National Comprehensive Cancer Network). There are many prognostic tests available in the market but only a few are validated on Indian patients. CanAssist Breast test is one such example. This is a home-grown, indigenous test that analyses critical biomarkers in the tumour to assess the risk of recurrence and helps oncologists to personalize treatment plans.
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Breast cancer takes a significant physical and emotional toll on the health of the patient. By utilizing a prognostic test for patients with early breast cancer, we can determine the most suitable treatment option for the patient, which will help us to ensure an improved and happy life for the patients.
The article is contributed by Dr. Anubha Bharthuar, HOD, Medical Oncology & Hematology, Patel Hospital, Jalandhar.