The MammaPrint® Test, a Tumor Profiler

Gene expression tests can be a very good way to learn more about your particular form of breast cancer. Based on the information these tests provide, your doctor can then decide how best to treat your cancer, or even choose no further treatment after surgery.

Gene expression tests are not the same thing as genetic testing, which is done using a sample of blood, saliva, or other tissue. Genetic testing is generally carried out to ascertain whether a person has a mutation (abnormal change) in a gene that is linked to a higher risk of breast cancer, such as BRCA1/2.

The MammaPrint test is one such gene expression test, also known as a tumor profiler. It was created by Agendia, a privately-held company in Amsterdam that develops and markets genomic diagnostic products.

How the MammaPrint test works

After you have had your breast cancer surgery or a biopsy, some tissue from the tumor is sent for examination. They look at the activity level of 70 different genes known to be associated with breast cancer. After examining the tissue, a recurrence score is then calculated which will tell whether you are at low risk or high risk for recurrence. Based on that information, your doctor can then decide whether any further treatments would be beneficial to you after surgery.

The Best Candidates for the MammaPrint Test

those with stage I or stage II breast tumors
those with invasive tumors
those whose tumors are smaller than 5 cm
those who had cancer cells in three or fewer lymph nodes
those with both hormone-receptor-positive or hormone-receptor-negative tumor cells
the tissue must be taken during the original biopsy or surgery

There are several other tumor profiling tests used to analyze breast cancer, including the Oncotype DX test, which has been validated by more research. The Oncotype DX test is presently the most widely used genomic test for breast cancer.

What is the Cost?

In the United States, the cost of the MammaPrint test ranges between USD$3,000 to $4000. It is covered by US Medicare and some private health insurance, depending on whether the individual’s breast cancer matches the test’s parameters. Be sure to ask your health insurance company if you are covered, should you be considering having the MammaPrint test.

Also, be aware that Agendia offers a reimbursement assistance program to help you with your insurance claim. If you don’t have insurance or your insurance company doesn’t cover the MammaPrint test, Agendia may still be able to help. Contact one of their patient advocate representatives by phone at 1-888-363-7868 or email at billing@agendia.com.

Unfortunately, in Australia, the Medical Services Advisory Committee (MSAC) did not support public (government) funding for the MammaPrint test. They based that decision on a review of the safety, clinical effectiveness and cost effectiveness of the test.

According to an Australian government website [1], “MSAC based its conclusion on its appraisal of a study known as the MINDACT trial which investigated the use of the MammaPrint® test in a clinical trial setting.

The trial aimed to show whether information provided by the MammaPrint® test could be added to existing clinical information to inform decisions about the use of adjuvant chemotherapy for early breast cancer. The trial showed that, overall, breast cancer outcomes were poorer in women who did not have chemotherapy based on the MammaPrint® test, compared with those who received chemotherapy.

“As a result, MSAC had little confidence that the MammaPrint® test could be used to justify withholding chemotherapy without negatively impacting upon important outcomes, including overall survival.

The MammaPrint test is available to Australia patients, but patients must pay the cost of it themselves, there are no government subsidies.

MammaPrint Research

We do have quite a bit of research [2], [3], [4], [5], [6], [7] on the MammaPrint test, which suggests that it may be useful to help make treatment decisions based on the expression of certain genes, as to the risk of the cancer returning within 10 years after diagnosis.

One 2019 review of medical studies [8] found that all of the tests analyzed (including MammaPrint) were able to provide prognostic information on the risk of relapse, but that the results were more varied in those patients with positive lymph nodes than for those with node-negative disease.

If you have been diagnosed with early-stage breast cancer and are trying to decide whether or not adding chemotherapy to your treatment plan would be beneficial, the MammaPrint test may be of very real assistance to help you and your doctor make that decision.

References:

[1] https://breast-cancer.canceraustralia.gov.au/treatment/mammaprint-70-gene-signature-test/questions-patients-about-mammaprint

[2] 2016: Special Plenary Session: Results of the MINDACT Clinical Trial – http://winconsortium.org/files/O4.5-SPECIAL-PLENARY-SESSION-Results-of-MINDACT-clinical-trial-Suzette-Delaloge.pdf
[3] 2017: The Era of Multigene Panels Comes? The Clinical Utility of Oncotype DX and MammaPrint – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5649994/
[4] 2019: MammaPrint and BluePrint Molecular Diagnostics Using Targeted RNA Next-Generation Sequencing Technology – https://www.ncbi.nlm.nih.gov/pubmed/31173928
[5] 2019: Multigene expression signatures in early hormone receptor positive HER 2 negative breast cancer – https://www.ncbi.nlm.nih.gov/pubmed/31553709
[6] 2019: Prospective, multicenter study on the economic and clinical impact of gene-expression assays in early-stage breast cancer from a single region: the PREGECAM registry experience – https://www.ncbi.nlm.nih.gov/pubmed/31300934
[7] 2019: Prospective Validation of a Genomic Assay in Breast Cancer: The 70-gene MammaPrint Assay and the MINDACT Trial – https://www.ncbi.nlm.nih.gov/pubmed/31264430

 

[8] Tumour profiling tests to guide adjuvant chemotherapy decisions in early breast cancer: a systematic review and economic analysis – https://www.ncbi.nlm.nih.gov/pubmed/31264581

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Please Don’t Needlessly Lose Your Breasts to Mastectomy

Photo courtesy of freedigitalphotos.net and marin

Image source: freedigitalphotos.net and marin

While I was doing my research for yesterday’s article, I came across an article concerning needless mastectomy, a matter of which I was blissfully unaware.  Today I’m sharing that with you because you need to know.

Women are often enduring mastectomies for no good reason.

I’m not saying it’s always the case, but by the time you’ve finished this article, hopefully you’ll know the best reasons for having a mastectomy and when you should go after a second opinion.

On October 27, 2012, Nicholas Regush of ABC News wrote “While we hear news almost daily of the need for women to have mammograms and to inspect their breasts for changes that could suggest breast cancer, the actual treatment for breast cancer that many women receive, especially poor ones, is often outrageously out-of-date, if not bordering on the criminal.”  Here’s a link to the full article.

The article goes on to state, “In Texas, for example, a study of breast cancer treatment at one large urban hospital revealed that 84 percent of the women with early stage breast cancer had mastectomies and only 16 percent had lumpectomies. The women who lost their breasts were mostly poor.”

Mr Regush referenced an article written by Diana Zuckerman, President of the Washington, DC-based National Research Center for Women and Families.  The article was published in the Journal of the American Medical Women’s Association.  Despite much digging, I wasn’t able to get hold of a copy of that article, but I did discover that Ms Zuckerman has been extremely proactive with the Breast Cancer Public Education Campaign.

Because many women diagnosed with breast cancer do not have all the facts they need to get the treatment that is best for them, the National Research Center has been working to raise awareness of this issue.

Unnecessary Mastectomies

What I discovered from some of the online articles I read was that if a doctor was trained before 1981, his patient is much more likely to have a mastectomy. Apparently, old medical habits are hard to break.

Research is clear that lumpectomies are as safe as a mastectomy for most women with early stage disease.

Back in my grandmother’s day, nearly every woman who was diagnosed with breast cancer underwent mastectomy, often while under anesthesia for the biopsy itself with no participation in a discussion about treatment options.  How fortunate we are that this is no longer the case.

However, tens of thousands of women with breast cancer are losing a breast (sometimes both) unnecessarily each year.  Many women are getting their breasts removed for no good reason — meaning that such decisions are often not based on sound medical judgment but more on the basis of other factors such as her income (it’s cheaper to perform a mastectomy than lumpectomy followed by expensive radiation treatments), the training of her doctor, the age of her doctor, and where she lives.  Sometimes it’s based purely on fear of the return of the disease.

There is absolutely no data that mastectomy (either single or bilateral) in a breast cancer patient improved survival rates or helped them live longer.  It appears that many women are doing this in panic mode.

Mastectomy vs Lumpectomy

Presuming you have already found a breast lump and your doctor has told you it’s malignant, you will need to make the decision between a mastectomy and lumpectomy.

There’s a helpful article in www.breastcancer.org titled Mastectomy vs Lumpectomy.  Please read the article, it references the deciding factors, advantages and disadvantages, and there’s no need for me to reiterate it here.

When Mastectomy Makes Sense

  • If the tumor is big and, after the lumpectomy, very little breast tissue would remain
  • If there are multiple tumors in more than one quadrant of the breast
  • If you do not want to undergo radiation therapy after the surgery (and you don’t have to – I chose against radiation after my lumpectomy but I was very proactive in my health care and chose something else)
  • If you believe you will have less anxiety about a recurrence of breast cancer with a mastectomy

There is an alarming trend of more and more women removing healthy breasts because they are panicked or in fear of breast cancer returning or migrating to the other breast.  In some cases, doctors recommend prophylactic mastectomy, which is surgery that is performed to reduce your breast cancer risk.  That is a whole, huge topic unto itself and the subject of my next article.

While I can’t tell you what to do, I do want you to be aware that YOU HAVE CHOICES.  Please don’t choose mastectomy purely out of fear.  Sign up for my newsletters (use the colored box on the right) and allow my experience to gently  help you through this process.  It is my honor to walk with you on this journey.

The Most Helpful Yoga Position After Latissimus Dorsi Flap Surgery

Fabulous After Latissimus Dorsi Flap Breast Reconstruction

If you’ve just had a breast reconstruction and your surgeon utilized the Latissimus Dorsi Flap procedure, you’ll want to know about this helpful yoga position called Balasana.

Once your incisions have healed, the drains have been removed, you are no longer sore and your surgeon says it’s okay, I recommend doing this yoga position just as soon as you can manage it.

Click here to see the video (skip the ad!).

Don’t worry if you can’t get into the position initially, it’s most likely something you can work towards.  Just go as far as is comfortable for you on the day.

Why To Do It!

While this type of breast reconstruction surgery can be wonderful and give you back your figure, it can provide problems.

This surgery can really curtail your range of motion on the affected side if you are not proactive.

I found this particular yoga position so beneficial because it’s gentle, it really helped with my range of motion, it cuts down on adhesions (which can be caused by the newly formed uniting tissues – adhesions can block circulation and cause pain, limited movement, and inflammation) and really helps you to reclaim your body.

I also found deep tissue massage to be extremely beneficial.

How Often?

Do this yoga position at least 5 times a week!  It doesn’t take long, and it really does help so much.  May it be the beginning of a wonderful new relationship between you and yoga.

If you’d like to stay connected, sign up for my free e-newsletters on the right, or “like” me on Facebook (MarnieClark.com) and I’ll do my utmost to keep you informed and empowered on your healing journey.

Breast Cancer Diagnosis? Understanding Your Pathology Report

Photo courtesy of rgbstock.com and willhei

Image source: rgbstock.com and willhei

If you have a new breast cancer diagnosis, you will need help understanding your pathology report!

There will be all sorts of new terms to come to grips with and all kinds of things you will want to know in order to determine your course of action.

The Pathology Report

When you have a biopsy, the tissue removed from your breast is sent to a pathologist.

The pathologist is the physician who looks at the tissue under a microscope and determines whether or not the cells contain cancer.

He/she then prepares a report of the findings, including the diagnosis, and sends it to the ordering physician (either your surgeon or your oncologist).

Along with other test results or X-rays, the pathology report will help to guide your diagnosis, prognosis and treatment.

Ideally, an interdisciplinary team that includes your oncologist, radiologist, surgeon and pathologist will plan your treatment.  I also included a naturopath and Chinese medicine doctor and I found that this approach worked beautifully for me.

Always ASK FOR A COPY of your pathology report from your doctor for you to keep with your medical records.   It can be hard to take in all the findings at once and having a copy of the report you can refer to later is really helpful.

The Susan G Komen Foundation has a great checklist of questions to ask your doctor about your pathology report:  Questions to Ask Doctor About Biopsy .

Print it out and take it with you.

Helping You Understand the Pathology Report

Okay, now here’s the difficult part – you’ve got your report, your doctor has told you a bunch of things and now you have to make sense of it all.

Invasive what?  How big was it again?  Staging?  Grade?  The tumor had hormone receptors?  What does it all mean?

Fortunately, www.breastcancer.org has created a 23-page report which does a good job at explaining what all those terms mean for YOU.  How I wish I’d had this report when I was going through this!!!

Here it is: Your Guide to the Breast Cancer Pathology Report

They also offer some good advice:  “Don’t focus too much on any one piece of information by itself.  Try to look at the whole picture as you think about your options.”

The report explains all about types of breast cancer, grades, staging, margins, hormone receptors, and a good explanation of what HER2 means (page 11).  It’s absolutely awesome, I’m so glad someone put this together to help us make sense of this!

The only thing I would add to this is to say that your level of determination to beat this is just as important as anything the doctor recommends.

If you would like my help with getting through breast cancer in an inspiring and ultra-healthy way, please sign up for my free e-newsletters on the right, and/or “like” me on Facebook (Marnie Clark Breast Health Coach).  It is my honor to help you through this.

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