New Tool Can Help Predict Recurrence Risk

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A study found that a tool that looks at four breast cancer characteristics seems to do a good job of predicting whether early-stage hormone-receptor-positive breast cancer is likely to come back (recurrence). The tool assessed recurrence in women diagnosed with early-stage hormone-receptor-positive breast cancer that had been treated with hormonal therapy before surgery.

Hormonal therapy and chemotherapy are used before and after surgery to improve the prognosis of early-stage hormone-receptor-positive breast cancer. Treatments given before surgery:

  • weaken the cancer
  • lower the need for lymph node removal
  • minimize the extent of surgery

After surgery, the treatments weaken any cancer cells that may have been left behind and reduce the risk of the cancer coming back.

Many women diagnosed with early-stage hormone-receptor-positive breast cancer wonder if they need chemotherapy after lumpectomy or mastectomy. Since chemotherapy can have uncomfortable or potentially serious side effects, doctors want to give chemotherapy only to women with a high risk of the cancer coming back. The tool evaluated in this study, called PEPI (preoperative endocrine prognostic index), may help women and their doctors make more informed decisions about chemotherapy.

The PEPI tool predicts the risk of breast cancer coming back in women who got hormonal therapy before surgery by looking at four breast cancer characteristics:

  • tumor size
  • whether cancer cells are in nearby lymph nodes
  • hormone receptor status of the cancer
  • Ki67 blood levels (Ki67 levels are linked to a cancer's tendency to grow and spread; doctors call Ki67 a tumor cell proliferation marker)

The PEPI tool looks at these characteristics AFTER hormonal therapy, when the cancer is removed during surgery. Based on the characteristics, the PEPI tool assigns a score -- the higher the score, the greater the risk the cancer will come back. Women with higher scores are more likely to benefit from chemotherapy after surgery.

In this study, the researchers found:

  • A PEPI score of 0 predicts a LOW risk of recurrence; 3 years after surgery only 3% of women with this score had the cancer come back.
  • A score of 1 to 3 predicts an INTERMEDIATE risk of recurrence; 3 years after surgery 5% of women with this score had the cancer come back.
  • A score of 4 or higher predicts a HIGH risk of recurrence; 3 years after surgery 17% of women with this score had the cancer come back.

The link between PEPI scores and the risk of recurrence was similar when the tool was used to evaluate other groups of women. Looking at the PEPI score AND the stage of the cancer helped better predict recurrence risk: the higher the PEPI score and the more advanced the cancer was at surgery, the greater the risk of recurrence.

The researchers concluded that among women who got hormonal therapy before breast cancer surgery, women with a PEPI score of 4 or higher are most likely to benefit from additional treatments after surgery, including chemotherapy, to reduce the risk of the cancer coming back. This is especially true when the breast cancer is stage II or III.

While the PEPI tool looks promising, it needs to be studied in many more women before doctors can routinely use the tool to help make decisions about chemotherapy after surgery.

Another chemotherapy decision-making tool is the Oncotype DX test. This test is used in post-menopausal women diagnosed with hormone-receptor-positive breast cancer. The Oncotype DX test measures the levels of 21 genes in breast cancer cells from a cancer tissue sample. These genes can affect how the breast cancer will behave and respond to certain treatments. These measurements are used to calculate a recurrence score. The higher the recurrence score, the more likely the cancer is to come back or spread. Women with a high recurrence score are more likely to benefit from chemotherapy in addition to hormonal therapy. Women with a low recurrence score may be able avoid chemotherapy that probably won't give them any additional benefits.

If you've been diagnosed with early-stage hormone-receptor-positive breast cancer, you may want to ask your doctor about how chemotherapy decisions will be made. Every woman's situation is unique. Your treatment plan should look at all available information and include a thorough discussion of the pros and cons of all options being considered. Together, you and your doctor will make the best decisions for YOU.

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