A genomic test (also called a genomic assay) analyzes the activity of a group of genes that are linked to the risk of early-stage, hormone-receptor-positive breast cancer coming back (recurrence). A genomic test can help a woman and her doctor figure out her individual risk of recurrence and if she's likely to benefit from chemotherapy to reduce the risk of recurrence. Currently, there are two genomic tests for breast cancer: Oncotype DX and MammaPrint.
The small study reviewed here found that about 33% of the women who had genomic testing said they didn't really understand the test results. It's important to know that this many women didn't understand the results because doctors are ordering more genomic tests to help make treatment decisions for many women diagnosed with early-stage breast cancer.
The researchers looked at the medical records of 77 women diagnosed with early-stage, hormone-receptor-positive early-stage breast cancer between 2004 and 2009. All the women had Oncotype DX testing to help plan treatment:
The researchers found many positive results:
But some results weren't as positive:
These findings suggest that doctors might want to make sure their patients completely understand genomic test results. Doctors also should clear up any confusion and ease any anxiety patients might have about the results, particularly if the results predict a high recurrence risk.
If you've been diagnosed with early-stage, hormone-receptor-positive breast cancer, you and your doctor may decide that genomic testing is appropriate for your situation. The genomic test results are reported separately from your pathology report. The genomic test results predict the risk of the cancer coming back based on selected gene activity in breast cancer cells. Your doctor will use the genomic test results to help decide if you would benefit from chemotherapy to reduce the risk of recurrence.
When your doctor goes over your genomic test results with you, be sure you clearly understand all the results and how the information will be used to guide your treatment plan. If you're not sure you understand your results or if the results make you anxious, be sure to ask your doctor to go over the information again and address anything you're confused or worried about.
Discussions of genetic test results for breast cancer recurrence risk frequently miss the mark for patient comprehension, according to a survey of women with early-stage breast cancer.
A third of the survey respondents said they did not fully understand discussions with healthcare providers about results of genomic testing. The findings underscore the need to improve communication with patients about risk and treatment decision-making, investigators reported online in Cancer.
"Most women had high perceived understanding of what they discussed with physicians regarding their test results," Janice P. Tzeng, of the University of North Carolina in Chapel Hill, and colleagues wrote in conclusion. "However, a significant number of women did not fully understand discussions about their genomic-based recurrence risk, which presents the need to continue developing optimal ways to communicate and ensure both perceived and actual comprehension of genomic-based information.
"Finally," they wrote, "women with intermediate and high genomic-based recurrence risks deserve special attention, as they are more likely to suffer from worry about recurrence and distress regarding their result."
The findings came from a survey and medical-record review of 77 women with early-stage breast cancer. All the women had estrogen receptor-positive tumors and zero to three involved lymph nodes. They were evaluated by means of the Oncotype DX genomic test from 2004 to 2009. Complete data were available for 68 of the patients.
Half of the patients had test results indicating a low risk of recurrence, and another 37% had results indicating an intermediate risk. A quarter of the patients recalled having anxiety about their test results.
The authors found that 71% of the respondents accurately recalled the recurrence risk indicated by their test results. Two-thirds thought that they understood much of what they were told about the test results, leaving a third of the study group with incomplete or inadequate understanding of their results.
When asked whether they would have the genomic test again, 96% of respondents said they would, and 95% said they would recommend the test to other women in the same situation.
Additionally, 95% of the women said the test results helped them better understand their treatment options' chances of success, 71% believed their test results were accurate, and 76% found the test useful because it could determine with certainty whether they had a high risk of recurrence.
"Overall, results suggest that women are satisfied with genomic testing, given that they would recommend the test to other women and would have the test if they had to decide again," the authors wrote. "They also saw many benefits and few concerns about genomic testing."
The study was supported by the American Cancer Society.
The authors had no disclosures.
Primary source: Cancer Source reference: Tzeng JP, et al "Women's experiences with genomic testing for breast cancer recurrence risk" Cancer 2010; DOI:10.1002/cncr.24990.
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