I am 42, female with Stage 2 breast cancer. Is chemo needed?

Question

Hi doctor,

I am a 42-year-old woman recently diagnosed with stage II invasive ductal carcinoma of the left breast. My tumor is ER-positive, PR-positive, and HER2-negative. My oncologist mentioned something called “genomic testing” or “oncotype DX” to decide if I need chemotherapy. My Ki-67 is 18%, and the lymph nodes are negative.

I am confused about how this test works and what the “recurrence score” means. Does it really help decide whether chemotherapy is necessary? Also, my aunt had breast cancer at 48. Should I undergo BRCA1/BRCA2 genetic testing too? If the results show a mutation, will it affect my treatment or my daughters’ future risk?

Please advise.

Answer 1

Hi,

Welcome to icliniq.com

I completely understand how stressful and worrying it can be to receive a diagnosis of breast cancer. I just want to reassure you that your tumor is not one of the aggressive types, especially since it is hormone-positive, meaning ER-positive and PR-positive, so it responds well to hormonal therapy.

It is also good that we are still in the early stages. Regarding the genetic tests your doctor requested, he is absolutely right; we do need to perform them.

The first test, called oncotype DX, is very important because it examines the deoxyribonucleic acid (DNA) inside the cancer cells themselves. It helps us know whether the tumor has a high risk of coming back or if it is a low-risk type. How do we know that? We know it from the score:

If the oncotype DX score is 0 to 15, this means the chance of the cancer coming back is very low, so we usually continue with hormonal therapy only.
If the score is between 15 and 25, we look at other factors in your case, such as any genetic risks, and sometimes we recommend adding chemotherapy to hormonal therapy to further reduce the chance of recurrence.
If the score is above 26, then we usually recommend chemotherapy, because it helps lower the risk of the cancer returning.

As for the breast cancer gene (BRCA) test, it is also an important test because it tells us about the genetic or inherited factors in your body that might be passed on to your daughters. Since your aunt developed breast cancer at the age of 48, there is a fair possibility that your BRCA test could be positive. If it turns out to be positive, we can then decide on the targeted therapy that could be used in the future if, God forbid, the cancer ever comes back.

In addition, we recommend that your daughters do the genetic test once they reach 25 years old so we can know whether they also have a high risk or not. And if it turns out that any of your daughters has a higher chance of carrying the gene, please do not be scared; this is something we can manage.

There are many preventive options available for people who are considered high risk. In some cases, we simply do regular follow-up and screening. In others, we may give hormonal therapy to reduce the risk. And in certain cases, we might recommend preventive surgeries to make sure they never develop cancer at any stage of their lives.

I hope my explanation was clear to you, and please know that I am always here and available to answer any of your questions at any time.

Thank you.