Tests To Help With Breast Cancer Treatment Decisions

When you’ve just received a diagnosis of breast cancer, you are faced with many different treatment options. Your mind is in a whirl with fear, confusion, and disbelief. While none of these feelings help decision making, there are some tests that can help: Oncotype DX and Mammaprint. 

These tests are genomic tests that analyze the activity of specific genes in the breast tumor. They can help you determine if your risk of breast cancer coming back is high or low, which can help you in making a decision about whether to have chemotherapy, radiation, or other therapies to reduce risk after surgery.

There are two main types of tests – Oncotype DX and Mammaprint.

Oncotype Dx has two tests for breast cancer – one for Ductal Carcinoma in situ (DCIS) – Oncotype DX DCIS and one for invasive breast cancer – Oncotype DX.  Mammaprint has one test for invasive breast cancer. Let’s look at these in greater detail.

What are genomic tests?

Genomic tests look at specific genes in your individual tumor and try to determine what is driving its growth. This is different from genetic tests which look at your inherited risk or predisposition for cancer. Genomic tests provide information that can help tailor your treatment plan to you as an individual. They are a type of personalized medicine. This is really important, because not all breast cancers are the same and, in fact, some breast cancers might have more in common with a prostate cancer than they do with another type of breast cancer. One size treatment definitely does not fit all.

Oncotype DX DCIS

Image showing the incidence of DCIS from blog on CALMERme.comThis test is only for people diagnosed with DCIS or, as it is often called, “stage zero” breast cancer. In addition to general information such as tumor size, margins, and grade, Oncotype DX DCIS helps determine the likelihood of DCIS recurring or invasive breast cancer occurring within the next 10 years.

It examines a sample of the tumor tissue that has already been removed during the lumpectomy for DCIS. By looking at the expression of 21 different genes in the tumor, it provides a DCIS score of between 0-100. The lower the score, the lower the risk of recurrence. Two scores are given, one to determine the risk of recurrence of DCIS and another for the risk of occurrence of an invasive breast cancer.

Knowing the DCIS score can help you decide whether to have radiation treatment  following the lumpectomy. If your risk of recurrence is low, then maybe you can spare yourself further treatment and the possible side effects that go with it.

To be eligible for Oncotype DX DCIS, you need to have recently been diagnosed with DCIS and had lumpectomy surgery. The decision should be made in discussion with your doctor/oncologist.

In the US, insurance might cover the cost of this test; the testing company will help you determine if this is the case and provide information to your insurers, as necessary. In the UK, these tests can be conducted under the NHS or privately.

Many oncologists are now familiar with these tests for invasive breast cancer; sadly, the Oncotype DX DCIS test does not appear to be known by all oncologists, so it’s good for you to be proactive and start the discussion. Here is a link to the validation work done on the test that you can forward to your oncologist, and further links are given at the bottom of this post:

Clinical validation of oncotype DX DCIS

I definitely think it is worth having a discussion with your oncologist, sharing the references as necessary, and if you don’t get anywhere with the oncologist, talk to your family doctor or surgeon.

Oncotype DX and Mammaprint

Both Oncotype DX and Mammaprint are genomic tests suitable for early stage invasive breast cancer. They both predict the benefit of chemotherapy or other types of treatment, as well as the likelihood of 10 year recurrence.

They are similar tests but have some differences, as outlined below:

Comparison of oncotype DX and mammaprint for invasive breast cancer

Looking at this table can help determine if you are eligible for either of these tests.

As with Oncotype DX DCIS, some insurance companies in the US will pay for these tests whereas some don’t include them in coverage. Both testing companies offer financial assistance or guidance, so it’s worth calling them to discuss if you are interested and want to check coverage. In the UK, these tests can be conducted under the NHS or privately.

These tests are important because some of the cancer treatments, like chemotherapy, can have many side effects and are hard to get through. If there is little to no benefit in these treatments for you as an individual, then these genomic tests give you the confidence to not have a treatment that has greater potential for risk than for benefit.

Obviously the decision of further treatment is based on more than just these results. It involves detailed discussion with your oncologist, but also personal consideration of what you want and how you feel. Remember, you can take your time over treatment decisions. You might feel rushed, but take adequate time until you feel comfortable that you are making the right personal decision. These tests can go a long way in giving you confidence in your decision, but it is still a personal choice that needs to be right for you as an individual based on your mind and spirit, as well as your body.

Here are links to each of these three tests for more information

Patient information on Oncotype DX DCIS

Oncologist information on Oncotype DX DCIS

Patient information on Oncotype DX

Oncologist information on Oncotype DX

Patient information on Mammaprint

Oncologist information on Mammaprint

Let me know if you’ve had any of these tests and how they helped you.

Ruth BaillieRuth Baillie is originally from the UK and now lives most of the year in Northern California. She holds two Master’s degrees, one in Personalized Nutrition (distinction), and another in Health Psychology. She is a Registered Nutritional Therapist, Certified Professional Cancer Coach, and Cancer Guide, and has undertaken considerable post-graduate studies in integrative naturopathic oncology. She is the author of “Choices in mind-body medicine for cancer patients in Sonoma County, California” and her research has been published in peer-reviewed journals.

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Natural Killer Cell Therapy and Cancer Treatment

learn-about-natural-killer-cells-nk-cells-for-breast-cancer-treatmentNatural killer (NK) therapy involves using natural killer cells derived from peripheral blood samples or cord blood samples as a treatment for cancerous diseases. It may be used as a treatment for those cancers that have failed to be eradicated by stem cell transplant treatment.

One article (1) looked at the use of natural killer cell therapy and the treatment of cancer. It studied ways in which NK therapy can be an effective way to kill cancer cells. They found that natural killer cell therapy directed specifically at cancer cells can preferentially kill cancer cells, leaving normal cells alone. The mechanism of action appears to be antibodies directed at cancer cells, which activate natural killer cells that go on to kill cancer cells.

They noted that this type of therapy is currently very expensive so it isn’t yet sure that it can be a cost-effective way to treat cancer.

Source: 1.Klingemann H. Challenges of cancer therapy with natural killer cells. Cytotherapy. March 2015; Volume 17, Issue 3, Pages 245–249.

Dr. Adem Gunes

Dr. Adem Gunes Dr. Adem Gunes has built the world’s largest database of scientifically tested natural substances with proven effects in cancer treatments. In 2009, he was appointed as the Chief Physician of ProLife Clinic in Innsbruck, Austria, and played a key role in the establishment of the research laboratory. He is also the co-founder of the first Austrian hyperthermia center. Now, Dr. Adem works closely with cancer patients from around the world (including Germany, Thailand, Dubai) to recommend them a complementary cancer clinic or to create a personalized care plan for patients to follow at home.

Questions and Answers About High-Dose Vitamin C

High-Dose Vitamin C

  1. What is high-dose vitamin C?

    Vitamin C (also called L-ascorbic acid or ascorbate) is a nutrient that humans must get from food or dietary supplements since it cannot be made in the body. Vitamin C is an antioxidant and helps prevent oxidative stress. It also works with enzymes to play a key role in making collagen.

    When taken by intravenous (IV) infusion, vitamin C can reach much higher levels in the blood than when it is taken by mouth. Studies suggest that these higher levels of vitamin C may cause the death of cancer cells in the laboratory.

    A severe deficiency (lack) of vitamin C in the diet causes scurvy, a disease with symptoms of extreme weakness, lethargy, easy bruising, and bleeding. The lack of vitamin C in patients with scurvy makes collagen thinner in texture; when vitamin C is given, collagen becomes thicker again.

  2. What is the history and use of high-dose vitamin C as a complementary and alternative treatment for cancer?

    High-dose vitamin C has been studied as a treatment for patients with cancer since the 1970s. A Scottish surgeon named Ewan Cameron worked with Nobel Prize-winning chemist Linus Pauling to study the possible benefits of vitamin C therapy in clinical trials of cancer patients in the late 1970s and early 1980’s.

    Surveys of healthcare practitioners at United States CAM conferences in recent years have shown that high-dose IV vitamin C is frequently given to patients as a treatment for infections, fatigue, and cancers, including breast cancer.

  3. What is the theory behind the claim that high-dose vitamin C is useful in treating cancer?

    More than fifty years ago, a study suggested that cancer was a disease of changes in connective tissue caused by a lack of vitamin C. In the 1970’s, it was proposed that high-dose ascorbic acid could help build resistance to disease or infection and possibly treat cancer.

    Later studies showed that the levels of vitamin C that collect in the bloodstream depend on how it is taken.

  4. How is high-dose vitamin C administered?

    Vitamin C may be given by intravenous (IV) infusion or taken by mouth, although much higher blood levels are reached when given intravenously.

  5. Have any preclinical (laboratory or animal) studies been conducted using high-dose vitamin C?

    Laboratory studies and animal studies have been done to find out if high-dose vitamin C may be useful in preventing or treating cancer.

    Laboratory studies

    Many laboratory studies have been done to find out how high-dose vitamin C may cause the death of cancer cells. The anticancer effect of vitamin C in different types of cancer cells involves a chemical reaction that makes hydrogen peroxide, which may kill cancer cells.

    Laboratory studies have shown the following:

    However, not all laboratory studies combining vitamin C with anticancer therapies have shown benefit. Combining dehydroascorbic acid, a particular form of vitamin C, with chemotherapy made it less effective in killing some kinds of cancer cells.

    Animal studies

    Studies of high-dose vitamin C have been done in animal models (animals given a disease either the same as or like a disease in humans).

    Some of the studies showed the vitamin C helped kill more cancer cells:

    • High-dose vitamin C blocked tumor growth in animal models of pancreatic, liver, prostate, sarcoma, and ovarian cancers and malignant mesothelioma.
    • High-dose vitamin C combined with chemotherapy in a mouse model of pancreatic cancer showed that the combination treatment shrank tumors more than chemotherapy treatment alone.
    • Another study showed that vitamin C made a type of light therapy more effective when used to treat mice injected with breast cancer cells.
    • A study in a mouse model of ovarian cancer showed that combining intravenous high-dose vitamin C with the anticancer drugs carboplatin and paclitaxel made them more effective in treating ovarian cancer.

    However, other animal studies have shown that vitamin C interferes with the anticancer action of certain drugs, including the following:

    • Mouse models of human lymphoma and multiple myeloma treated with combinations of vitamin C and chemotherapy or the drug bortezomib had more tumor growth than mice treated with bortezomib alone.
  6. Have any clinical trials (research studies with people) of high-dose intravenous (IV) vitamin C been conducted?

    Several studies of high-dose vitamin C in patients with cancer have been done in recent years, including the following:

    Studies of vitamin C alone

    • Intravenous (IV) vitamin C was studied in patients with breast cancer who were treated with adjuvant chemotherapy and radiation therapy. The study found that patients who received IV vitamin C had better quality of life and fewer side effects than those who did not.
    • A study of IV vitamin C and high doses of vitamin C taken by mouth was done in patients with cancer that could not be cured. Vitamin C was shown to be a safe and effective therapy to improve quality of life in these patients, including physical, mental, and emotional functions, symptoms of fatigue, nausea and vomiting, pain, and appetite loss.
    • Vitamin C has been shown to be safe when given to healthy volunteers and cancer patients at doses up to 1.5 g/kg, while screening out patients with certain risk factors who should avoid vitamin C. Studies have also shown that Vitamin C levels in the blood are higher when taken by IV than when taken by mouth, and last for more than 4 hours.

    Studies of vitamin C combined with other drugs

    Studies of vitamin C combined with other drugs have shown mixed results:

    • In a small study of 14 patients with advanced pancreatic cancer, IV vitamin C was given along with chemotherapy and treatment with a targeted therapy. Patients had very few bad side effects from the vitamin C treatment. The nine patients who completed the treatment had stable disease as shown by imaging studies.
    • In another small study of 9 patients with advanced pancreatic cancer, patients were given chemotherapy in treatment cycles of once per week for 3 weeks along with IV vitamin C twice per week for 4 weeks. These patients had disease that did not progress for a period of months. The combined treatment was well tolerated and no serious side effects were reported.
    • In a 2014 study of 27 patients with advanced ovarian cancer, treatment with chemotherapy alone was compared to chemotherapy along with IV vitamin C. Patients who received IV vitamin C along with chemotherapy had fewer serious side effects from the chemotherapy.
    • Patients with acute myeloid leukemia, refractory metastatic colorectal cancer, or metastatic melanoma treated with IV vitamin C combined with other drugs had serious side effects and the disease got worse.

    More studies of combining high-dose IV vitamin C with other drugs are in progress.

  7. Have any side effects or risks been reported from high-dose vitamin C?

    Intravenous high-dose ascorbic acid has caused very few side effects in clinical trials. However, high-dose vitamin C may be harmful in patients with certain risk factors.

    • In patients with a history of kidney disorders, kidney failure has been reported after ascorbic acid treatment. Patients with a tendency to develop kidney stones should not be treated with high-dose vitamin C.
    • Case reports have shown that patients with an inherited disorder called G-6-PD deficiency should not be given high doses of vitamin C, due to the risk of hemolysis (a condition in which red blood cells are destroyed).
    • Since vitamin C may make iron more easily absorbed and used by the body, high doses of the vitamin are not recommended for patients with hemochromatosis (a condition in which the body takes up and stores more iron than it needs).
  8. Have any drug interactions been reported from combining high-dose vitamin C with anticancer drugs?

    A drug interaction is a change in the way a drug acts in the body when taken with certain other drugs. High-dose vitamin C, when combined with some anticancer drugs, may cause them to be less effective. So far, these effects have been seen only in some laboratory and animal studies. No clinical trials have been done to further research these drug interactions in humans.

    • Combining vitamin C with an anticancer drug called bortezomib has been studied in cell cultures and in animal models. Bortezomib is a targeted therapy that blocks several molecular pathways in a cell, causing cancer cells to die. Several studies showed that vitamin C given by mouth made bortezomib less effective, including in multiple myeloma cells. A study in mice transplanted with human prostate cancer cells, however, did not show that giving the mice different doses of vitamin C by mouth made bortezomib therapy less effective.
    • An oxidized form of vitamin C called dehydroascorbic acid has been studied in cell cultures and in animals with tumors. Several studies have found that high doses of dehydroascorbic acid can interfere with the anticancer effects of several chemotherapy drugs. Dehydroascorbic acid is found in only small amounts in dietary supplements and in fresh foods.

    See Question 5 and Question 6 for more information on combining vitamin C with anticancer drugs.

  9. Is high-dose vitamin C approved by the U.S. Food and Drug Administration for use as a cancer treatment in the United States?

    The U.S. Food and Drug Administration (FDA) has not approved the use of high-dose vitamin C as a treatment for cancer or any other medical condition.

    Because dietary supplements are regulated as foods, not as drugs, FDA approval is not required unless specific claims about disease prevention or treatment are made.

Source: National Cancer Institute: PDQ® High-Dose Vitamin C. Bethesda, MD: National Cancer Institute. Date last modified (04/08/2015). Available at: http://www.cancer.gov/about-cancer/treatment/cam/patient/vitamin-c-pdq. Accessed <5/9/2015>.

22 Questions to Ask Your Oncology Team About Your Cancer Treatment Protocol

Questions to Ask Your Oncology Team From Breast Cancer Authority Contributor Margot Malin BlogBy Margot Malin, CEO of Lots To Live For, Inc.

Patients who are well informed and take a proactive role in making choices about their cancer treatment protocol are likely to be more comfortable as they progress through treatment. Knowledge is empowering and knowing what to expect and what comes next demystifies the process.

Be your own health advocate by asking questions to become informed and “buy in” to your treatment protocol. It is a good idea to bring a friend or relative with you to medical appointments both for emotional support, and also because a second set of “eyes and ears” might understand what is being said differently, they may think of a whole different set of questions, or might interpret ambiguous or confusing information in a different way. Take notes so you can remember what was discussed. After all, going to a doctor can be both emotional and terrifying.

Here are 22 questions to ask your oncology team about your cancer treatment protocol:

  1. What is the goal of chemotherapy and/or radiation for my cancer?
  2. Why are you recommending chemotherapy / radiation? If you had cancer would you treat yourself with this protocol? How long have you been prescribing this treatment and how many patients have received it?
  3. What is the treatment period for the radiation regimen that you are proposing?
    What is the likelihood that it might be interrupted due to adverse skin reactions?
  4. Which specific chemotherapy drugs will I be given? What are your expectations for this medication? Are there other options that can produce the same or similar results?
  5. If you are proposing more than one chemotherapy drug, what is the reason for selecting the specific “cocktail” that you recommend?
  6. What has the success rate been? Do you expect that the tumor will disappear completely, or just shrink in size? Will the cancer start growing again after treatment?
  7. How will I know if the chemotherapy or radiation is working? How do you plan to assess the effectiveness of the treatment?
  8. What is the likelihood that my survival time will be increased as a result of this treatment? What is the expected survival time increase as compared to no treatment?
  9. What is the likelihood that my quality of life will be improved after I receive this treatment?
  10. What are the risks associated with this treatment with regard to morbidity (adverse effects from the treatment), mortality and the risks of developing another cancer?
  11. How will I receive the chemotherapy: how often; how long; oral or intravenous?
  12. Where will I go to get my chemotherapy treatments?
  13. What can I do to prepare for treatment and decrease the chance of debilitating side effects?
  14. What side effects should I expect and how long will they last? What can I do to reduce uncomfortable side effects if they occur? (please visit http://www.LotsToLiveFor.com for products to reduce and relieve side effects of cancer treatment)
  15. What should I do if I lose weight and don’t seem to be getting the proper nutrition?
  16. What support can you suggest to boost the efficacy and reduce my risk of dangerous side effects? Can you suggest suitable herbal and natural remedies? Will you help me devise a supplement program?
  17. Are there any clinical trials which might be suitable for me which I might want to explore?
  18. If my insurance company asks for a second opinion, or if I would like to get one, can you suggest another oncologist to contact?
  19. Does your practice or does this facility offer an Oncology Nurse Navigator for their patients? (See blog post entitled “What is an Oncology Nurse Navigator?”)
  20. Can you recommend a Cancer Coach? (See blog post entitled “Cancer Coach-Trained to Help Cancer Patients Along Their Journey – Could a Cancer Coach
    Help You?” )
  21. What lifestyle changes will I need to make to prepare for treatment, during treatment and after treatment with regards to: Diet, Activities, Work and Exercise?
  22. Do you recommend complementary therapies such as yoga, exercise, acupuncture, meditation, and do you have other suggestions?

Receiving a diagnosis and discussing treatment options can be overwhelming. It is helpful to be prepared for appointments with a concrete list of questions and to take thorough and complete notes. Sometimes it helps to try to take a step away, and approach the discussion clinically. As hard as it is, try to be unemotional and evaluative. Do research, take notes and keep thorough records. We hope these questions will help you take control, and understand your treatment better.

To be forewarned is to be forearmed. Know your options and embrace your informed decisions. Knowledge is power and empowerment makes you a better patient.

If readers of this blog post have additional suggestions to add to this list, please comment on this blog or on http://www.facebook.com/LotsToLiveFor .

Related Article:

About Margot Malin: Intellectually cMargot Malinurious and fiercely independent, Margot Malin has a passion for knowledge.  After receiving her MBA from The Wharton School, she launched her career by analyzing and evaluating businesses.  In 2002 she embarked on the “creative reinvention” phase of her career with the intention of “giving back”. Margot founded Lots To Live For, Inc., an internet retailer that sells carefully selected products to reduce and relieve the uncomfortable and unpleasant side effects caused by chemotherapy and radiation.

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