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.

Cancer Pre-Treatment Check List – 6 Tips To Make Your Life Easier Once You Begin Treatments

Breast Cancer Pre-Treatment Check ListBy Margot Malin, CEO and Founder of www.LotsToLiveFor.com

Receiving a diagnosis of cancer can be overwhelming. There are so many questions swirling through your mind and so many things to put in order. Here is a short list of 6 tips suggested by other patients to help make your treatment both more comfortable and better organized.

  1. Familiarize Yourself with Your Medications and their Side Effects
    If you are going to receive chemotherapy, find out the names of your medications. Ask your oncologist or oncology nurse about the expected side effects so that you can prepare for them mentally and research some products that might help to reduce the side effects. If you are going to receive radiation, find out the duration of the sessions and what the expected effect on your skin will be, and how you can mitigate side effects. Take very good notes when you speak to your oncology team about your treatment and diagnosis.
  2. Schedule a dentist appointment
    Cancer treatment can cause side effects in your mouth.  A good cleaning and dental checkup before treatment starts can help prevent painful mouth problems. A dentist can help you protect your mouth, teeth, and jaw bones from damage caused by head and neck radiation and chemotherapy. Serious side effects in the mouth can delay, or even stop cancer treatment. It will be difficult to receive dental procedures during cancer treatment. Your dentist may also give you important tips to protect your mouth during treatment and to help you care for possible mouth problems. Ask your cancer care team to stop smoking or chewing tobacco. People who do not use tobacco have fewer mouth problems. You can view some oral care products that have been specially developed for oral care during oncology by clicking here.
  3. Order some new products in advance to test them to see if you have any reactions to them, and to see if you like their feel and other characteristics.
    Research and order skin care, hair care, oral care, anti-nausea, and nutritional products in advance so you are prepared with products to help soothe potential side effects.  Test them on your skin, scalp, and mouth before you start treatment to be sure that they agree with you. Clear the use of them with your oncology professionals.  You will be happy and relieved to have them once you begin treatment.
  4. Make a List of Things that will need to be done and circulate it to friends and relatives so they can sign up to help you
    Treatment will probably make you tired. Frequently friends and relatives want to help, but they don’t know what to do. Here’s your chance to help them help you. Make a list of things that you might need help with and dates that you will need help. The more specific you are with dates and times, the easier it will be for people to help.  Circulate the list to friends and relatives by email and invite them to sign up. Here are some ideas to include:  grocery shopping, baby sitting, driving carpools, rides to and from doctor appointments, rides to and from chemo, company during chemo, dropping off dinner for the family, doing laundry, helping the kids with homework, or other things that might be specific to you or your family.  Don’t be afraid to ask for little favors because people don’t want to be intrusive but they do want to help!  Even better……ask a friend to organize this schedule for you!
  5. Create a Treatment Goody Bag for Yourself
    Put together a tote bag of items that you might want to bring with you to treatment to make yourself more comfortable, and also to help you pass the time.  Here are a few suggestions to get started:  a blanket, hat, gloves, warm socks, a water bottle, sucking candies or mouth moisturizer spray, reading material, listening material, and a journal.  We will expand on this section in our next blog post where we will give more descriptive product suggestions and ideas.
  6. Meet with a Naturopathic Doctor
    A Naturopathic Doctor can help to improve the efficacy of treatment, lessen side effects and also to help you devise a wellness plan going forward. He or she will take a more holistic view of your body and give you product and supplement suggestions that might not included in the treatment provided by your oncology team.  Integrative medicine, practiced by many ND’s is healing-oriented medicine that takes account of the whole person (body, mind, and spirit), including all aspects of lifestyle. It emphasizes the therapeutic relationship and makes use of all appropriate therapies, both conventional and alternative.  A consultation with a naturopathic doctor will open your eyes to complementary approaches which can sustain you through treatment and beyond. Your oncology team focuses on getting rid of your cancer – your can help you protect the rest of your body and prevent unnecessary damage.

Each of these 6 tips should help to reduce the uncertainty and confusion that come with a cancer diagnosis and treatment plan. Try to organize and simplify your daily schedule whenever possible. Don’t forget to ask for help!

Margot Malin is CEO and Founder of Lots To Live For, Inc.  Lots To Live For sells personal care products to reduce and relieve the unpleasant and uncomfortable side effects of chemotherapy, radiation, and other cancer therapy.  We deliver comfort during cancer. Please view our website at http://www.LotsToLiveFor.com Please visit us on Facebook at http://www.facebook.com/LotsToLiveFor

2014 New Years Resolutions – Want vs Needs

Breast Cancer Yoga Happy Bew YearShifting into 2014 Green Wood Horse

By Kathleen  O’Keefe – Kanavos In part one of this blog we discussed   New Year Resolutions, the  Chinese New Year and wants vs needs tied into the shift of consciousness taking place in the world.

Now is the dawning of a new year with a shift toward consciousness and self-awareness.   I’m ready to make the shift into personal responsibility. My first New Year resolution will be to allow myself to love, embrace, and always put myself first. I give myself permission to be number one in my life. How can I possibly share with others if I am empty? I want to be embraced by others but need to love myself first.

During chemotherapy, my psychotherapist armed me with a powerful mantra to help survive the uncertainty of treatment. “You are number one. No one and nothing is more important than you.” She was right.  Years later, as a cancer hotline phone counselor and mentor, that mantra is still important.  If charity begins at home, and home is where the heart is, then an empty heart cannot give anything to anyone else.

The importance of this mantra was even more evident during my Stitch-n-Bitch (as we liked to call ourselves) radiation therapy group. It broke my heart to see the care-giver suddenly discarded when their circumstances shifted, and they needed family care.  These women felt that without family love and devotion they were useless. Their chances for recovery were challenged by their depression and feelings of emotional emptiness. Our little group spent hours discussing wants versus needs. We want a beautiful house, but we only need shelter. We want to eat in fancy restaurants, but we only need nutritious food.  We want others to love us, but we need to love ourselves. The list of wants versus needs is endless. Realizing the difference between them may be the first step in avoiding emotional and financial bankruptcy. When I see something enticing, I’ll ask myself, “Do I need that, or just want it?”

In 2014, I will focus on inner-balance by being kind, and forgiving to myself.  I will seek out and join a community “sister-hood of women” who can be my support system. Their strength will keep me from feeling alone during times of despair, and their resources will help me meet the needs of my family and friends.

When my body is fatigued, I will rest. When my soul is tired, I will meditate, and give thanks for all that I have. I will surround myself with things I love; my husband, friends, pets, plants, music, and fragrant candles while taking a warm bubble bath. While I care for my body my soul will soar.

Like the Chinese yin and yang, which are seemingly opposing forces bound together, intertwined, and interdependent in the natural world, we are complex creatures comprised of body and soul. These two diabolically different parts must be in balance as a duality for complete health of body and mind. Like yin and yang, male and female, body and soul are a dynamic equilibrium. If one disappears, the other must disappear as well, leaving emptiness.

Too many of us have lost a part of ourselves and are experiencing an emptiness of being. The two faced mythical King Janus, patron of the new year, had two faces for an important reason; one to see the past and one to see the future. Although we too can also look in both directions, we tend to focus and judge ourselves by past events that cannot be changed. It’s time to face forward into a new year of balance comprised of yin and yang, old and new, need and want.  You can learn from your past to build a positive future. The good news is that a sisterhood of women is only a phone call, blog, website, social media site, magazine or tweet away to help refill you with the love you deserve and NEED.

Balance yourself. Know you needs. Embrace the new shift taking place in the new year. Take care of your soul and it will take care of you . . . then you can take care of the wants of others.

BIO: Kathleen O’Keefe-Kanavos, Intuitive Life Coach, survived three breast cancers, wrote SURVIVING CANCERLAND: Intuitive Aspects of Healing (Cypress House, Jan 2014) http://tinyurl.com/p7cjfxa  websites: http://www.survivingcancerland.com  & Access Your Inner Guide, Hosts Living Well Talk Radio, Cancer Q&A columnist- CapeWomenOnlineMagazine,  Dream Queen columnist-Wellness Woman 40 & Beyond,Blogger for BreastCancerYoga.com, YourDreamIntrepretation.com, WakeUpWomen, PATHEOS; R.A. BLOCH Cancer Foundation Hotline Counselor. Represented by Steve Allen Media

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