oncotype test???

[sunny Lisa]

Hi All, I am wondering if I need more tests on my tissue samples (grade III, DCIS, 4 nodes tested neg.)? Please explain Oncotype and FISH tests. Thank you, Lisa.

[MGordon]

Keep things sunny!!!! I'll start with the FISH tests.

It is estimated that approximately 1 in 4 breast cancers have too many copies of the HER2 gene, resulting in the over-production of protein receptors found on the surface of tumor cells. These special proteins bind with other circulating growth factors to cause uncontrolled tumor growth. HER2 positive breast cancers tend to grow fast. But these tumors also may respond very well to anti-HER2 antibody therapy (our friend Herceptin) and also to increased doses of chemotherapies.There are two tests for HER2, IHC (ImmunoHistoChemistry) and FISH (Fluorescence in situ Hybridization). The IHC test looks at the protein on the surface of the cell by staining the cell with an antibody. The protein on the surface of the cell can be affected by tissue formalin fixation onto the slide. This can cause inaccurate interpretation of IHC results. In addition, IHC testing is subjective: the reader must judge the degree of color change in the cell against a non-standardized chart. The fluorescence in situ hybridization test (FISH) is more accurate and reliable. It is good for all kinds of tissue: fresh, frozen, and those formalin fixed, paraffin embedded tissue. It is also good for stored formalin fixed paraffin embedded tissue samples too. The FISH test measures HER2 gene abnormality at the stable DNA level. The FISH test "paints" the HER2 genes inside the cell, so they may be accurately counted.

Clear as mud? FISH kinda removes the "human error" component to the test.

[MGordon]

On to Oncotype - Oncotype is a diagnostic test to try to calculate the possibilty of recurrence and isolate what chemo to treat with.

Oncotype is a cancer test that uses the unique gene expression profile of a patient's tumor to quantify the likelihood that her breast cancer will recur. Oncotype can provide doctors with a better understanding of the aggressiveness of individual tumors, and can also assess a patient's likely benefit from certain types of chemotherapy. This information may provide an added measure of confidence that the treatment plan is tailored to the patient's individual disease.

[MGordon]

Another test that may be of interest for you is the Bayer-Serum test. If your biopsy has identified you as HER2 positive, your oncologist can continue to montior your "HER2 Status" with this blood test instead of further surgical or needle biopsies. Just wanted to mention it...

Love and Light
Mel

[MJo]

Occasionally I go onto the Ask An Expert board at Johns Hopkins. In responses to several questions about the Oncotype, the doctor has said the oncotype is useful EXCEPT if you have Her2. I think most her2 cancers will show up as high risk or high moderate risk. If any Her2 cancer has showed up as a low risk on the Oncotype, I'd like to know about it. So if your cancer is already going to show up as high risk and your health insurance will give you trouble about paying for the Oncotype, I'd skip it. (I had it last year. Got a score of 32, the beginning of high risk category. My insurance won't pay for it. I will have to shell out 3000).

[suzan w]

Mjo...DON"T pay for your oncotype test yet!!! Call the lab...Genomic...they will be your advocate!!! They filed 3 appeals on my behalf and after 18 months the insurance co. PAID!!! I worked with a wonderful woman, Pam, the # is 877-235-4349!!! Anyhow...I do think, after all, that most Her2 cancers do show up as high-risk, mine did. But I am glad I had the test done, and then did the chemo, because if I hadn't I would always have wondered...what if??? And this disease if filled with enough what-if's!

[KRISS]

HI
When I met my onc for the first time last week he asked me if I wanted to participate in a study. They were doing the oncotype on early BC. He said if insurance wouldn't cover it that the company would eat it. After really talking about it and being her2+ we decided to go ahead with the chemo the next day but he was still going to order the test. I find out results on the 22nd. I'm not sure about any of the details but it might be something to look into.

Kriss

[Bev]

My impression was oncotype was reccomended for stage 1 or 2a node neg. If you came back low risk you could be spared chemo. I have heard most HER2+ come back high risk.

I think all the data the test generates may be helpful in the future.

As IIIa and HER2+, I really don't think the test will change your tx reco at this point in time. Do let us know what happens. BB

[Bev]

Oops, just reread and saw grade 3, DCIS. So stage 1? Yes, do the oncotype, it's geared for your scenario. The HER2+ and grade 3 are working against you though. Do contact your insurance company and push it to higher management. This test can save them money if it's decided chemo is not your best course. If I were in your shoes, I'd like to do Herceptin anyways. BB

[Jean]

Lisa,

Oncotype DX test helps make chemo decisions for women with ER-Positive
cancer.

Regards,
Jean