The Newest Life-Saving Breast Cancer Treatments

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The 21-Gene Test

What it is:  A new test that can help determine whether you're likely to experience a cancer recurrence and therefore benefit from chemotherapy. Each year more than 50,000 women are diagnosed with hormone-sensitive breast cancer, which relies on estrogen to grow. But researchers have long known that a substantial number -- perhaps as many as 50 percent -- of these women are at low risk for the cancer to return to begin with and therefore may not need to go through the discomfort and side effects of chemotherapy, which include fatigue, nausea and vomiting, decreased appetite, hair loss, mouth sores, and infertility.

The test, also called Oncotype DX and available since January 2004, analyzes 21 genes, the majority of which are key to the growth and spread of cancer cells. On the basis of an analysis of tissue collected during your biopsy, your risk of recurrence is assessed and given a score. A score of 17 or below is considered low risk; 18 to 30, intermediate; 31 or higher, high risk.

In a retrospective study sponsored by the National Cancer Institute, in Bethesda, Maryland, involving 668 patients, women with high scores reaped a 25 to 27 percent drop in recurrence risk over 10 years, while women with low recurrence scores saw little, if any, benefit from the addition of chemotherapy. "The test helps take a lot of the guesswork out of a treatment decision," says Sheila E. Taube, PhD, associate director of the institute's cancer-diagnosis program.

Who can consider it: Women with early-stage, lymph-node-negative, hormone-receptor-positive cancer. Your doctor can tell you if your cancer fits this description, since all breast cancer tumors are checked for stage (which describes the cancer's size and how far it has spread), lymph-node status (whether the cancer has spread to the lymph nodes under your arms), and hormone-receptor status (an indication of whether the cancer needs the hormone estrogen to grow). To learn more about the 21-gene test, click on "Oncotype DX" at The test is pricey -- $3,450 -- so find out whether your health insurance will cover it before you request it.

Continued on page 4:  Dose-Dense Chemotherapy


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