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Breast cancer patients want genomic test that predicts risk of recurrence

CHAPEL HILL - New research from the University of North Carolina at Chapel Hill and the National Institutes of Health finds most breast cancer patients would be receptive to a new genomic test that can determine the chance of breast cancer recurrence and help plan treatment.

Oct. 16, 2007

Breast cancer patients want genomic test that predicts risk of recurrence

CHAPEL HILL - New research from the University of North Carolina at Chapel Hill and the National Institutes of Health finds most breast cancer patients would be receptive to a new genomic test that can determine the chance of breast cancer recurrence and help plan treatment.

Currently, doctors treating patients with breast cancer make treatment decisions and predict the risk of recurrence based largely on the location and size of the tumor and if the cancer has spread to lymph nodes and distant sites of the body. But not all patients who are similar in terms of these clinical indicators get the same benefits from treatment.

In an attempt to remedy that situation, scientists at UNC and elsewhere have been studying the genetics of breast cancer have identified a number of activity patterns in the genes of individual tumors that make them biologically different from others and which could provide valuable clinical information, such as how likely the tumors are to be invasive, how well they might respond to different treatments, and how likely they are to recur or spread.

While the test is still under study and a not yet a part of clinical care, it appears that such differences in gene expression patterns may be used as biomarkers, or tumor profiles to which treatment can be individually matched.

The new study, from the UNC Lineberger Comprehensive Cancer Center, School of Public Health and department of psychology in the College of Arts & Sciences is the first to demonstrate breast cancer patients’ interest in genomic risk testing and how these results might influence decisions about adjuvant care.

The UNC study, led by Noel Brewer, Ph.D., assistant professor of health behavior and health education in the School of Public Health, asked 139 women who were treated for early-stage breast cancer questions that presented hypothetical scenarios reflecting different test outcomes and potential treatment decisions.

“We assessed women’s attitudes towards risk for recurrence testing, how results would affect their choices about adjuvant treatment, and potential concerns about and perceived benefits of testing,” said Dr. Suzanne O’Neill of the National Human Genome Research Institute, part of the National Institutes of Health, who was involved in the study.

The study, published Oct. 10, 2007, in the Journal of Clinical Oncology, found most patients would have been interested in a genomic test that showed their risk for recurrence at the time they were treated, had it been available. The majority said they would “definitely” want to be tested (76 percent), receive their results (87 percent), and discuss these results with their physicians.

“Breast cancer patients can see real benefits for their medical care and improving their chances for curing their cancer” that the test would provide,” O’Neill said.

Most women preferred an active role in decision making about treatment and would have wanted the results incorporated into their treatment planning. In addition, the women said they would be willing to pay the out-of-pocket cost of approximately $1,000 for the test.

Those who expressed more concerns about testing tended to be less interested in testing and in incorporating results into treatment decision making.

“Overall, our results indicate that patients will welcome this information, that they prefer to be involved in how their test results will guide treatment choices, and that they will be sensitive to results when making decisions about their treatment,” the authors stated.
“These findings have important implications for communicating with patients newly diagnosed with breast cancer, as risk for recurrence testing transitions into clinical care.”

Study coauthors included Sarah E. Lillie, MPH, National Cancer Institute; Edward F. Morrill, department of psychology; Barbara K. Rimer, Dr.P.H., dean of the School of Public Health; and Dr. E. Claire Dees, and Dr. Lisa A. Carey, Lineberger Center and Schools of Medicine.

The research was supported by grants from the American Cancer Society, the National Cancer Institute and the Lineberger Center.

Note: Contact Noel Brewer at (919) 966-3282 or ntb1@unc.edu

Lineberger Cancer Center contact: Dianne Shaw, (919) 966-7834 or dgs@med.unc.edu

School of Public Health contact: Ramona Dubose, (919) 966-7467 or rjdubose@email.unc.edu

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