Should I get the Oncotype DX test for Breast Cancer?

Cancer Blogs, Dr. Diane Hastings — By on November 21, 2010 at 7:47 am

 The Oncotype DX is a new screening tool that is being recommended to some women with breast cancer. This new test provides an estimate of the likelihood of cancer recurring within ten years. Oncotype DX testing is only suggested for women with stage I or II cancer, that is estrogen receptor positive with no positive lymph nodes. The test targets women who plan to be treated with hormone therapy. The breast cancer specimen is sent to a lab and examined for 21 different genes (five are reference genes and 16 are cancer genes.) A level of these genes is calculated and a recurrence score is derived mathematically. If your score is over 31, then you are considered a high risk for recurrence; while a score below 17 is low risk for recurrence. The purpose of Oncotype DX is to fine tune cancer treatment for early stage cancers. Some early breast cancers do recur and warrant more aggressive treatment, i.e. chemotherapy. While many early cancers are adequately treated without chemotherapy. 

The Oncotype DX test for breast cancer has been available since 2004 from Genomic Health.  This company is studying similar recurrence testing for other cancers, particularly colon cancer. The test is most beneficial if you are not considering chemotherapy for treatment of your cancer, as a low recurrence score will help you feel confident in your treatment decision. Oncotype testing is not useful if other factors clearly dictate the need for chemotherapy; or for patients with non-invasive carcinoma in situ. However, a study done to validate the use of Oncotype DX testing found that this test lead to significant reclassification of risk groups. Thus, by tumor size and other criteria, some high risk patients were found to have a low recurrence score. Thereby saving them from undergoing chemotherapy.  Moreover some patients classified as low-risk (28% according to Genomic Health’s website) received a high recurrence score indicating that adjuvant chemotherapy would be beneficial in these patients who would not have otherwise received chemotherapy.

Should you request Oncotype DX testing as part of your treatment plan? Based on the validation studies available so far, oncotype DX testing is extremely useful in determining treatment – particularly if your case is not clearcut.  However, the cost of this test is in the range of $3500 -$3800 and some patients have said that the test was not covered by their insurance. If your tumor is node negative and estrogen receptor positive, then most companies are covering the test. However, as always, I would call your insurance provider to determine coverage.

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