December 7, 2013 – Gene Expression Profiling

Yesterday’s appointment with Dr. Subramanian yielded the news that my gene expression results indicate I will likely benefit from chemotherapy.  The oncotype test looked at a panel of 21 genes in the tumor tissue from my lumpectomy to calculate a recurrence score from 0-100.  It helps identify which women with early-stage, estrogen receptor positive (ER+) [HER2- and post-menopausal with lymph node negative (N-)] invasive breast cancer are more likely to benefit from adding chemotherapy to their treatment.  My current recurrence score is 19.  Based on the clinical validation study, that means that of 100 women with my specific diagnosis, 19 will experience a recurrence of breast cancer somewhere in the body within 10 years.  For those patients whose breast cancer is treated with 5 years of anti-hormone therapy with tamoxifen, the average rate of distant recurrence is 12%.  My course of treatment is surgery, radiation, and 5 years of anti-hormone therapy.  Including chemotherapy cuts that 12% risk rate roughly in half (5-7%).  

At the moment, I have to admit that I’m a little freaked out about the idea of chemo.  Previously, it had only been mentioned as a treatment option IF cancer was found elsewhere in my body.  Those test results aren’t all in yet -- in fact, some of them have only just been scheduled.  This test looks only at my genes to provide an indicator as to whether my type of cancer will return based on the statistics specific to this type of tumor.  The higher the recurrence score results, the greater chance that the breast cancer may return, and the more likely that chemotherapy will provide a better outcome.  

And I’m all for doing whatever will improve my numbers… I have a lot of things still on my to-do list and I’m not ready to start crossing things off because of a lack of time left to do them.  So chemo will start before Christmas, it could be as early as this week.  We are referring to this as chemo-light.  It’s a 12-week course, with me receiving 4 treatments, one every 3 weeks.  It’s not as many drugs and it’s much shorter than the more usual six-month or year-long course.  And yes, I will lose my hair, and my doctor has already given me prescriptions for nausea.  And I’m looking at recipes and food suggestions and other tips to help get through it.  Because I plan to.

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