Advanced diagnostics
Advanced diagnostics in breast cancer have greatly evolved, providing more precise and personalized information about the tumor's biology. These diagnostic tools help in early detection, accurate staging, and guiding treatment decisions, leading to improved outcomes for patients. Below are some of the key advanced diagnostic methods used in breast cancer.
The experts at Hyderabad Breast Clinics understand that no breast cancer is same and it is important to identify the specific type of breast cancer each patient has. Even though all cancers in the breast are called by same nomenclature (Breast Cancer), modern testing help us identify the subtle differences and can predict and suggest which type of treatment ( Type of Chemotherapy molecule, Immunotherapy or Targeted therapy). Such information will allow us to tailor the treatment to the last detail. This personalised treatment will allow avoiding un necessary treatment, reduce toxicity, increase success rates while reducing overall costs.
1. Molecular Profiling and Genomic Tests
Molecular profiling helps identify specific genetic mutations, markers, and gene expressions that can influence cancer treatment and prognosis. Some of the widely used genomic tests include:
- Oncotype DX: This test analyzes the activity of 21 genes within a tumor to predict the likelihood of breast cancer recurrence and whether a patient will benefit from chemotherapy. It is used primarily in early-stage, hormone receptor-positive (HR+), HER2-negative breast cancer.
- MammaPrint: A 70-gene test used to assess the risk of cancer recurrence. It is often used in early-stage breast cancer to guide treatment decisions regarding the need for chemotherapy.
- Prosigna (PAM50): This test evaluates 50 genes to determine the risk of recurrence in early-stage, hormone receptor-positive breast cancer. It helps identify the tumor subtype (e.g., luminal A, luminal B) and provides information about the cancer’s aggressiveness.
- BRCA1/BRCA2 Testing: Genetic testing for mutations in the BRCA1 and BRCA2 genes is critical for determining hereditary breast cancer risk and guiding preventive measures or treatments, especially in high-risk individuals.
- Next-Generation Sequencing (NGS): This broad molecular profiling tool sequences multiple genes at once, identifying specific mutations that can guide the use of targeted therapies.
2. Immunohistochemistry (IHC)
IHC is a common test used to detect specific proteins in cancer cells that indicate the presence of hormone receptors or HER2 receptors, which are crucial for determining treatment approaches.
- Estrogen Receptor (ER) and Progesterone Receptor (PR): These receptors indicate that the cancer is hormone receptor-positive, and hormone therapy may be an effective treatment.
HER2/neu Testing: HER2 status is determined to check for overexpression of the HER2 protein, which suggests that the cancer may respond to targeted therapies like trastuzumab (Herceptin) or pertuzumab.
3. Liquid Biopsy
Liquid biopsy is a non-invasive diagnostic tool that analyzes circulating tumor cells (CTCs) and circulating tumor DNA (ctDNA) found in a patient’s blood. It allows for:
- Monitoring treatment response: Detecting tumor mutations and assessing if the cancer is responding to therapy.
- Identifying resistance mutations: It can detect mutations that confer resistance to certain treatments (e.g., hormone therapy or targeted therapies).
- Early detection of relapse: Liquid biopsy can identify minimal residual disease or signs of cancer recurrence earlier than conventional imaging.
4. Digital Mammography with Tomosynthesis (3D Mammography)
Digital breast tomosynthesis (DBT) is a type of 3D mammography that provides more detailed images of the breast compared to traditional 2D mammography. It is particularly effective in:
- Improving detection: Detecting small, early-stage cancers that may be missed on standard mammograms.
- Reducing false positives: Minimizing unnecessary biopsies and follow-up testing by improving the clarity of the images.
- Benefiting women with dense breasts: More accurately assessing dense breast tissue, which is harder to evaluate with conventional mammograms.
5. Contrast-Enhanced Spectral Mammography (CESM)
CESM combines traditional mammography with contrast dye to highlight areas of increased blood flow, which are often associated with tumors. This technique can be useful in:
- Identifying smaller tumors: Detecting cancers that are not easily visible on standard mammograms.
- Evaluating tumor response: Tracking changes in blood supply to a tumor before and after treatment.
Conclusion:
Advanced diagnostics in breast cancer provide critical insights into the biology of the tumor, enabling tailored treatment plans, more accurate prognoses, and improved monitoring of treatment response. These technologies have revolutionized breast cancer care, shifting towards more personalized, targeted approaches for better outcomes.
