Tests for Prognostication
Prognostic gene test panels for breast cancer are tools that analyze the expression of specific genes in tumor cells to predict the risk of recurrence and guide treatment decisions. Multiple panels are available commercially which examine different set of genes from 21 in Oncotype Dx to 70 genes tested in Mamma Print.
Prognostic gene test panels
These tests are done on breast cancer cells after surgery or biopsy to look at the patterns of a number of different genes. This process or test is sometimes called gene expression profiling. Based on the information gained from these tests, we can estimate the risk of disease recurrence ( prognosis) and thus tailor the treatment avoiding harmful treatments that may not benefit this particular patient. This is another form personalisation of treatment.
All breast cancer patients who are hormone positive may not benefit from chemotherapy and some of these tests can predict if the patient would benefit from the chemotherapy.
Key Prognostic Gene Test Panels
Oncotype DX Breast Recurrence Score
- Patients with node-negative or limited node-positive (1–3 nodes) disease.
- Prognostic and Predictive: Guides both risk assessment and chemotherapy benefit.
MammaPrint
- FDA Approved: Validated for both node-negative and node-positive patients.
- Purpose: Assesses the risk of distant recurrence within 10 years.
Prosigna (PAM50)
- Purpose: Classifies breast cancer into molecular subtypes and predicts 10-year risk of recurrence.
- Genes Tested: 50 genes associated with tumor biology.
Considerations for Using Gene Panels
- Eligibility : Not all tests are suitable for all patients. Most are limited to specific subtypes (e.g., ER-positive, HER2-negative).
- Cost and Insurance Coverage : Many tests are expensive but are often covered for eligible patients.
- Physician and Patient Preferences : Treatment decisions should integrate test results, clinical judgment, and patient preferences.
How Prognostic Panels Impact Treatment
Risk Stratification
Helps identify patients with low recurrence risk who can safely avoid chemotherapy. Identifies high-risk patients who may benefit from aggressive treatment.
Personalized Medicine
Tailors treatment to the individual's tumor biology, avoiding over- or undertreatment.
Long-Term Management
Assists in decisions regarding extended hormonal therapy for late recurrence risk.
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