For many years, researchers and clinicians thought that all cancers from the same site were essentially the same.

"Each cancer is a different disease."

But now they understand that each cancer is an individual disease, and that if they are to treat it successfully, they need to find treatment solutions that are equally as personal.

For the majority of cancer patients, surgery remains the cornerstone of treatment, together with chemotherapy and radiation therapy. The problem, however, is that for some breast cancer patients, chemotherapy offers little extra benefit - and at the same time may expose the patients who receive it to a raft of unpleasant and often debilitating side effects.

 

How do we get cancer?

 

Cancer occurs because of faults in the human genes that control cell growth. These damaged growth genes are called ‘oncogenes’ and damage can occur for three reasons:
 

  • The person is born with a defective gene, such as the BRCA breast cancer gene.
     
  • The person is exposed to toxins in the environment, such as cigarette smoke, which can damage the genes.
     
  • Genes can simply wear out, which partially accounts for the increase in cancer incidence as we age.
     

 

Anticipating how people with cancer will benefit from their treatments has perplexed cancer specialists for a long time. Research has made clear that even though two cancer patients may have the same cancer type, each patient within that type will have a unique tumour based on individual factors including their genetic profile.

"Even patients with the same type will have a unique tumour based on individual factors."

“This is entirely new knowledge, so what we are trying to do now in the medical community is to identify for each patient his/her type of disease and then to give the drug that will work best,” says Dr Caroline Archer, consultant oncologist at Portsmouth Hospitals NHS Trust. The thinking is that when treatment gets personal everyone will benefit:
 

  • patients will receive access to a range of new more effective, targeted treatments.
     
  • scientists will be able to develop new drug treatments that target specific genetic faults and design more efficient clinical trials.
     
  • doctors will be given access to high-quality genetic tests that enable them to tailor treatment for each patient.
     
  • the nhs will benefit from time and cost savings so doctors can treat patients more effectively.
     

What is Oncotype DX?

 

Oncotype DX is a test that the NHS is now using to help doctors decide how to treat a person’s breast cancer, and in particular, whether chemotherapy will be of benefit. Whether you are offered chemotherapy depends on a number of factors. These include:
 

  • the type of breast cancer you have
     
  • the grade of the breast cancer
     
  • the size of the breast cancer
     
  • whether there are signs the cancer has spread
     

Through genomic analysis, Oncotype DX scores a person’s risk of cancer recurring, which allows doctors and patients to discuss with more confidence how likely your cancer is to respond to treatment with chemotherapy. Dr Archer says: “Things are not always clear cut in medicine and this gives the clinician and patient extra confidence in the treatments being recommended.”

 

 

How does it work?

 

The test analyses a group of 21 genes found in a sample of breast cancer tissue taken during surgery. The results are presented as a Recurrence Score, which will be a number between 0 and 100. The higher the score, the higher the risk of recurrence and the more likely it is that chemotherapy will have an additional benefit. 

"We need to ensure every penny of taxpayers’ money is well-spent."

Importantly for a health system that needs to ensure every penny of taxpayers’ money is well-spent, the UK’s medicines watchdog, the National Institute for Health and Care Excellence, has endorsed use of the test in the NHS as a cost effective part of breast cancer care. To date, Oncotype DX is the only test of this type to receive this endorsement and it is the view of Dr Archer that it has saved thousands of patients the burden of chemotherapy, that might cause them to lose their hair, suffer sickness and extreme fatigue and loss of earnings if they are unable to work. For the health service, the benefit is tens of thousands of pounds saved on an expensive therapy offering little significant incremental benefit. Her hope is that in the future this test may also be recommended for use in other types of breast cancer, and for similar technology to be developed for other cancers, for example, prostate cancer in men.

She says: “Certainly, chemotherapy has financial implications for the health service, but it also has significant personal implications for the patient. By using this test, we hope to identify those patients who will be able to do as well without chemotherapy as they will with it.”

 


Genomic Health does not give treatment for cancer or advise patients on their treatment plans. Anyone in doubt about their own health or cancer should seek medical advice from a qualified healthcare professional.