Photo:  Aleseia Saunders
Aleseia Saunders was overjoyed when she learned that she was pregnant with her first child at the age of 33. However, this joy was soon overshadowed when her doctor expressed concern over a lump in her chest at her first prenatal exam.
"He thought it was just a cyst, but he recommended a biopsy and an ultrasound, just to be sure," says Saunders Health . Two weeks later, Saunders got a phone call at work. "They told me it was cancer – an invasive ductal carcinoma," says Saunders. "It was quite heartbreaking to get a call like this first while I'm in the office, and secondly, to get it I've just learned that I was pregnant. I thought, 'Where am I going from here?' Saunders quickly made an appointment with an oncologist, and on her first meeting with him, the doctor made a plan. "He told me to stop the pregnancy and then he started talking about the different medications they use in chemotherapy "To explain," she recalls. He told me and my family to go home and think about it, but he also said, "She can not carry this baby." The oncologist explained that chemotherapy is recommended because Saunders was of young African-American descent and had no family history of breast cancer, which can all be indicative of her cancer being aggressive and requiring aggressive treatment, but Saunders knew that chemotherapy meant would lose her baby ̵
Dr. Weintritt saw things differently: he hoped that she could give birth to a healthy baby and still beat her cancer. To be on the safe side, he wanted to run a test called MammaPrint, which sequenced the genes in her tumor and provided more information about which type of treatment works best.
What is the MammaPrint test?
MammaPrint is one of several currently available genomic tests that enable doctors to analyze breast cancer tumors. These tests help physicians make decisions about patients who fall into a gray zone when it comes to receiving chemotherapy.
"We used to treat every patient we thought was having risk functions," says Maggie DiNome, MD, associate professor of surgery at David Geffen School of Medicine and director of UCLA Breast Health. (Dr. DiNome did not treat Saunders, and she has no connection to the MammaPrint test.) "We would give chemo because a patient was young or because the tumor was larger than a certain size or because he had a positive lymph node."
But then doctors began to understand that not all breast cancers are the same – and they should not be treated the same. This is where these genomic tests come into play.
The MammaPrint test examines 70 different genes in the tumor of a patient and uses this information to determine if a patient has a low or high risk that the cancer will return within 10 years. Those who receive high scores are good candidates for chemotherapy (which may reduce this risk), while those with a low score are unlikely to benefit from chemo alongside surgery and radiation. (See also: After these 10 steps, the risk of cancer can be reduced by 40%.)
While MammaPrint has been approved by the FDA for nearly a decade, doctors have only used it in recent years, Dr. DiNome. Clinical studies – including a major study published this summer in the New England Journal of Medicine [19459005 – have further shown that many breast cancer patients can be treated without chemotherapy (even if they have certain risk functions). This gives physicians more evidence to trust these tests.
The MammaPrint test is usually performed on tissue from an already surgically removed breast tumor so that no additional procedure is required from the patient's point of view. In Saunders' case, however, her doctor performed the test on a biopsy sample because of her pregnancy.
But it got better, and today both Saunders and 3-year-old Julia have clean health. "After Julia's birth, I arranged for her to meet Dr. Weintritt," says Saunders. "She must have recognized his voice from all my time when I was pregnant, because when he started talking, she lit and started to giggle and coo."
Saunders knew she wanted to have more children someday She worked with her doctors on a plan to discontinue tamoxifen after two and a half years (which can cause pregnancy complications). Today she is expecting again, and her second daughter is expected in December.
"I am so grateful, because if I had only taken the advice of the first oncologist and had chemotherapy, I might not have had children after that, let alone give up my first pregnancy," she says. "That's one reason why I tell my story because I want other women to know that they have other options."
What is to know about genomic testing for breast cancer
? Not every breast cancer patient is a candidate for genomic testing or can be treated without chemotherapy, Dr. DiNome. In the United States, MammaPrint is approved for use in Stage I or II cancers, invasive and less than 5 inches.
"These tests are really only beneficial for the group in which you think that you think about it could give you chemotherapy," Dr. DiNome. If patients already have a low risk profile without the test, they do not need it. Conversely, if the tumor is very large or has other characteristics that clearly increase the risk, the physician will always follow the recommended chemo.
MammaPrint is not the only option for this type of test. Another test called Oncotype DX examines 21 genes. While MammaPrint provides only a "low" or "high" value, the Oncotype DX results add an "intermediate risk" category. (The latest research indicates that even women in this intermediate category can do without chemo, says Dr. DiNome.) (See also: Why are women more likely to die from breast cancer?)
Both MammaPrint and Oncotype DX can be used Become women with hormone-positive cancers. MammaPrint can also be used in women with hormone-negative cancers, but DiNome says most doctors do not order it for these cases. "In hormone-negative tumors, we have no other targeted therapies other than chemotherapy," she says. "So if you do not give chemotherapy, you're really putting these patients at risk."
These tests are generally approved by insurance companies. DiNome says that Oncotype DX is currently more likely to be approved, as it already gives longer tests. It's also very difficult to cover both of these, she says. "Patients should really talk to their oncologist about which test they recommend and which test is best for them," she says. (See also: This woman found that she had ovarian cancer when trying to get pregnant.)
Dr. DiNome sys Unsurprisingly, the Saunders oncologist three years ago had not considered ordering a MammaPrint test. Some doctors believe that their results are slow, especially among young women. (Although younger women were included in genomic breast cancer testing studies, most participants were postmenopausal.)
However, experts are becoming more and more self-confident. DiNome. "We're getting more and more data that supports the fact that we can not use the same treatment for every patient with hormone-positive cancer," she says. "We now know that the molecular signature of the tumor is the most important predictive factor we should rely on when evaluating the treatment."
The breast cancer staging system also changed in early 2018, and now it will take genomic testing and consider the genetic makeup of the tumor. "The entire community now recognizes that this is an important part of the diagnosis," says Dr. DiNome. "Now everyone is on the radar."
The bottom line, says Dr. DiNome, more and more women – like Saunders – can do without chemotherapy thanks to these tests. "This is definitely good news," she says, "and it's great to be moving toward personalized care."
This story originally appeared on Health.com by Amanda Macmillan.