New Breast Cancer Guidelines

The St Gallen International Breast Cancer Guidelines were recently updated to include the Oncotype DX test for breast cancer as the only screening tool for women with early stage ER+/Her2- breast cancer to determine the benefit of chemotherapy.

On some levels this is great news but again it is not for all women. The criteria for the Oncotype DX test for breast cancer are:

"You may be a candidate for the Oncotype DX breast cancer test if you are medically eligible for chemotherapy and:

• You have been diagnosed with stage I,II or IIIa invasive breast cancer.*
• Your breast cancer is estrogen-receptor positive (ER+) and Human Epidermal growth factor Receptor -negative (HER2-) and you do not have lymph node involvement (also known as lymph-node-negative breast cancer).

        OR

• You are a post-menopausal woman recently diagnosed with node positive, hormone-receptor-positive, Human Epidermal growth factor Receptor -negative breast cancer"

The problem is that while most women have ER+, Her2- and node negative breast cancer, not all do. For example, I was not given this test because I had one tiny positive lymph node. Apparently they are starting to do some testing on women with node positive disease. The Oncotype DX test is also available for colon and prostate cancer as well.

I have digressed. I do like the fact that this test is available for some if not all. I do like the fact that it is covered by most insurance companies. I do like the fact that it helps determine if a patient will benefit from chemotherapy before they receive it. I do like the fact that it is part of standards for treatment.

I do not like the fact that it is still part of the conversation about treatment - do you remember the little analogy - an ounce of prevention is worth a pound of cure? Why can't we put that into the guidelines?

Delays can cost lives

Back in early Pinktober, Good Morning America had a 'Pink' Day and had one of their staff, Amy Robach, have an on air mastectomy. Now she is told that she has breast cancer and that the mastectomy saved her life. Now that may be a bit overly dramatic but she had skipped her mammogram at age 40.

A family member, who shall remain nameless, was given a pass by their PCP for a colonoscopy at age 51 instead of age 50. At 51, they had a giant malignant polyp and they could not get clear margins, so they had a colectomy to ensure there was no more cancer. What if they had continued to skip their colonsocopies?

A new study found that young women diagnosed with breast cancer who do not have a lot of money face delays in their treatment which could lead to the higher mortality rates experienced by them.

What does this tell us? Delays are not good. It probably is not a good idea to delay testing and treatment when dealing with cancer.

PS Obviously it is not a profound kind of day for me. This was a pretty lame post.