Molecular biology has changed the prognostic staging in breast cancer and made one step ahead towards precision medicine and personalised medicine in breast cancer. High clinical risk with a low genomic risk or molecular analysis of tumour tissue, can avoid chemotherapy. Staging of BC has been updated NCCN guidelines on molecular assays for breast cancer patients. Anatomical staging now has shown can have an additional information on tumour analysis, the genetic information on number of genes and the definition of low, intermediate and high risk that will dictate the risk for recurrence and predict the 10 year survival, will dictate and tailor the treatment that is best to avoid the future recurrence and increase survival.
21 Oncotype DX 21 gene expression on tumour tissue, for early stage breast cancer and for DCIS. Prognostic index for recurrence of early stage I, II BC and the benefit from Chemotherapy For DCIS to identify the benefit for radiation RxValuable for cases of early stage I, II BC hormonal positive and lymph node negative.
70 gene Mamma Ptint, prognostic market on the analysis of 70 Gene performed on tumour tissue. Prognostic market for 10 year survival as well as the risk of distant recurrence and the benefit of chemotherapy treatment. for Cases of BC of young age.
Endo/Predict/EPClin 12 Gene expression risk score on tumour tissue, value on the decision treatment about Chemotherapy for patients with HR- positive and HER2 negative, node- negative breast cancer, Not for node-positive BC.
BCI ( breast cancer index) for prognostic and predictive values. 5 gene molecular grade index, predicts the benefit on the extend endocrine therapy, with prognostic value on distant recurrence for Luminal A, more than Luminal B breast cancers.
50 gene assays, Prosigma (PAM-50)is based on the subtype of BCLuminal A, Luminal B, HER2, and basal-like TNBC, predicts the adjuvant hormonal Rx and the benefit of adjuvant chemotherapy and pathological complete response in neoadjuvant chemotherapy.
More is use is 21 but equally support on evidence with 70 gene assays Predictive or prognostic it helps to be precise on treatment of breast cancer, and be an individualised treatment for each patient’s, type of BC.
Best of Luck
Dr Zoe Vlamaki MD FRCS
Breast Oncoplastic and General Surgeon
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