A recurrence score in breast cancer is a specialized tool designed to personalize treatment decisions for individuals diagnosed with certain types of breast cancer. This score provides insights into the likelihood of the cancer returning in the future. It also indicates the potential benefit of adding chemotherapy to a patient’s treatment plan, typically alongside hormone therapy. This information aids in tailoring treatment strategies to the specific characteristics of an individual’s tumor.
What a Recurrence Score Measures
A recurrence score is derived from a genomic test, which analyzes the activity of specific genes within a breast cancer tumor sample. For example, the Oncotype DX Breast Recurrence Score test examines the expression levels of 21 genes, with 16 related to cancer and 5 serving as reference genes.
This analysis provides two distinct types of information. It offers prognostic insights, indicating the likelihood of the cancer returning in a distant part of the body. It also provides predictive information, estimating the potential benefit of adding chemotherapy to hormone therapy. This detailed genetic profile helps healthcare providers and patients make more informed choices beyond traditional factors like tumor size or grade.
Who Receives a Recurrence Score Test
The recurrence score test is primarily used for individuals with early-stage, hormone receptor-positive (HR+), HER2-negative invasive breast cancer. This typically includes patients with stage I, II, or IIIA breast cancer, with or without up to three positive lymph nodes. The test is performed on a tumor tissue sample removed during a biopsy or surgery. Oncotype DX is a widely recognized example, supported by major cancer organizations like the National Comprehensive Cancer Network (NCCN) and the American Society of Clinical Oncology (ASCO).
Understanding Your Recurrence Score Results
The recurrence score is typically presented as a numerical value from 0 to 100. This score falls into risk categories: low, intermediate, and high, which indicate the probability of cancer returning. A lower score generally suggests a lower likelihood of recurrence if treated with endocrine therapy alone. For instance, a score of 0-25 for postmenopausal individuals, or 0-15 for premenopausal individuals with node-negative disease, often indicates a low risk of recurrence and minimal to no benefit from chemotherapy.
Conversely, a higher score indicates an increased likelihood of distant recurrence. A score of 26-100 generally signifies a high risk of recurrence, and suggests a greater potential benefit from adding chemotherapy. These scores provide a personalized assessment of recurrence risk over a specific period (e.g., nine years) without chemotherapy. Intermediate scores (e.g., 16-25 for premenopausal, node-negative patients) may involve further discussion with the oncology team, as there might be a small benefit from chemotherapy or other treatments like ovarian suppression.
How the Recurrence Score Guides Treatment Decisions
The recurrence score guides personalized breast cancer treatment, complementing other clinical and pathological factors. Doctors consider the score alongside tumor size, tumor grade, and lymph node involvement. For patients with a low recurrence score (often 0-25), the likelihood of recurrence is generally low, and chemotherapy may offer minimal or no additional benefit beyond hormone therapy. This information can help patients avoid chemotherapy side effects like nausea, fatigue, and hair loss.
Conversely, for those with higher recurrence scores (typically 26 or above), the test indicates a greater potential for chemotherapy to reduce recurrence risk. In these instances, chemotherapy benefits in preventing recurrence are generally considered to outweigh its risks. The recurrence score empowers shared decision-making, weighing personalized recurrence risk against potential benefits and side effects of different treatment approaches. This ensures treatment plans are tailored to the individual’s tumor biology and overall health.