Navigating Survivorship for Hormone Receptor-Positive, Early-Stage Breast Cancer Patients

If you have been diagnosed with hormone receptor-positive (HR+), early-stage breast cancer, you may feel like you are faced with countless decisions when it comes to managing your treatment. Should you undergo chemo, surgery, or radiation? What about anti-estrogen therapy? What will the side effects of treatments be and how long should you be on medications?

All these choices can feel overwhelming, especially when you are not sure if a particular treatment is likely to benefit you. Luckily, as technology continues to advance in breast cancer care, we now have tools available to help guide you and your healthcare team in making optimal, personalized decisions throughout your survivorship.

What are genomic tests and how can they help guide my survivorship care plan?

In breast cancer, genomic tests evaluate your individual tumor biology to assess things like your risk of a recurrence and whether or not a particular form of treatment is likely to benefit you. Genomic tests can provide invaluable information to you and your healthcare team. Knowledge is power, and the more information you have regarding your individual cancer, the better equipped you are to make personalized decisions.
Some genomic tests are prognostic, meaning they provide information regarding your risk of your cancer coming back. Other tests are predictive, meaning they can assess your individual tumor biology to determine if a particular type of treatment is likely to reduce that risk. Tests that provide both prognostic and predictive components can be extremely valuable in providing a holistic picture of your individual risk and benefit, allowing you and your healthcare provider to make informed decisions.

For HR+, early-stage breast cancer, predictive tests can help you determine what types of treatment you may need, and how long you will need to be on them. Different tests are used at different time points. For example, you may receive an Exact Sciences Oncotype DX^® test when you are initially diagnosed to determine whether or not you would likely benefit from chemotherapy.

Another critical time point for women on anti-estrogen therapy to treat this particular type of breast cancer is five years after diagnosis. The Breast Cancer Index^® genomic test (BCI) can help address one of the critical decisions you face during your survivorship: whether or not you should continue anti-estrogen therapy past five years. The test provides two key results, including your risk of late distant recurrence (metastatic recurrence after the five-year mark) and whether continuing to take anti-estrogen therapy beyond the five years is likely to reduce that risk. This information can help you and your healthcare team make an informed and personalized decision on the optimal length of anti-estrogen therapy for you.

How might test results affect my treatment plan?

Historically, healthcare providers have evaluated different clinical factors to help them determine which patients should continue anti-estrogen therapy beyond five years. This may include things like nodal status, tumor size, and tumor grade. However, these factors do not accurately predict whether or not extending anti-estrogen therapy is likely to reduce your risk of recurrence after year five.1-4 Only BCI has been recognized by national oncology guidelines to predict likelihood of benefit.^5,6

Results from genomic tests like BCI may have a significant impact on your treatment plan. In fact, a recent study showed that ~40% of treatment decisions regarding extended anti-estrogen therapy changed following BCI results.⁷ Approximately 2/3 of these decisions changed from a recommendation for extended anti-estrogen therapy to a recommendation to stop at year 5, potentially sparing patients of uncomfortable side effects and adverse health outcomes associated with anti-estrogen therapy. One patient, Stephanie, recounts her struggle with side effects from tamoxifen, “I did not like endocrine therapy from the start. I had issues with collecting my thoughts and still struggle a little bit with finding the right words in certain moments. I experienced the side effects of dryness in all parts of my body to the point that I had to stop wearing contacts. I felt that I had to go on various medications to counteract the effects of the tamoxifen. Taking the medication was also daily reminder that I had cancer.”

On the other hand, it is important to stay on the medication if it helps reduce your chance of recurrence. For women who experience a recurrence, approximately 50% of those recurrences happen after the five-year mark.⁸ Approximately 1/3 of recommendations that changed following BCI shifted from a “no” to a “yes” for extended anti-estrogen therapy, identifying women who were likely to reduce their risk of a potentially life-threatening metastatic recurrence by continuing the medication.⁷ It is important to use all the available tools to gather information that will help you and your care team make informed decisions regarding your care.

How can I increase confidence and comfortability in my treatment decisions?

Utilizing personalized results from genomic tests can alter your treatment decisions and increase confidence and comfort around your survivorship care plan. In fact, 45% of patients changed their preferences for extended endocrine therapy after receiving BCI results.⁷ Additionally, 41% of patients felt more comfortable with their treatment decisions following a Breast Cancer Index^® test.⁷ Knowing longer treatment is likely to benefit you may help you increase their resolve to continue on treatment. On the other hand, patients whose BCI indicates that they are unlikely to benefit from treatment may feel more comfortable discontinuing the medication unnecessarily.

On the other hand, Stephanie recalls what it felt like when she received her BCI results, which indicated that longer anti-estrogen treatment was unlikely to benefit her and decided to discontinue at the five-year mark. “It gave me the freedom to consider myself cancer free. I have been off of the medication for approximately 18 months. I’m finally able to wear contacts again and do not find quite the level of dryness throughout my body. My libido has increased again, though not to the pre-medication level.”

When you are empowered with information on whether a particular treatment is likely to benefit you, you have the power to determine the best course of action based on your individual needs and preferences. Survivorship can be full of unknowns, but leveraging tools that provide personalized results to help guide treatment decisions can help you feel more in control.

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