Anyone with any experience doing a genetic assay for breast cancer patients.
Please share it here.

It seems for early stage invasive breast cancer in Malaysia like stage 1 or 2a or 2b, the specialist either oncologist or breast surgeon won’t do a gene assay test to determine chemotherapy treatment viability or not.

This is a requirement for US and also UK. And recommend in Aus/Nz.

One of the established gene assay - Oncotype-DX, will cost around 25-30k myr. And a new one Endopredict by Sividon diagnostic should be around 10-15k MYR. The issue is, none of these test are available easily or promoted in maalysia. The reason given is cost effectiveness - even in ministry of health guidelines. And standard adjuvant treatment for breast cancer patients are chemo straight away, even though in overseas adjuvant treatment has advances.

Even chemo has different drugs in private hospitals vs government hospital or university hospital. Due to budget constraints, places like NCi Putrajaya will offer gen 1 chemo drugs, university hospital will use second gen like fec combinations or a generic 3rd gen taxane and big private hospitals will use branded 3rd gen taxane based chemo drugs.

To make The decision to chemo or not, is hard, how do you guys decide on it, just based on the current method only without gene assay??? Just follow ER/PR status, tumour size, tumour grading aggressive or not and sentinel node biopsy result that show whether the carcinoma has metastasis or not. Why not add gene assay to the decision making process. I believe gene assay won’t be covered by any insurance policy in Malaysia, be it cancer policy or not.

Come share your experience.

not sure what you mean by chemotherapy viability..........

for early stage breast cancer, why don't go straight for mastectomy?

A mastectomy was done. Sentinel node biopsy was done and the result is negative, which means no metastasis.

As an adjuvant therapy (post surgery - mastectomy or lumpectomy) - onco will normally suggested a chemo based on er/pr, tumour size and tumour agrresiveness grading. in that scenario, gene assay was never use in breast cancer prognosis before making a clinical decision to offer chemo to patient. Even for a patient to ask for a gene assay, it is hard to get it - weird.

Another test that is useful to decide for "adjuvant" treatment for breast cancer after surgery - is "Ki67" test. You can do this in Pantai Premier Pathology lab. Ki67 is also included in "Oncotype-DX" gene assay report.

Somehow, certain private hospitals or university hospital doesn't do Ki67 test on the core biopsy tissue or the tumour (after lumpectomy or mastectomy). Which is weird or unknown. Considering a lot of unknowns still with breast cancer. No one really knows for sure how breast cancer develops - which gene that caused it specifically or what medical conditions causing it to developed from DCIS.

I would say, the more tests we can conduct to help breast cancer patient make an informed decision on how to be treated - it is better. Wouldn't you guys agree?