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Overview: Mammostrat Assay
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A diagnosis of breast cancer evokes a wide range of emotions. At the same time, there are so many unanswered questions about potential next steps, prognosis, and treatment—all swirling about without any clarity. Many women gain control by becoming educated and actively involved in treatment decisions. In consultation with your physicians, you make the final decision about the best course of treatment personalized for you. Equipping yourself with the knowledge you need to make informed decisions will enable you to determine the best possible treatment options.
Characterizing Your Tumor
The first step to making informed treatment decisions is determining everything possible about your cancer, i.e. a complete clinical analysis or characterization of the biology of your cancer. Traditionally, a sample of your breast tissue (small biopsy sample or surgically removed tissue) will be sent to a pathologist responsible for the clinical testing of your tumor. Tests routinely conducted on your specimen may include determining the size of the tumor, the grade of the tumor, the status of the lymph nodes and the the detection of certain protein receptors such as estrogen receptor (ER), progesterone receptor (PR), and HER2. In addition to these routine tests, your physician or pathologist is considering ordering a new diagnostic test called Mammostrat®. Mammostrat will help determine the chance that your cancer may return in the future (called a “recurrence”).
Risk of Recurrence and Your Treatment Decisions
Mammostrat is a test for early stage breast cancer patients whose tumor has been diagnosed as “estrogen receptor positive”, (“ER+”). ER+ tumors may respond to anti-hormonal therapy, while tumors lacking ER expression are unlikely to respond. Mammostrat assigns your tumor to one of three risk categories indicating your relative risk of having a recurrence (high risk, moderate risk, or low risk).
Women with early stage, ER+ breast cancer, whose tumor is completely removed by surgery, have a very favorable outcome,and most women will remain disease free even in the absence of any prescribed chemotherapy. However, a subset of women with ER+ breast cancer, classified as high risk by Mammostrat, have a type of cancer with an increased risk of recurrence. Patients in this higher risk group may want to consider a more aggressive treatment regimen which includes chemotherapy. Mammostrat is a test to determine whether your cancer is at higher risk of recurrence.
Chemotherapy Considerations
Patients classified as “high risk” by Mammostrat have an increased likelihood of having a breast cancer recurrence and gain the greatest benefit from additional chemotherapy. Whether to receive chemotherapy in addition to other standard treatments is a very personal decision and should be discussed with your oncologist. Factors influencing your decision may include your age, your health, and your own personal views about treatment. Your Mammostrat risk category along with your medical history and key pathology features identified in your tumor will allow you and your doctors to determine the best course of treatment for you including whether chemotherapy is an option you wish to consider.
How Does Mammostrat Work?
The figure above shows how Mammostrat helps classifies breast cancer patients into smaller subcategories eventually assigning a low, moderate, or high risk category to three different groups. We know from studying our genes that breast cancer is not one single disease but is made up of many different subtypes of cancer. Imagine the various colored squares of Level 1 as a group of breast cancer patients. The different colors in this group represent all the different types of breast cancer that exist. Traditionally, pathologists used several well-established cancer diagnostic tests such as ER and HER2 to divide breast cancers. In Level 2, the green, blue, and yellow squares have been separated from red and purple squares. But, ER+ cancers are still a mix of cancer subtypes (green, yellow, and blue squares in Level 2). Some women in this mix will have a higher risk of recurrence. Mammostrat separates this ER+ mix of patients into separate groups of low risk (green), moderate risk (blue), and high risk (yellow)(Level 3). Patients and their physicians can then use this risk information to make informed decisions about treatment.
Taking the time to understand your reports and speaking to your diagnostic team will give you a feeling of ownership to help you receive the individualized treatment and best course of action for you.
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