During your breast cancer surgery, a sample of the breast cancer tissue removed by the surgeon will be sent to a pathology laboratory for testing. The results of these tests provide important information such as the size of the tumour, how fast the cancer cells are growing, whether there is cancer present in the lymph nodes in your armpit and whether there are any hormone receptors on the cancer. This will help your medical team to determine the best treatment options for you.
For information about breast cancer pathology visit the fact sheets page where you can download the pathology fact sheet and the Glossary of pathology terms. You will also find some useful information in Cancer Australia's Guide for women with early breast cancer -- available in My Journey Kit.
Oncotype DX
Your surgeon or medical oncologist may talk to you about a test called the Oncotype DX Breast Cancer Assay, or Oncotype DX. This is a relatively new test in Australia, although it is widely used in the United States.
The Oncotype DX test analyses 21 genes within a sample of tumour tissue to predict the risk that the breast cancer may recur. It can be helpful in determining whether or not you would benefit from chemotherapy. If the test shows you have a high risk of recurrence, chemotherapy may be recommended. If your risk of recurrence is low, you may be able to avoid chemotherapy and continue with other less-invasive treatments, such as radiotherapy and hormone therapy.
Oncotype DX is not suitable for all types of breast cancer. It is useful only in women (pre and post menopausal) whose tumours are oestrogen receptor positive (ER+) and whose lymph nodes are either negative (ie where the cancer has not spread to the lymph nodes) or positive (up to 3 nodes).
You do not need to provide a new tissue sample for an Oncotype DX test. If you decide to have the test, your doctor will ask the pathologist who examined the tumour tissue removed during your breast cancer surgery to provide a portion for Oncotype DX testing. The portion will be sent to America, where all Oncotype DX testing is currently done. Your doctor will usually receive the results within 2-3 weeks.
There is currently no Medicare rebate for the Oncotype DX test and it is quite expensive at $4000. If you have private health insurance, you may like to ask your insurance fund if they can provide a rebate to you.
If you are interested in Oncotype DX testing, you may like to talk to your breast cancer surgeon or medical oncologist about whether it is suitable for you.
Breast cancer tissue banks
You may be asked prior to your surgery (by letter or in person) whether you would like to donate some of your breast cancer tissue to a tissue bank.
Tissue banks collect breast cancer samples, and information about the women who donate them, for use in breast cancer research. If you agree to participate, you will be asked to complete consent forms.
If you have consented, the pathologist will pass on a small part of the sample provided to him/her by the surgeon to the tissue bank. This will be excess tissue that is not required by the pathologist for your pathology reporting.
The samples at the tissue bank may be used immediately, stored frozen, or preserved in paraffin wax for future research. In addition to donating your tissue, you may be asked to provide a blood sample and information about your general health.
All tissue banks are bound by rigorous ethical standards, so that the care and confidentiality of donors is assured.
