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Breast cancer pathology

During your breast cancer surgery, your surgeon will remove the tumour and a small amount of healthy tissue surrounding it. This will be sent to a pathology laboratory for testing. The results of these tests will provide important information such as whether all the cancer has been removed, how big the tumour is, and how fast the cancer cells are growing. This information helps your medical team to decide the best treatment options for you.

To help you understand breast cancer pathology further, BCNA has created a Breast cancer pathology fact sheet which can be downloaded or ordered and gives you access to a glossary of pathology terms. 

Gene profile tests

Your surgeon or medical oncologist may talk to you about gene profile tests such as Oncotype DX, Prosigna, EndoPredict or MammaPrint. 

These tests assess a sample of your tumour to predict the likelihood of the cancer recurring or the likely response of the cancer to treatment (chemotherapy or hormone therapy). If there is a high risk of recurrence, your doctor will likely recommend chemotherapy. If there is a low risk of recurrence, you may be able to avoid chemotherapy. Doctors can use this information to help make recommendations about the best treatment for you.

There is currently no Medicare rebate for these tests and the prices can vary up to several thousands of dollars. If you have private health insurance, you may like to ask your insurance fund if they can provide a rebate to you.

Gene profile testing, sometimes also referred to as genomic testing, is only suitable for some types of breast cancer. If you are interested in seeing whether it is appropriate for you, you may like to talk to your breast surgeon or medical oncologist .

Oncotype DX

The Oncotype DX test analyses 21 genes within a tumour sample.

Type of breast cancer: Hormone receptor positive (ER+), HER2-negative (HER2-) breast cancer, where the lymph nodes are either negative (i.e. where the cancer has not spread to any lymph nodes) or positive in less than three nodes.

You do not need to provide a new tissue sample for an Oncotype DX test. If you decide to have the test, the tumour tissue removed during your surgery will be used for Oncotype DX testing.

Cost: ~$5,000.

Wait time on results: The test is processed in the USA and your doctor will usually receive results within 2–3 weeks.

Prosigna

Prosigna analyses 50 genes within a tumour sample.

Type of breast cancer: Hormone receptor positive (ER+), HER2-negative (HER2-) breast cancer, where the lymph nodes are either negative (i.e. where the cancer has not spread to any lymph nodes) or positive in less than three nodes.

You do not need to provide a new tissue sample for a Prosigna test.  If you decide to have the test, the tumour tissue removed during your surgery will be used for Prosigna testing.

The tissue analysis, along with the size of the tumour and number of lymph nodes that had cancer in them, will provide an individual score which will give an indication of the risk of your cancer recurring. The test is also able to estimate the risk of recurrence after five years of hormone blocking therapy. Knowing this may help you and your doctor decide whether continuing hormone blocking therapy for more than five years is better for you. 

Cost: $2,900.

Wait time on results: The test is processed in Australia and your doctor will usually receive results within 10 working days.

EndoPredict

EndoPredict is a test that analyses 12 genes within a tumour sample.

The information provided by EndoPredict can help you and your doctor decide whether chemotherapy may be of benefit to you.

Type of breast cancer: Hormone receptor positive (ER+), HER2-negative (HER2-) breast cancer, where the lymph nodes are positive, but in less than three nodes.

You do not need to provide a new tissue sample for the EndoPredict test. If you decide to have the test, the tumour tissue removed during your surgery will be used for EndoPredict testing. 

The tissue analysis, along with the tumour size and number of lymph nodes that had cancer in them, will provide a score which will help determine your risk of recurrence. This can help guide your treatment decisions about chemotherapy and hormone therapy.

Cost: $2,900.

Wait time on results: The test is processed in Australia and your doctor will usually receive results within 10 working days.

MammaPrint

MammaPrint is a test that analyses 70 genes within a tumour sample to look for changes associated with a higher risk of breast cancer recurring (coming back).

In April 2019, the Medical Services Advisory Committee (MSAC), the independent authority responsible for making recommendations to the Australian Government on new tests and treatments that should be covered by Medicare, made a recommendation that MammaPrint not be listed on the Medicare Benefits Schedule. It found that choosing not to have chemotherapy based on a MammaPrint test result could negatively impact outcomes.

If you are offered a MammaPrint test, we suggest you discuss this further with your treating team or seek a second opinion.

More information about the MSAC decision is available on the News pages of this website

 

Breast cancer tissue banks

Before your surgery, you may be asked if 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. This information is used for breast cancer research. If you agree to participate, you will be asked to complete a consent form.

If you have agreed, the pathologist will pass on a small, surplus part of the sample provided by the surgeon.

The tissue bank may use your samples immediately, or they may choose to store, freeze or preserve the sample in paraffin wax for further use. In addition to donating your tissue, you may be asked to provide a blood sample as well as information about your general health.

All tissue banks are bound by rigorous ethical standards, which ensures care and confidentiality for donors.