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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 that can be downloaded or ordered and gives you access to a glossary of pathology terms. You will also find some useful information in Cancer Australia’s Guide for women with early breast cancer which is available in your My Journey Kit.

Pathology tests

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

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.

The recently published international MINDACT study confirms that women who return a low risk genomic test do not receive any significant benefit from taking chemotherapy. Genomic testing may prevent potentially around 2,000 Australian women unnecessarily going through this treatment.

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.

Genomic testing is only suitable for some types of breast cancer. If you are interested in seeing whether it is relevant or you, you may like to talk to your breast surgeon or medical oncologist about whether it is suitable for you.

Oncotype DX

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

Type of breast cancer: Not suitable for all types of breast cancer. Only hormone positive (ER+), HER2-negative (HER2-) breast cancer, where the lymph nodes are either negative (i.e. where the cancer has not spread to the lymph nodes) or positive, but 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: ~$4,500.

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: Not suitable for all types of breast cancer. Only hormone positive (ER+), HER2-negative (HER2-) breast cancer, where the lymph nodes are either negative (i.e. where the cancer has not spread to the lymph nodes) or positive, but 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 therapy. Knowing this may help you and your doctor decide whether continuing hormone 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.

MammaPrint

The MammaPrint test analyses 70 genes within a tumour sample to determine whether there is a higher or lower risk that the breast cancer may recur (come back).

Type of breast cancer: Not suitable for all types of breast cancer. Only hormone positive (ER+), HER2-negative (HER2-) breast cancer, where the lymph nodes are either negative (i.e. where the cancer has not spread to the lymph nodes) or positive, but in less than three nodes.However, MammaPrint is not suitable for all types of breast cancer. It is most useful for women who have tumours that measure between 20mm & 50mm (i.e. T2), although some women with higher grade larger 10mm to 20mm (T1c) tumours may also benefit from MammaPrint testing.

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

Cost: $4,200. The MammaPrint result now comes with the additional genomic test BluePrint, which classifies breast tumours into luminal, HER2 or basal subtypes.

Wait time on results: The test is processed in the USA and your doctor will usually receive the results within 10-14 days of the tissue leaving Australia.

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: Not suitable for all types of breast cancer. Only hormone 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.

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.