Rethinking Breast Cancer Treatment: One Patient's Story

In the United States, one in five new breast cancer cases is stage 0 disease, but for Amy Thigpen, a mother of three who works in an oncology clinic, breast cancer is not a statistic; it is personal. After all, her mother is a breast cancer survivor, and later, she too faced-off with a similar diagnosis. After Amy’s mother was diagnosed with early-stage invasive breast cancer, Amy was determined to be proactive about her breast health. She had a feeling something was not right and requested a mammogram from her doctors at the age of 34, even though clinical practice guidelines do not recommend screening before the age of 50. The mammogram found a small tumor that was confined to the milk ducts; fortunately, it had not spread to the surrounding tissue. At that point, Amy faced her diagnosis – stage 0 breast cancer, known as ductal carcinoma in situ, or DCIS. An oncology nurse in the hematology oncology department at Physicians East in Greenville, North Carolina, Amy worked alongside a breast cancer specialist and had seen many patients battle the disease and struggle with the many decisions that had to be made – including whether or not to pursue post-surgery treatment. After caring for so many cancer patients over the years, Amy now was speaking with her doctors about a difficult decision of her own, as it was not clear whether her cancer would come back and if she needed radiation therapy. Amy was familiar with genomic testing and a tool doctors sometimes used to guide treatment decisions. Her mother had received the Oncotype DX test for her invasive breast cancer and used the test results to help inform her decision of whether she needed chemotherapy. Inspired by her mother’s experience, Amy talked to her doctor about genomic testing, and since the Oncotype DX test was now available and validated to provide the 10-year risk of an invasive or a DCIS local recurrence in DCIS patients, they decided to move forward. The Oncotype DX DCIS Score result has been shown to change treatment recommendations in 30 percent of patients and doctors rank it as the most important factor in treatment planning for DCIS patients. When Thigpen received her Oncotype DX test results, her DCIS Score result was zero. “I was so excited, I carried the results to my doctor and knew we had our answer. I wouldn’t have radiation. The test probably saved me from having to go through six weeks of radiation that my body really did not need, as well as the side effects that it can cause.” "When a woman is diagnosed with DCIS, my goal as a physician is to accurately assess her individual risk for cancer returning so we can define and personalize an appropriate treatment plan with greater confidence," said Michael Alvarado, M.D., breast cancer surgeon, the University of California, San Francisco Helen Diller Family Comprehensive Cancer Center. Reflecting on a UCSF-led study of the clinical utility of the Oncotype DX test for DCIS, Dr. Alvarado added that that test was “an objective biomarker that provides independent information beyond what has been available to physicians before, which can be seen as the biggest advancement in the management of DCIS in more than a decade." To encourage other women to pursue personalized treatment, Amy decided to share her story on www.MyBreastCancerTreatment.org, a patient education resource providing information around breast cancer and the benefits of genomic testing. The tools, resources and eligibility quiz offered on this website enable patients and their loved ones to empower themselves with information about their specific cancer and work with their doctor to confidently select a treatment plan that can guide personalized treatment decisions based on their individual tumor. “You have to be your own advocate and push for what you truly feel in your heart is right, because when the day is over, you have to be 100 percent comfortable with your treatment plan.”