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When genomic and standard test results diverge: implications for breast cancer patients’ preference for chemotherapy

  • Preclinical Study
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Abstract

Purpose We examined how women incorporate potentially differing genomic and standard assessments of breast cancer recurrence risk into chemotherapy decisions. Methods 165 women previously treated for early-stage breast cancer indicated their interest in chemotherapy regimens to prevent recurrence of breast cancer in response to six hypothetical vignettes that presented breast cancer recurrence risk estimates from standard criteria and a genomic test, some of which were discordant. Results Standard and genomic test results each elicited greater interest in chemotherapy when they indicated high rather than low risk for recurrence (89% vs. 26%, and 87% vs. 22%, respectively, Ps < 0.001). Genomic test results had a larger impact on chemotherapy preferences than standard measures to predict recurrence. Conclusions Some women may be reluctant to forgo chemotherapy when genomic tests indicate low recurrence risk but standard criteria suggest high risk. Additional research including replication of the findings of this small, vignette-based study is needed.

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Acknowledgments

We thank Sarah Lillie and Edward Morrill for their help in planning and conducting the study; the interviewer team for their help with data collection; Claire Dees, Beth Fogel, and other physicians and nurses of the University of North Carolina Breast Center for their assistance; and two anonymous reviewers for their helpful comments on an earlier version of the paper. Most importantly, we thank the women who participated in this study. Financial support for this study was provided in part by grants from the American Cancer Society (MSRG-06-259-01-CPPB) and the Lineberger Comprehensive Cancer Center. The funding agreements ensured the authors’ independence in designing the study, interpreting the data, writing the report, and publishing it.

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Correspondence to Noel T. Brewer.

Appendix

Appendix

The wording for the six scenarios that presented the results of the standard and RFR tests are below. Participants indicated their interest in chemotherapy using a 5-point response scale labeled from “definitely would not” to “definitely would”.

Please continue to recall the time when you were first diagnosed with breast cancer.

  1. 1.

    If the Test result said your cancer had a high chance of recurring would you want to have chemotherapy?

  2. 2.

    If the Test result said your cancer had a low chance of recurring would you want to have chemotherapy?

The Recurrence Risk Test results can disagree with the result of other tests. The Recurrence Risk Test might show a high chance of the cancer recurring (suggesting chemotherapy is needed). But other tests might show a low chance (suggesting chemotherapy is not needed). In this case, the patient and her doctor have to choose which test results to rely on.

  1. 3.

    If all of the tests said low risk, would you want chemotherapy?

  2. 4.

    If the Recurrence Risk Test said low risk but the other tests said high risk, would you want chemotherapy?

  3. 5.

    If all of the tests said high risk, would you want chemotherapy?

  4. 6.

    If the Recurrence Risk Test said high risk but the other tests said low risk, would you want chemotherapy?

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Brewer, N.T., Edwards, A.S., O’Neill, S.C. et al. When genomic and standard test results diverge: implications for breast cancer patients’ preference for chemotherapy. Breast Cancer Res Treat 117, 25–29 (2009). https://doi.org/10.1007/s10549-008-0175-2

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  • DOI: https://doi.org/10.1007/s10549-008-0175-2

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