title: The impact of the 21-gene recurrence score assay on decision making about adjuvant chemotherapy in early-stage estrogen-receptor-positive breast cancer in an oncology practice with a unified treatment policy.
abstract: BACKGROUND
  The 21-gene recurrence score (RS) assay has been validated in retrospective studies as prognostic of distant disease recurrence and predictive of the benefit of adjuvant chemotherapy in estrogen-receptor-positive breast cancer (BC). There is limited published data on the impact of the assay on clinical practice, particularly in the context of a single practice with a unified treatment policy.
  
  
  METHODS
  Between 2006 and 2009, RS was obtained on 135 patients in a single practice with a uniform treatment policy. Treatment recommendations before and after RS result were analyzed retrospectively. Pre-RS treatment recommendations were based on clinicopathological features and Adjuvant! Online (AO) calculated survival advantage. RS and AO survival advantage for adding chemotherapy were compared for each patient.
  
  
  RESULTS
  The distribution by risk group of RS was low- 49.6%, intermediate-37.8%, and high-12.6%. In 34 patients (25.2%, 95% confidence interval 17.9% to 32.5%), recommendation for chemotherapy was changed after obtaining assay result. Most changes (70.6%) were from chemotherapy to no chemotherapy. The RS correlated poorly with AO predictions.
  
  
  CONCLUSIONS
  The 21-gene assay, when applied in a consistent manner in early-stage BC, changes treatment recommendations in one-quarter of patients tested.
authors.affiliation: Department of Oncology, Ben-Gurion University of the Negev, Beer Sheva. Electronic address: dgeffen@bgu.ac.il.
authors.forename: D B
authors.initials: DB
authors.lastname: Geffen
authors.affiliation: Department of Oncology, Ben-Gurion University of the Negev, Beer Sheva.
authors.forename: S
authors.initials: S
authors.lastname: Abu-Ghanem
authors.affiliation: Department of Pathology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva.
authors.forename: N
authors.initials: N
authors.lastname: Sion-Vardy
authors.affiliation: Independent Statistical Consultant, Tel Aviv.
authors.forename: R
authors.initials: R
authors.lastname: Braunstein
authors.affiliation: Department of Oncology, Ben-Gurion University of the Negev, Beer Sheva.
authors.forename: M
authors.initials: M
authors.lastname: Tokar
authors.affiliation: Department of Oncology, Ben-Gurion University of the Negev, Beer Sheva.
authors.forename: S
authors.initials: S
authors.lastname: Ariad
authors.affiliation: Department of Pathology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva.
authors.forename: B
authors.initials: B
authors.lastname: Delgado
authors.affiliation: Department of Surgery, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
authors.forename: M
authors.initials: M
authors.lastname: Bayme
authors.affiliation: Department of Surgery, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
authors.forename: M
authors.initials: M
authors.lastname: Koretz
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000235:genetics* / Q000378:metabolism / Q000473:pathology; D018567:Breast Neoplasms, Male / Q000188:drug therapy / Q000235:genetics; D017024:Chemotherapy, Adjuvant; D003657:Decision Making; D005260:Female; D020022:Genetic Predisposition to Disease; D005820:Genetic Testing / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000235:genetics* / Q000517:prevention & control; D009367:Neoplasm Staging; D011960:Receptors, Estrogen / Q000096:biosynthesis*; D011980:Receptors, Progesterone / Q000096:biosynthesis; D012189:Retrospective Studies
chemical_list: D011960:Receptors, Estrogen; D011980:Receptors, Progesterone