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My Treatment Decision Patient Profiles

Patient Profiles - Deborah W.













In April 2007, Deborah had a mammogram after skipping a few years. Additional mammograms and an ultrasound suggested that she might have breast cancer. A core needle biopsy revealed that she had ductal carcinoma in situ.

Deborah, then 53, met with a surgeon who ordered an MRI of her other breast to make sure there was no cancer there. She also did a separate biopsy to check for lymph node involvement, and found none. Her surgeon informed Deborah that a mastectomy was her only surgical option, and that it should "cure" her cancer.

After her mastectomy, pathology results showed that the cancer had broken out of Deborah's milk ducts and had turned into invasive ductal carcinoma. At this point, her surgeon said that Deborah would likely need to be on a five-year hormonal therapy and might also need radiation.

A panel of radiation oncologists recommended against radiation; they thought it might do more harm than good, because any cancer cells left after the mastectomy would be very close to Deborah's chest wall, over her heart.

Deborah's next step was to see an oncologist, who prescribed a five-year course of treatment with an aromatase inhibitor. Realizing that she would need to see an oncologist often, Deborah found one closer to her home.

During their first appointment, the first thing the new oncologist asked Deborah was, "What are the results from your Oncotype DX® test?" Deborah hadn't heard of the test, so her oncologist explained that it can help doctors assess whether women with certain types of breast cancer are likely to benefit from chemotherapy.

Deborah worked with her surgeon's office to order the test. Her Recurrence Score® result was a 33, meaning she had about a 22% chance of recurrence (on average, with a range of 17% to 27%). Her oncologist immediately began chemotherapy, telling Deborah that she should have started it weeks before.

"Looking back at my treatment decisions, it was a real rollercoaster," Deborah said. "I kept hearing I was going to be cured, which made me confident that I would be, but it turned out I was at a high risk of recurrence. The Oncotype DX test and my Recurrence Score result really helped change everything."

Now 54, Deborah has completed chemotherapy and continues to take an aromatase inhibitor. To keep her strength up, she began working with a personal trainer soon after she was diagnosed, and continues to train today. A professional painter of murals and decorative finishes before her diagnosis, Deborah now focuses on pet portraits. And speaking of pets, both Deborah and her husband Randy stay busy with their two standard poodles.

Patient Profiles - Deborah C.













When Deborah was diagnosed with breast cancer in September 2007, the news was unwelcome, but not unexpected.

Deborah, 44, had been having mammograms since she was 30. Her breasts had fibrocystic tissue, along with extensive calcification, which resulted in lump-like calcium deposits. After one of those lumps grew in size over a span of 7 months, she had a lumpectomy and a biopsy, which led to a diagnosis of breast cancer.

Her pathology report showed that the margins were not clear, so Deborah and her surgeon had to decide between additional surgery to clear the margins followed by radiation, and a mastectomy. Because she wanted to minimize the chances of local recurrence, and because there was a high risk that her other breast might also develop cancer, Deborah wanted to have a double mastectomy, and her surgeon agreed.

After surgery, Deborah did research online to help evaluate whether chemotherapy would be beneficial for her. A brief mention of the Oncotype DX® test drove Deborah to research it further, and she and her oncologist agreed that she should have the test.

Deborah's Recurrence Score® result was 14, indicating that her risk of recurrence was low and that she would likely derive little benefit from chemotherapy, which came as a relief. She said she was pleased to find out that there was a test that could help her evaluate how beneficial chemotherapy might be for her. “I was already resisting the idea of having chemo, both because it seemed unlikely to be of much benefit, and because it would have undesired and negative side effects,” she said. She explained that her Recurrence Score result supported her decision, in consultation with her physician, not to have chemo.

Deborah remains busy with her animal rehabilitation practice, working with cats and dogs that have orthopedic and neurological problems. In fact, when she was diagnosed with breast cancer, her first thought was for her patients. “I realized treatment was going to take a lot of time out of my schedule, which may sound strange. But I have a duty and responsibility to my animal patients, and I needed to balance that against my treatment.”

Always an avid athlete, Deborah continues to run, jog, cycle, weight train, and swim.

Patient Profiles - Katherine













In 2003, Katherine, a 53-year-old podiatrist and one of the first female karate black belts in the United States, found a lump in her breast during a self-examination. After multiple rounds of tests and a double mastectomy to remove her invasive breast cancer, Katherine had to choose whether to get chemotherapy to reduce the likelihood of her cancer recurring.

As Katherine contemplated her decision, her husband learned about Oncotype DX®, a new test that was coming onto the market. Katherine's physician had heard about the test, but didn't think that it would be available for a couple of years. They made a deal: if she did the legwork in researching when the test would become available, he would order it for her. In the meantime, standard assessments of Katherine's tumor indicated that chemotherapy would be necessary. She called Genomic® Health regularly to see if the test was available.

In January 2004, Katherine became the first woman to use the Oncotype DX test and learned she had a Recurrence Score® result of 18.

Following treatment with an aromatase inhibitor, Katherine has become a certified ski instructor along with her husband. They enjoy spending time together with their dog, Connor, who is also a cancer survivor.
Patient Profiles - Linda













"Of all the things that could ever happen to me in my life, I never thought I would get cancer," Linda said. Still, that was her sudden reality when she was diagnosed in June 2006. "There was a shock factor there." Speaking of her initial experience and the rapid journey from diagnosis, to an MRI, to surgery, Linda called it "a long, terrible weekend."

Linda had a mammogram exactly one year before her diagnosis that showed nothing. Then, the next one showed a 2.2-cm tumor. She saw a surgeon and had a biopsy, then received a phone call telling her it was malignant. Within a week or so, Linda had a right breast lumpectomy and her doctors instructed her to have radiation and tamoxifen therapy.

"I was against having chemo," Linda said. "My oncologist told me about a clinical trial involving the Oncotype DX® test. Although I didn't participate in the trial, I did want to have the test, and Genomic Health® was invaluable in helping me get reimbursed for it. We sent off the tumor and two weeks later, I had my result — my score was 28, meaning I was at medium to high risk for cancer recurrence."

"Oncotype DX affected my treatment decision totally," Linda said. She noted that her surgeon and oncologist recommended chemo. Although she had been completely against it, she decided to undergo chemo because the test results indicated that she was at medium to high risk for recurrence. Linda said that she was more confident in her decision. A week after that meeting, Linda started chemotherapy.

"I shaved my hair; my attitude was, 'cancer isn't getting it.' It had been brown. When it came back, it was silver," said Linda. "I teach third-grade religious education. I subbed one day while I had a bald head. I wore a scarf. All the kids wanted to see my bald head. A few months later, some of the same kids saw me again and said, 'Mrs. Porter, you have hair!'"

It took Linda almost a full year to get her strength back. "I'm back to working full time as a human resources manager for an engineering firm, and doing volunteer work," said Linda. "I love entertaining and cooking. Every four months, I see my surgeon, radiologist or oncologist, then my gynecologist and family practice doctor." Linda's cancer was detected following a regular mammogram. Linda said, "be faithful to your mammograms!"

Patient Profiles - Susie













Susie, a retired nurse, found a dimple in her breast during a self-exam in February 2007. Although a mammogram and an ultrasound showed no evidence of an abnormality, a surgeon with whom she had previously worked insisted that she come in for an exam. He was concerned with what he found.

A biopsy revealed that Susie, age 55, had breast cancer. The following week, she had a lumpectomy and a sentinel node biopsy. She had Stage I, node-negative cancer. Susie's oncologist, surgeon and radiation oncologist agreed that she would need radiation therapy, but could forgo chemotherapy. However, Susie, a former oncology nurse, was concerned that her cancer might be more likely to recur without chemotherapy.

Her oncologist ordered the Oncotype DX® test. Susie's Recurrence Score® result was 16, indicating that her recurrence risk was in a low-risk group. The test indicated that she was in a group that was not likely to benefit from chemotherapy, and her oncologist planned to treat Susie with radiation and tamoxifen.

“The Oncotype DX test sealed the deal,” Susie said. “Knowing I could make a game plan with some certainty helped me get back to normalcy.”

Susie completed her radiation therapy in the summer of 2007, and continues to take tamoxifen. Now 56, Susie is busy helping raise two of her young grandchildren. She is also active in a garden club and enjoys skiing with her family.

Patient Profiles - Joyce













When Joyce had a routine mammogram in 2006, everything seemed fine. Then the chief of radiology at her local hospital called her in for additional imaging. She was called back a second time for a surgical biopsy, which revealed that Joyce, at age 63, had breast cancer.

Although Joyce had been diagnosed at a smaller medical practice in the Boston area, her son-in-law, a California-based surgeon, advised her to take advantage of the resources available at the major teaching hospitals in Boston, and referred her to a surgeon at one of the hospitals there for treatment.

A lumpectomy and removal of a sentinel lymph node revealed that Joyce had node-negative, infiltrating ductal carcinoma.

After surgery, Joyce met with her oncologist to discuss the next step in her treatment. Her oncologist recommended radiation therapy, and said that chemotherapy might also be needed. Joyce began researching breast cancer treatment, and found that chemotherapy can affect the heart, bones, and brain, as well as cause nausea and hair loss. "I really didn't want to have it," she said. "Given my age and the type of cancer I had, it didn't seem likely that I would benefit much from chemo."

She asked her oncologist if there was a test that could tell her whether chemotherapy would likely be beneficial, and her oncologist recommended — and ordered — the Oncotype DX® test. Joyce's Recurrence Score® result was a 24, indicating that she was at an intermediate risk for cancer recurrence. In patients with a Recurrence Score in the intermediate range, the benefit from chemotherapy is unclear.

Joyce and her oncologist decided against chemotherapy. "My Recurrence Score result was one more piece of information that helped us make that decision," she said. "You want to get as many facts together as you can." Joyce had radiation therapy and is taking tamoxifen.

Now 65, Joyce is back to her normal life. "After a 20 year break, I've returned to selling real estate," says Joyce. "It just goes to show that life goes on even after a set back like breast cancer." She also stays busy taking care of her young grandson. A former art teacher, she works on prints and watercolors in her home studio. She stays active by participating in Jazzercise. She and her husband enjoy time in the kitchen cooking and traveling.

Patient Profiles - Suzie













When Suzie had a routine mammogram in September 2007, it revealed a clustering of micro-calcifications in her breast. After a sonogram and wire localization biopsy, she was diagnosed with both invasive and non-invasive breast cancer.

Suzie, now 63, was floored. A retired university economics professor and administrator, as well as a devotee of rigorous daily exercise, she had never been sick or missed a day of school or work. Knowing that she and her husband were about to leave on a month-long trip abroad, her surgeon started Suzie on hormone therapy before she left.

When she returned, Suzie met with her surgeon to plan her next step. The invasive cancer had been removed during the wire localization biopsy. To remove the non-invasive cancer, Suzie and her surgeon decided on a mastectomy and removal of the sentinel lymph nodes. This way, she was able to avoid radiation and its potential side effects.

After the mastectomy, her surgeon told Suzie that she seemed to be a good candidate for the Oncotype DX® test, which could help guide her chemotherapy decision and which could be performed on the original biopsy specimen of her invasive cancer. Suzie researched the test online and was determined to ask her oncologist about it.

When she met her oncologist several days later, Suzie was pleasantly surprised to learn that her oncologist had already ordered the test, after carefully reviewing her file. More good news soon followed: Within a few days, Genomic Health® called Suzie to inform her that her insurance would cover the full cost of the test.

Less than a week later, Suzie received the best news of all. Her oncologist called to tell her that her Recurrence Score® result was an 8, meaning that chemotherapy would likely be of little benefit, so her oncologist recommended against it. "I was elated," Suzie said.

Suzie will be taking hormone therapy for at least 5 years. "I have hot flashes and night sweats from the hormone therapy," Suzie said. "My friends and family laugh when I pull my sweater off in the middle of dinner, but I am able to do everything I did before." In fact, Suzie and her husband spend a good deal of time sailing and take their boat to the Bahamas every other year. She also enjoys scuba diving, walking, running, and cycling.

"The Oncotype DX test was a gift to me," she said. "Oh, I think daily about having cancer, but my test results give me great peace of mind regarding the possibility of recurrence."

Patient Profiles - Cat













Catherine ("Cat"), a registered nurse and pharmaceutical sales representative, found a lump in her breast while taking a shower in April 2006. She contacted her family physician the next day, and had a mammogram and ultrasound. After a core biopsy, her physician told Cat, now 56, that she had breast cancer.

To learn about breast cancer and her treatment options, Cat began doing research online. She found www.breastcancer.org, a very informative Web site, and learned a lot from its chat room and message board. After Cat posted her biopsy results online, a cancer survivor named Pat recommended that she look into the Oncotype DX® test, because she was a candidate for it, and pointed Cat to www.oncotypeDX.com.

Cat mentioned the test to her oncologist, but found her reluctant to order the test. She had ordered it for a few patients, but because all their results fell in the intermediate-risk range, she was unconvinced of the test's value. She also argued that insurance might not pay for the test. Cat still thought that Oncotype DX could be helpful and was willing to pay for it, so her oncologist ordered the test.

Before she received the result, Cat went in for her lumpectomy. Anticipating that Cat would need chemotherapy, the surgeon wanted to put in an implantable port at the same time. But Cat refused, reasoning that she wanted to be sure she would be likely to benefit from chemotherapy before having a port implanted.

When Cat received her Recurrence Score® result, it was a 0, suggesting a low risk of distant recurrence assuming five years of tamoxifen therapy. "I didn't know you could even get a 0!" she said. "I was thrilled!" She and her oncologist agreed that she would not be likely to benefit from chemotherapy. In addition, her insurance company completely covered the cost of the test.

Following her lumpectomy, Cat had radiation treatment. She is on hormonal therapy, and is continuing to do well. In the summer of 2007, she drove from her home state of Florida to North Carolina, to meet and spend a weekend with Pat, who had told her about Oncotype DX. "It was an emotional meeting," Cat said. "Both Pat and her daughter have had breast cancer. She had been through so much herself, but was so helpful to me. We were strangers when we ‘met' online, but we've really bonded over the course of my journey through treatment."

Patient Profiles - Elizabeth













In September 2005, Elizabeth, a jewelry designer and full-time mom, noticed a lump in her breast and thought it was probably a fibroid. When she went for a routine mammogram that month, Elizabeth told the technicians about the lump, but it did not appear on the films. A sonogram showed the lump as a solid mass. Elizabeth immediately underwent a biopsy, which revealed a 1.9-centimeter tumor.

Fortunately, the tumor was lymph node-negative (N-) and estrogen receptor-positive (ER+), which meant it was contained — all positive for Elizabeth's prognosis.

She underwent a lumpectomy, followed by radiation treatment. Her tumor was close to the breastbone, so to be safe, her surgeon removed 23 lymph nodes along with the tumor.

Next, Elizabeth began to search for an oncologist, visiting two oncologists who had come highly recommended. Given her status as pre-menopausal, and the size of her ER+, N- tumor, both of them recommended chemotherapy followed by hormonal therapy — the standard treatment for this type of cancer.

“This was heartbreaking to me, to be hit with this at 40 years old with two young boys. I still wanted a third child,” said Elizabeth, now 42.

Elizabeth's mother had been diagnosed with non-invasive breast cancer at age 64, and was treated with a lumpectomy and radiation. Elizabeth had hoped that her treatment would be similar. After her diagnosis, Elizabeth researched doctors, treatment and support systems to find what would work for her. “It was like a full-time job,” she said.

One morning, Elizabeth's brother called to tell her about Oncotype DX®, which he'd seen on TV. Elizabeth asked her surgeon about the test, and he determined that she was a candidate for the test and ordered it for her. None of the oncologists she had been to had told her about the test. “I found out about it from my brother, an investment manager at Morgan Stanley — not the medical professionals I'd spent so much time seeking out,” she said.

Elizabeth's Recurrence Score® result was 16, indicating that her recurrence risk was in a lower range. Elizabeth made an appointment with an oncologist at a cancer center in New York, to discuss her result. After the previous oncologists' recommendations of chemotherapy and hormone therapy, Elizabeth was surprised to hear her new oncologist say that she didn't think chemotherapy was necessary, and was confident treating her with hormone therapy alone. Elizabeth's Recurrence Score suggested that chemotherapy would provide minimal benefit.

Today, Elizabeth has completed radiation therapy and is continuing hormonal therapy. She is confident in her decision not to undergo chemotherapy, based on her Recurrence Score results. “What a great thing to be differentiated within this class of women with breast cancer,” she said. “Not all cancers are the same, so why treat everyone the same way with something so toxic? It's so remarkable that finally, you can distinguish one person's cancer from another — I'm just so thankful.”

Patient Profiles - Sandy













For Sandy, a 38-year-old preschool teacher and young mother, the thought of breast cancer never crossed her mind; she did not do regular breast self-examinations. However, during Memorial Day weekend in 2006, she made an unexpected and alarming discovery — a lump the size of a small marble in her left breast.

Confirmed by mammography and ultrasound, the abnormality was revealed to be malignant by a needle biopsy procedure. Less than one month after her initial discovery, Sandy underwent a lumpectomy to remove the tumor, as well as removal of 11 lymph nodes, all of which turned out to be negative for cancer.

Sandy then faced the challenging decision of whether or not to have chemotherapy. She knew women with tumors the size of hers — slightly over one centimeter — were on the borderline in terms of being recommended for chemotherapy treatment. Guided by her physician, she turned to the Oncotype DX® test for greater insight about her tumor so that she could make an informed decision about beginning a therapy associated with so many potentially debilitating side effects.

When her Recurrence Score® result came in at 28, at the high end of the intermediate-risk range, Sandy immediately decided to proceed with a two-month course of chemotherapy. Although she experienced bouts of fatigue, she found the side effects to be surprisingly manageable. In fact, with help and support from her husband and two young sons, she continued her job teaching a lively group of four-year-olds. A competitive swimmer in high school, she also kept up an active exercise program, swimming three times a week.

"The additional information provided by Oncotype DX made a difficult decision much easier," said Sandy "It was as if I was standing at a huge fork in the road, and Oncotype DX helped me decide which path to follow. Once I began treatment, there was no second-guessing. I felt as if I had made the best possible decision for me, I was able to concentrate all my energies on getting better."
Patient Profiles - Susan













In 2004, at the age of 59, Susan, a high-school art teacher who had been married for 39 years, with three children and six grandsons, had a routine mammogram revealing an irregularity that turned out to be infiltrating ductal carcinoma.

Following a lumpectomy to remove the tumor and a sentinel lymph node biopsy, Susan underwent a series of tests, including a PET/CT scan to determine if the cancer had spread. She was reassured when all of these tests were negative, but Susan wanted to have more confidence that her cancer was not likely to recur. After hearing about Oncotype DX® from a friend, Susan asked her doctor
about it.

Her physician agreed that she would be an appropriate candidate, since her tumor was lymph node-negative and estrogen receptor-positive, and this information could help them evaluate her subsequent treatment options.

To Susan's and her physician's surprise, her Recurrence Score® result was 31, indicating that she was at a high risk of her breast cancer returning and would be expected to benefit significantly from chemotherapy.

"I looked at the doctor like he had the wrong person," recalled Susan. "I was just cruising along with all of these negative tests and thought I'd be done with it all by the end of the summer."

Based on her high Oncotype DX results and other factors, Susan's physician recommended chemotherapy, which she began immediately.

"Even though I didn't want to do the chemo, I knew it would lessen the chances of cancer recurring. And based on all of the other tests I had after the lumpectomy, my doctor said he wouldn't have recommended otherwise," explained Susan.
Patient Profiles - Laurie
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Laurie, a published non-fiction author and Harvard-trained anthropologist, was no stranger to cancer, having survived Stage IIIB non-Hodgkin's lymphoma in 1977 at the age of 27. Back then, Laurie was treated with radiation and a lengthy course of chemotherapy.

However, that did little to ease the shock when an annual mammogram came back abnormal in November 2005. "In my gut, I knew it was cancer again," Laurie, now 58, said.
A biopsy confirmed her suspicions.

Laurie already had an oncologist she trusted, and he enlisted a surgeon and radiologist. Because Laurie had previously undergone radiation therapy, her medical team was unsure if a lumpectomy was a viable option. Fortunately, the team tracked down medical records from three decades prior, and was able to administer radiation therapy in such a way that Laurie was able to have a lumpectomy rather than a mastectomy. Because her margins were not clear after the first surgery, Laurie underwent two surgeries.

She began hormonal therapy right away, but wanted to avoid chemotherapy because she had previously received it for her lymphoma. "Given my history, going through chemo again would have been terribly risky," Laurie said.

Her oncologist recommended using the Oncotype DX® test to determine the likely benefit Laurie would obtain from chemotherapy. She was relieved when her Recurrence Score® result of 17 indicated that she had a relatively low risk of her breast cancer returning. With the numbers on her side, Laurie, in close consultation with her oncologist, opted to forgo chemotherapy. "There are so few resources that can give you that degree of guidance, direction and information to make your treatment decisions," Laurie said. "I felt like science was really taking care of me."

Laurie has completed radiation therapy and is in a five-year course of hormonal therapy. She has been cancer-free for two years. An avid hiker, long-distance swimmer and tai-chi practitioner, she remains very physically active.
Patient Profiles - Diane













A commercial airline pilot with 27 years of experience, 50-year-old Diane is no stranger to making difficult decisions. Yet in December 2005, when she discovered a small lump in her left breast during a self-examination, she found herself on a critical quest for assistance and answers.

An inconclusive mammogram led to an ultrasound, which revealed small areas of concern. A tissue biopsy confirmed her worst fears. Rather than one sizable tumor, Diane's cancer took the form of many tiny tumors scattered within a 2½-inch area of her breast. She was immediately treated with a mastectomy and breast reconstruction in mid-January 2006.

More tough questions followed. Although the tumors themselves were very small, the affected site was quite large, so Diane's physician could not confidently rule out the need for chemotherapy based on standard measures such as tumor size and grade. Diane worried about her future health and job security. "Because I am petite, there was concern that I would be less able to withstand the serious side effects of chemotherapy," said Diane. "In addition, airlines vigilantly monitor the health of their pilots, and a diagnosis of cancer can mean a permanent suspension from flying."

In his search for information, Diane's physician turned to Oncotype DX® for a genomic analysis of her disease. About a week later, Diane learned that her Recurrence Score® result was 13, suggesting that she has a lower risk of recurrence. In discussions with her physician, she felt more confident that she could avoid chemotherapy and its side effects without increasing the likelihood of recurrence, and was able to continue her career and active lifestyle. Also, she was able to keep her long hair, which she'd spent 23 years growing.

"Thirteen is my lucky number now," Diane stated.












In June 2004, at the age of 55, Penny had a mammogram that raised some questions about her right breast. Additional mammograms, including some with magnification, were inconclusive, so Penny went on with her life, enjoying retirement after working as an information systems analyst.

Then in December, during her annual gynecological exam, Penny's doctor found a lump in her right breast. A subsequent mammogram, ultrasound and biopsy confirmed that Penny had breast cancer.

"When I got the call from the surgeon, my husband and I both lost it," Penny said. "I thought I was dying. I felt like I had no control."

In March 2005, Penny underwent a double mastectomy. The surgery revealed that she had lobular breast carcinoma, which fortunately had not spread to her lymph nodes.

Penny had more treatment decisions to make, but struggled to understand exactly what type of breast cancer she had. Fortunately, a friend from Penny's Bible study group worked for Genomic Health®. He explained that, because her tumor was classified as lymph-node negative and estrogen-receptor positive, she could use a test called Oncotype DX® to determine the likelihood that her cancer would return.

Penny's doctor ordered the test. Her Recurrence Score® result was a 13, indicating that there was a low risk that her breast cancer would return. Penny and her doctor decided that she did not need chemotherapy, and opted for radiation and hormonal therapy instead. Penny credits the test with putting her back in control of her disease and her life.

Today, Penny is cancer free and busier than ever, growing and selling produce at her local farmers' market, making wine with her husband, and looking after more than 70 animals that live on their land.

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