Chemotherapy
Is Not Always the Answer: Facts for Early-Stage Breast Cancer Patiens
In everyday clinical practice, doctors consider various clinical factors to determine whether a patient with early-stage breast cancer needs chemotherapy after surgery. Some indicators of low recurrence risk include: small tumor size, favorable histological results (low grade), positive estrogen/progesterone receptor (ER/PR) status, negative HER2 status, and no lymph node involvement. When these criteria are met, patients are generally classified as low risk and may be treated with hormonal therapy alone.
However, in certain cases, clinical results can be inconclusive. For instance, a tumor may be large and high grade, yet ER/PR positive, HER2 negative, and without lymph node spread. In such situations, deciding whether to add chemotherapy becomes more challenging due to the unclear level of risk.
To aid in decision-making, additional tools are needed to strengthen clinical judgment—especially in determining whether a patient requires hormonal therapy alone or a combination with chemotherapy. The ultimate goal is to provide treatment that is truly appropriate, avoiding both under-treatment, which increases recurrence risk, and over-treatment, which may lead to unnecessary physical, psychological, and financial burdens.
To support this process, some physicians use clinical data-based tools like Adjuvant! Online and PREDICT Plus. These applications process patient clinical and pathological data to estimate recurrence risk and recommend suitable treatments. However, such tools do not yet account for the molecular characteristics of tumors, and some input parameters—like ER/PR status and grading—can be subject to interpretation variability.
As science advances, we now understand that cancer is a highly personalized genetic disease. This has given rise to genomic approaches—tests that analyze gene expression in cancer cells to predict how the disease will progress. One such scientifically validated and widely used test is MammaPrint.
What Is MammaPrint?
MammaPrint is a genomic test that analyzes the expression of 70 critical genes in breast cancer tissue to predict the risk of recurrence. The results divide patients into two broad categories: Low Risk and High Risk.
The test has been approved by the U.S. FDA and is included in international breast cancer treatment guidelines. The process takes about 2–3 weeks, as the sample must be sent to Agendia’s central laboratory in Amsterdam. The cost of the test is approximately IDR 40 million (around USD 2,500+).
When Should You Consider a MammaPrint Test?
Genomic tests like MammaPrint are particularly beneficial for patients with:
Stage I or II breast cancer
ER-positive, HER2-negative status
No or limited (1–3 nodes) lymph node involvement
This test is valuable when clinical results alone are not sufficient to determine whether chemotherapy is necessary. It also provides added reassurance for patients who wish to make informed treatment decisions based on solid scientific evidence.
While the cost may still be a barrier, MammaPrint can be a valuable option when conventional clinical data are inconclusive or when patients seek additional confirmation before making therapy decisions.
Other genomic tests available globally include Oncotype DX, EndoPredict, and PAM50. Among these, MammaPrint and Oncotype DX dominate the global market due to their strong scientific validation. However, MammaPrint is currently the only one available in Indonesia. For more information, visit the Indonesia Cancer Care Community’s website.
The Right Step Begins with Early Detection
As part of its commitment to supporting more effective cancer detection and care, KALGen Innolab offers comprehensive breast cancer screening services using advanced technology. These examinations are designed to detect cellular changes early, enabling quicker and more targeted medical interventions.
Don’t delay your screening.
Schedule regular check-ups and consult with our specialists at KALGen Innolab—because early detection can make all the difference in your recovery journey.
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