Medical oncology is one of the three main treatment modalities for cancer. The doctors in this specialty evaluate the patient’s type of breast cancer and determine the most effective treatment, which may include oral medication, chemotherapy and/or immunotherapy.
Chemotherapy
Chemotherapy is medicine given either by mouth, an injection, or by an intravenous (IV) line (into a vein). It is designed to destroy cancer cells in the body. Many patients with certain types of breast cancer receive chemotherapy before surgery (neoadjuvant therapy). When patients have appointments for chemotherapy that is given intravenously, they go to Level 6 in the Outpatient Cancer Center. There are both semi-private and private treatment bays, as well as a larger open area with a beautiful fireplace as its central feature.
When Chemotherapy May Not be Needed After Surgery
Does every patient treated for breast cancer receive chemotherapy? Not necessarily. Some patients who meet specfic criteria do not have to have chemotherapy after breast cancer surgery.
Gene expression testing can be used to determine if having chemotherapy is the right course of treatment. These tests look at a set of 21 genes in breast cancer cells after surgery or biopsy to determine the patterns, a process sometimes referred to as gene expression profiling. The goal is to get a “recurrence score,” also known as a 21-gene recurrence-score assay. This is a number between 0 and 100. The score reflects the risk of breast cancer coming back in the next 10 years after initial treatment and how likely a patient is to benefit from getting chemotherapy after surgery.
- A low score (0-25) means a low risk of recurrence. For most women with low-recurrence scores, chemotherapy isn’t needed. They generally have good outcomes when treated with hormone therapy.
- A high score (26-100) means a higher risk of recurrence. Women with high-recurrence scores are more likely to benefit from a combination of chemotherapy and hormone therapy to help lower the chance the cancer will come back.
For women age 50 or younger who have a low recurrence score of 16-25, there might be a small to moderate benefit from the addition of chemotherapy.
There are currently a few gene expression tests that look at different sets of breast cancer genes. More tests continue to be studied in large clinical trials to better understand how and when to use them. The type of test used depends on a patient’s situation. They are usually used for early stage cancers and testing isn’t needed in all cases. For example, if breast cancer is advanced, it might be clear that chemotherapy is needed, even without gene expression testing. In addition, these tests can’t predict with certainty that a woman’s cancer will come back with or without chemotherapy. Patients can ask their doctor if these tests might be useful for them.
Immunotherapy
The body’s immune system is responsible for fighting off infection. Immunotherapy is a form of medical treatment that activates the immune system to help fight cancer. The treatments come from a variety of living cells, which can be yeast, bacteria, plant or animal cells. They are large proteins that are injected into patients either to provide proteins they no longer have, or to help treat specific diseases. These agents are always injected, because the human digestive tract would destroy them if taken by mouth.
At Stony Brook Cancer Center, medical oncologists are on a multidisciplinary team with their breast cancer physician and healthcare colleagues. The team includes surgeons, radiation oncologists, radiologists, pathologists, oncology certified nurse practitioners and nurses, and additional healthcare professionals. The team meets regularly to discuss and collaborate on each patient’s treatment.
For more information or to schedule an appointment, call (631) SB-CANCER (722-2623).