Precision medicine grabs a lot of headlines these days – new tests, new diseases, and new ways of personalizing treatment to individual patients. But with therapies and technologies advancing daily, sometimes it’s hard to see the wood for the trees. The University of Michigan School of Nursing’s Christopher Friese asked a simple question often overlooked: “Is precision medicine actually helping?”
Fortunately for the 1,527 patients he surveyed – and countless more who receive genetic and genomic testing to help guide treatment decisions – the answer seems to be yes (1). Friese asked women diagnosed with early-stage breast cancer two questions: whether or not they had received the 21-gene recurrence score assay, which assesses a patient’s likelihood of relapse; and whether or not they had received chemotherapy. Current guidelines recommend the test for certain patients (those with particular tumor features and no spread of disease to the lymph nodes). A high score on the test indicates a need for chemotherapy. Ultimately, Friese and his colleagues found that most doctors’ testing recommendations were in line with the guidelines, and that the assay correlated well with treatment decisions. 87 percent of women with a high recurrence score (RS) received chemotherapy, whereas only 3 percent of those with a low RS did. Notably, 13 percent of women with no RS but a favorable prognosis were given chemotherapy – meaning that the assay may substantially reduce overtreatment. Although it seems doctors are using precision medicine well and satisfying patients (with most agreeing that the test was helpful and that they were happy with their treatment), Friese did note one area for improvement. Only 60 percent of patients accurately recalled their test results – which Friese believes could be remedied if both the assay and the outcome were better explained. Personalized treatment may be complicated, but it’s one more opportunity for pathologists to speak up and explain to patients the science behind their care.
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References
- CR Friese et al., “Chemotherapy decisions and patient experience with the recurrence score assay for early-stage breast cancer”, Cancer, [Epub ahead of print] (2016). PMID: 27775837.
