Imagine it’s early 2004, and you’ve just been diagnosed with breast cancer: It’s a common type — HR+, HER2-negative — and is early-stage. You’ve known women who've had breast cancer — maybe it runs in your family, or maybe your friend battled the disease. Either way, you're certain what this diagnosis means: chemotherapy. You worry about the grueling side effects: hair loss, nausea, and the fatigue and discomfort that seem so often to go hand-in-hand with chemotherapy.
But just as you begin to wrap your head around how chemotherapy is going to alter your life, your doctor tells you about a new tool that might change your treatment plan. By analyzing the genes in your tumor, this test will give you something known as a Recurrence Score® result, which provides information on the likelihood that your cancer will return in another part of the body and predicts whether you may or may not benefit from chemotherapy. The lower the Recurrence Score result, the lower the likelihood of your cancer coming back if you take endocrine therapy alone; the higher the Recurrence Score result, the higher the likelihood of your cancer returning. As your Recurrence Score result increases, so does the benefit of chemotherapy.
You wait expectantly for your results and are relieved when you receive a Recurrence Score result below 25. Based on this number and other relevant health information, your doctor explains that you may not benefit from chemotherapy. Together, you create a treatment plan that’s right for you.
Since its introduction over 20 years ago, more than 2 million patients have used the Oncotype DX Breast Recurrence Score® test to help with treatment decision-making. Of those 2 million, approximately 1.6 million may have been able to safely forgo chemotherapy.* The test has become a standard-of-care for guiding treatment in HR+, HER2- early-stage breast cancer, restoring a sense of agency to patients at a time when they might otherwise feel powerless.
Black women who have the highest mortality from breast cancer also benefit from the Oncotype DX Breast Recurrence Score test. Across studies, the Oncotype DX Breast Recurrence Score assay has been shown to be both prognostic and predictive of chemotherapy benefit regardless of race or ethnicity. In a country where people of color are vastly underrepresented in clinical trials, having a test that works for all is one small step in reducing healthcare disparities.
In 2011, at age 40, Sabrina Mayhew became one of the roughly one in eight women to develop breast cancer in their lifetime. As a nurse, Mayhew is more aware than most of the impact chemotherapy can have on a person’s life, and as a non-Hispanic Black woman, she knew she was nearly 40 percent more likely to die from the disease than a non-Hispanic white woman.** “The first oncologist I went to told me that because I was African-American, I would need to get aggressive chemotherapy,” she remembers. She got a second opinion, and that doctor recommended chemotherapy as well, but a different regimen.
After surgery, Mayhew began to plan for what felt like the inevitable. “The first thing I did was go out and buy myself a nice wig,” she says. But because the doctors were recommending different treatment plans, she wanted to get a third opinion. That’s when she met with a University of Michigan oncologist, who was the first to offer her the Oncotype DX® test. She agreed to the test and was told she would receive her score in around two weeks.
“During that time, the first oncologist I’d seen told me that I was losing precious time, and that I needed to start chemotherapy right away,” Mayhew says. “But I felt like I should wait until I got that score back. And when I finally did, it indicated that I would likely not benefit from chemotherapy.” Based on her Recurrence Score result, Mayhew and her oncologist decided she would forego chemotherapy, and instead she had radiation treatment and then endocrine therapy for five years. Nearly 15 years later, Mayhew is still cancer-free.
Jennifer Racz, MD, MBA, FRCSC, and director of Medical Affairs for Oncology at Abbott, says Mayhew’s experience illustrates exactly why the Oncotype DX test is such a critical tool, particularly for women in the highest risk groups. “We know that certain racial and ethnic minority groups are at a higher risk of being diagnosed with breast cancer at later stages and often with more aggressive subtypes of breast cancer,” she says. Naturally, this might lead someone to think that these women should receive the most aggressive treatment available, which would include chemotherapy.
But the Oncotype DX test has proven that this approach isn’t actually necessary or helpful and may lead to overtreatment of many patients, explains Dr. Racz. “Many patients want the most aggressive treatment possible. Without insights from the Oncotype DX Breast Recurrence Score test, they may receive treatment with no known benefit, often leading to potentially unnecessary adverse effects and financial toxicity. Ultimately, we only want to provide chemotherapy to those patients that we know will benefit from it.”
Instead of defaulting to a one-size-fits-all approach, tools like the Oncotype DX Breast Recurrence Score test allow treatment to be tailored to the individual — grounded not in fear or assumptions, but in evidence. For Mayhew, that meant avoiding chemotherapy without compromising her outcome; for millions of others, it’s meant having a clearer path forward at a moment that can feel overwhelmingly uncertain. And while no test can remove the weight of a cancer diagnosis, having access to information that enables more deliberate, personalized decisions is a significant step toward more equitable, patient-centered care.
*This estimate was calculated using the total global lifetime volume of patients that had an Absolute Chemotherapy Benefit result of <1% using the Oncotype DX Breast Recurrence Score test, as this value is defined for each nodal and menopausal (or assumed by age) status.
**Statistic compares breast cancer mortality rates for non-Hispanic Black women and non-Hispanic white women.
Sabrina Mayhew is a patient story ambassador for Abbott.
This story reflects one individual's experience. Not every person will have the same treatment, experience, outcome, or result. The Oncotype DX Breast Recurrence Score® test is ordered by your health care provider. Talk to your health care provider about whether the Oncotype DX Breast Recurrence Score test may be right for you. To learn more, visit exactsciences.com.
