Systemic Therapy

Michigan Photography, Roger Hart

CanSORT Investigator Chris Friese, PhD, RN

Systemic management of early-stage breast cancer includes treatments and evaluative tests to address and/or minimize the risk of cancer spread throughout the body.

Systemic treatments for breast cancer can include chemotherapy and hormonal (endocrine) therapy. The effectiveness of chemotherapy depends in part on the clinical features of the cancer tumor. Some women with early-stage breast cancer have a choice about whether or not to receive chemotherapy. Individualized care is achieved when chemotherapy and endocrine therapy decisions are appropriate for the patient (based on the clinical characteristics of the patient and the cancer itself) and the patient experiences high decision quality – meaning that she is informed, satisfied with the decision process, and her personal preferences are incorporated into treatment decisions.

Evaluative tests can sometimes be used to determine the estimated benefit of chemotherapy and the likelihood of cancer recurrence. Examples of these tests include the Oncotype DX® 21-gene assay and Mammaprint® 70-gene assay. Every breast cancer patient is different – systemic evaluative tests are not appropriate or necessary for all patients. Individualized care is achieved when the right evaluative tests are ordered for the patient.

Our project “Individualization of Systemic Therapy in Patients with Estrogen Receptor-Positive Breast Cancer” examines the individualization of evaluative tests and treatments for breast cancer via surveys to both patients and their doctors. Through our partnership with the SEER registries, a random sample of nearly 3,500 eligible women with estrogen receptor-positive breast cancer in Los Angeles County, CA and in the state of Georgia is being surveyed for the study. This project also includes collaboration with the industry developer of the leading genomic expression profiling test who administers the test to women in the areas we survey. Our program will acquire results of these tests to help evaluate the appropriateness of the care that the women receive and determine the role of these tests in treatment decision making and satisfaction with the treatment decision making process. Test results will also be used to validate the accuracy of clinical data collected on cancer cases via our partnering cancer registries.