Breast Cancer Index
Dear BC sisters,
If you’ve taken the Breast Cancer Index test I have a few questions. My MO is ordering the test to help me decide if I should extend my Armidex hormone therapy two more years for a total of seven years. I don’t think I could do another five. I also read the SALSA report which indicated there was no significant difference between extending therapy 7 vs 10 years.
Here’s my questions:
1. Does extended therapy affect the prognostic score by lowering distant recurrence?
2. Is the prognostic score still being reported as a percentage or is it reported as a high or low risk? I read on one of the threads that this reporting score was changed.
3. Does the predictive score determine how many years of extended therapy is recommended or does it simply state a yes or no.
I’m trying not to be stressed by yet another test and it’s results. Thank you in advance.
Blessings and love. 
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Does anyone have any information or experience ofinterpreting the results of the BCI?
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Hi Butterfly -
Just got my report. Re prognostic, it just says report is risk after five years of therapy. Unlike Oncotype score, it does not give an expected benefit of extending therapy or break down into number of years. It gives a simple yes or no for expected benefit.
Risk of distant recurrence is listed as a percentage.
As for how risk is stratified:
For N0 patients, BCI classifies risk of late distant recurrence (5-10y) as low vs high based on a BCI
Score cutoff of 5.1, corresponding to a 4.9% risk, as shown on the continuous
risk curve to the right. For N0 patients, BCI classifies cumulative risk of distant
recurrence (0-10y) as low, intermediate, or high using the following cutoffs:
BCI Score 5.1 (8.9% risk), BCI Score 6.5 (13.9% risk).Hope this helps with the stress!
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I did the BCI test 5 years ago, a genomic test done with tissue taken from my original tumor. The report has two parts, the prognostic - which is distant recurrence risk, and predictive - which is the likelihood of benefit from extended endocrine therapy, after taking endocrine therapy for the previous five years. The prognostic part of the report gives you a score from 0-10 - below 5 low, above 5 high. The predictive result is a high/yes, or a low/no.
Here is a link to what the report looks like, it is two pages so click at the bottom of the first part to see the second page of the report.
https://www.breastcancerindex.com/explore-the-report-patients
I pulled out my report to see if it looked the same as the sample report currently shown on the Biotheranostics site, and it is basically the same. It showed my score of 7.9 (out of 10) on the prognostic aspect - which constitutes a high result, and the low result on the predictive aspect, which is not a score but a simple low or high designation.
So, you can have a high/high result - which would be high risk of recurrence and high benefit of continuing anti-hormonals, a low/low - or low risk of recurrence and low benefit, a low/high - a low risk of recurrence with high benefit, or a high/low/ - the unfortunate combination of high risk of recurrence with low benefit of continuing anti-hormonals. The last one was my personal result - happens in about 10% of those tested, and the high risk of recurrence was not particularly surprising - I was node positive with a 2.6cm tumor. This result prompted my oncologist to ask me to continue letrozole, which I did, and took it for a total of 7.5 years. There is some question whether low benefit means no benefit, and I have read conflicting info. My oncologist indicated it is too soon to determine that with this test, so since I was tolerating letrozole decently I did continue. My BCI test result prompted me to ask for a PET scan status check based on the potential for low benefit all along the previous 5 years I had been taking anti-hormonals. In the interests of full disclosure, there is also question as to whether this test provides as accurate information for those who with Her2+ tumors, which mine was. My MO felt it was still worthwhile, but being Her2+ may have skewed the prognostic part of my result. I don't know that the predictive part would be affected.
Specific to your questions - the scoring is not influenced by continuing anti-hormonals, the prognostic score is numerical but the graph shows percentage based on that number, the predictive score is just a yes or no. As with OncotypeDx, this information should be used by your oncologist in concert with your clinical data, which is specific to you. The test is a tool, but not an absolute.
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Thank you RatherBeSailing and SpecialK for your informative replies. I really appreciate you sharing your test results SpecialK. I know so much of our journey is trying to determine the best course of action in our self-care.
One question I have is quantitatively how extending hormone therapy affect the Prognostic score of distant recurrence if the tests result show a “yes" benefit.
I'm waiting for a call back from a supervisor at Biotheranostics. But, haven't heard from them yet.
Thank you again. Blessings.
Butterfly
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butterfly - happy to help! Please share what the folks at Biotheranostics say about this as I think it will be helpful to anyone who comes along to read. In my comment above I mentioned that I had read from another member that low benefit really is no benefit on the predictive part - that was from a conversation had with someone at Biotheranostics. I am glad that the company is responsive to patient questions - at least I hope you get the call back! I only spoke to them regarding billing, for which they were very helpful. Ultimately, I elected to continue with letrozole since I was not having any issues - I will obviously never know if it provided benefit or not, but I felt better doing so. My decision was in large part because my MO, who I trust completely, asked me to. In the meantime, here is some linked info about the studies used for BCI which shows some criteria to recommend extending if you get a high benefit or yes answer on the predictive:
https://www.breastcancerindex.com/predictive-power-of-bci
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Thank you SpecIalK this is extremely helpful. I'll keep trying to get in contact with a rep.from Biotheranostics if I don't hear back in a few days. When and if I do, I'll be happy to share any helpful information with you and others
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I have never heard of this? Is this come kind of test they do at the time of diagnosis?
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Butterfly -
The BCI test looks at two factors - sensitivity to estrogen (this the "yes" or "no" as to benefit of extending therapy) and the Molecular Grade Index, which looks at proliferation and will give you your score, presented as a percentage of the likelihood of distant recurrence in years 5-10. They divide the latter statistic into low, intermediate and high risk groups depending on that recurrence risk.
The first link SpecialK sent you lists studies that look at BCI and the expected benefit if you are a "yes" on extended therapy. But the benefit depends on your risk group as determined by BCI, and also a bunch of other factors like number of involved nodes, tumor size, age, treatment, etc.
So it is incredibly complicated, and I don't think you'll have the information needed to assess the benefit for yourself until you get the results back. Also, as my oncologist pointed out, new studies are coming out all the time that may show different results and affect decision making.
Best of luck to you, and do keep us posted!
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HomeMom -
Breast Cancer Index (BCI) is performed after five year of hormonal therapy to determine whether extending therapy for another 2-5 years is beneficial. It turns out it may not really some help ER+ women to continue.
The test uses tissue from your original biopsy or surgery. It is expensive, but most insurers will now cover it.
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Will keep you posted.
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Ratherbesailing thank you for the answer. I'm staying on the AI for 3 more years anyway.
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Just ordered the Breast Cancer Index Test for $995. Could have gone through insurance, where Biotheranostics would have charged my insurance $5,000 and where I might have been liable for $2,000 of the bill (haven't met my deductible yet). Also, if I were poor, I could have qualified for more assistance. However, DH and I make too much money to qualify for help. So, I just decided to pay the $995 out of pocket.
After seven years, I'm getting a little tired of the monthly Zoladex shots, plus I've found it very difficult to lose weight on Zoladex + Aromasin. I'm hoping I can stop hormonal therapy soon, but who knows.
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When I did mine the rep from the company said they would waive what the insurance did not pay and I did not have to pay out of pocket at all for mine even though I had deductible to meet. I did end up with 10 years on hormonal meds but they ended up switching mine from tamox to letrozole after the test. Best wishes.
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Can someone explain the prognostic score of the Breast Cancer Index? I understand it’s on a scale of 0-10 with 5 or less a low risk and 5 above a high risk. But what does the percentage score actually mean? Also, the test is done on the original tumor material without taking into account radiation and/or chemotherapy. So is this a factor for figuring out your actual distant recurrence score?
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butterfly - here is some information that may help your understanding about the prognostic assessment of the BCI test. This is a comparison against Adjuvent Online, but does dissect how the prognostic aspect of the BCI test works.
https://breast-cancer-research.biomedcentral.com/articles/10.1186/bcr3038
While BCI testing is done on original tumor material, it is a genomic test just like OncotypeDx. The test is looking at genetic expression profiles to help inform cancer behavior as it relates to recurrence and medication benefit in ER+ patients who have already been treated with standards of care. Oncotype calculates chemotherapy benefit on original tumor material as well, and assumes the patient will have surgery (and rads if needed) and take anti-hormonal therapy, but hasn't done so yet. When these scoring systems were developed for these genomic tests, and other like them, they used studies with a variety of treatment combinations. Much like the algorithms used in the calculators Cancermath and Predict, the formulas are calculated using a spectrum of patient treatment.
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Thank you Special K. I appreciate the information.
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This thread and the responses are very helpful. My MO is ordering BCI for me, but I am a little confused as to whether it will provide actionable information. From what I *think* I understand, they don't have great data on a few categories that I belong to, specifically:
TAM only for 5 years (no AI); no chemo; diagnosed at <50.
I would appreciate if any of you who have dug in to the research and have a better understanding than I do, would weigh in on whether I am off base or not.
Like the OP, if the predictive score isn't going to be helpful, I'm not sure I want the stress of potentially receiving a high recurrence prognostic score.
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sg751,
There are four possible test results for the Breast Cancer Index and two scores: prognostic and predictive. The predictive score is either a yes or no if there is a benefit from extending endocrine therapy. The prognostic score is a percentage score that indicates a risk of distant recurrence. The raw score is converted into a scale of 1-10. A score lower than 5 is low risk and above 5 is high risk. So there are 4 possible results: 1. No benefit /Low risk 2. Yes benefit/lLow risk 3. Yes benefit/High risk 4.No benefit/High risk.
About 3 -5 of estrogen+ BC patients may not benefit in extending therapy. However in my case, even with my stats, my results came back Yes benefit/High risk. My MO was going to take me off Arimidex after completing 5 years. Now, I’ll be extending my therapy. My understanding is extending therapy will lower the prognostic score.
Now, let me caution you that consultation with your MO is very important. Testing is a personal choice and everyone’s medical situation is different with many variables.
I’m not sorry I took the test but I didn’t do my research ahead of time. I didn’t know about the prognostic score and my MO didn’t tell me. In fact, his PA called me with the results. I’ll be discussing my results with my MO at my next appointment.
I hope this clarifies things a bit for you and doesn’t muddy the waters. Sending peace and love.
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Hi all! We wanted to pop in here with some info from Breastcancer.org on Breast Cancer Index test.
We hope this helps!
--The Mods
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