Breast Cancer Index Test
Hello ladies, has anyone taken the Breast Cancer Index test to determine their risk of reoccurrence for the purpose of knowing how long they should be on Letrazole? Medical Oncologist for my cousin suggesting that she take the test but suggests waiting 5 years... My question, why wait 5 years?. Also is this test a relatively new test? thank you.
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dventi - Here is a link to information on the Breast Cancer Index test.
https://www.breastcancer.org/screening-testing/bre...
I hope this helps.
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Hi dventi,
Wait 5 years counting from when? Confused by your signature. So you have been taking letrozole 10 years, and they are suggesting that you take it for 5 more and then take the BCI test?
My understanding is that if you just start taking an AI today, you should be taking it for the next 5 years. Then they would reassess. Right now, there is the belief that some patients can benefit from taking the AI beyond 5 years. But if you are not there yet, there is no point on doing that assessment yet, because it´s not going to change the plan for the next 5 years, so why bother. In 5 years, this may all have change, so better wait till then.
LaughingGull
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I am sorry if I confused you.. I edited my post...The question was on behalf of my cousin.. who just started with AI.
Thank you for responding!
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Thank you for the information! Do you know if this is a relatively new test? PS I edited my post since I am doing research for my cousin... not me
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This test seems to have been in use for about 10 years. Medicare covers it so it has been around long enough to have shown its value in deciding whether to continue hormone therapy after five years.
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Thank you!
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Do you know if BCI is the latest and greatest test out there to determine risk of reocurrence? My cousin's MO stated it was a new test... maybe 10 years is new to them?
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There are many different calculators regarding recurrence. If you read the link maggie15 posted, you will understand that BCI is not just about recurrence.
It predicts whether there is any benefit in extending hormonal therapy past five years, with the answer given as a simple yes or no. In addition, it gives an estimate of distant recurrence from years 5-10 which may, or may not, be close to the numbers determined by other calculators. Yes, it is fairly new - I'm not certain it was available, or validated, when you hit the five hear mark on letrozole. And, yes, research is showing it to be a solid test as to whether there is a benefit in continuing hormonal therapy. As laughinggull said, there is absolutely no reason to run the test until your cousin is nearing the five year mark on hormonal therapy. All current guidance says that five years is the minimum. Your cousin's doctor is giving them good information.
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After my 5th year on AI I took the BCI test and had a YES result. As noted above the test will only give YES/NO result instead of a low/med/high result as in prior years. So, I continued another 2 years of AI with the intention of a full continuing for a total of 5 years. Now that I am out at 7 years total on AI my MO ordered a followup DEXA to look at bone density as the bones may decline with continued AI use. Sure enough my spine had a concerning decline in density so the continuation of AI was questionable. At my 7 year checkup my MO and I agreed to continue for an extra year with the understanding that my endocrinologist may recommend taking a bone med during to protect against any further bone loss. I am feeling good about this decision.
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I’ll be switching to anastrozole after 5 years of tamoxifen. I’ve been offered the Breast Cancer Index test, but have decided just to go ahead with the new medication. It sounds like there is a chance the results could come back telling me that I am indeed high risk and that hormone therapy won’t help, and if that’s the case, my anxiety will go through the roof. I’d rather just continue taking medication and assume it’s helping me. That may change, though, depending on how hard the side effects hit me.
There is one thing I haven’t been able to figure out about the BCI, though. From what I understand, they run tests on the original tumor to determine the likelihood of late recurrence (both local and distant?) and if that risk is low, you can stop taking the medication. But what about new primary tumors in the same or opposite breast? Isn’t it possible to get a “good” score for BCI, stop taking the meds, and then get a second, possibly more aggressive breast cancer that maybe could have been prevented with more hormone treatment? How is this figured into the recommendations?
Also, my CTS5 score is low-risk - does this also mean my BCI score would be low?
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purplecat,
That was the result I got — high risk of recurrence, no additional help from hormonal therapy. My MO said that I could quit after 8 years even with the nutty BCI result. My high risk of recurrence was largely due to me being HER2+. I don't know how all that is figured into the recommendations.
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Hi elainetherese I remember you form the +++ thread. I just completed 5y of anastrozole (got oophorectomy since I was premenopausal at diagnosis) and was offered the BCI test, which will take me time to organize as I will have to request the transfer of my slides, since I changed hospital after chemo. I have the same thoughts of what if it tells me high risk and no benefit?
Yesterday I saw my MO and I asked to change AI from Anastrozole to Exemestane to see if that alleviates my knee discomfort. And I will see her again in 3m, during which I will have to make this decision of taking the test or not. Inclined to do it.
You must be about to finish the 8y right? I would be excited and panicked.
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I had the BCI at year 4. We gave it a shot because I struggle so badly with tamoxifen. My MO’s thought was if it came back with no benefit I could consider stopping sooner. My results were high risk of distant recurrence and a benefit of extended hormone therapy. For what it’s worth my cts5 was high risk as well. It refers to distant recurrence on my report and does not mention local. What really got me was the 0-10 year cumulative risk of distant recurrence if done at time of diagnosis, mine was 42.3%. My MO was surprised by that and the risk percentage with 5 years of hormone therapy is 15%. So I still don’t fully understand the significance of the cumulative score but it gave me anxiety for sure.
These decisions we have to make throughout treatment can get heavy. I am still struggling with the decision to continue hormone therapy, especially now Knowing these results. I would say weigh if it is going to change your treatment path with the results. I am coming from a place that I would have been oddly relieved even if it was high risk but no benefit of extending therapy. As backwards as that sounds my QOL has suffered tremendously on tamoxifen and kinda was wanting the decision to be made for me. All the best to you.
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Laughinggull,
I finished the eight years in February. I don't miss the monthly Zoladex shots, that's for sure. I haven't really noticed many changes, but I never really got much in the way of SEs from Aromasin.
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Thank you Dani444. I was diagnosed at 47. Would you consider switching to ovarian suppresion + AI? Sorry to hear you are struggling so much with Tamoxifen. That sucks.
@elainetherese, thanks for responding -I find in encouraging that you didn't have too much in terms of SE with Exemestane.
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Laughinggull, I sure hope you have a better experience with Exemestane. I'm something of an outlier when it comes to SEs, though. So very different than my neighbor, who had metastatic BC and got every SE associated with her meds/treatments (RIP). I feel sort-of guilty for tolerating meds well.
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I tolerate meds well, too, but my knees and ankles are bothering me more and more.
Sorry for your neighbor. With metastatic disease she was probably getting higher doses of every med. This disease sucks when it becomes metastatic.
Have a great Sunday, everyone.
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Thanks, laughingull, Elaine, and Dani. Dani, I remember you from the December 2018 radiation thread - sorry to hear tamoxifen has been such a miserable experience, and even more about the recurrence risk. I have trouble comparing all these scores too, but a reduction from 43 to 15 percent does sound promising. I also found one recent study where they’d compared results for women who stayed on therapy for an additional 2-3 years vs. an additional 5, and found that there was no added benefit for those last couple of years. So, it may be just 2 more years instead of 5, which feels less overwhelming. I hope you and your team can find a solution that will keep you disease free and feeling well for many many many more years!
There’s survival, and then there’s disease-free survival. There’s local, regional, and distant recurrence. There’s recurrence, and then there’s new primary. Contralateral vs. ipsilateral. No wonder the statistics and studies can be so confusing.
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