getting pushback from oncologist re. genomic testing

When people write genomic testing, I thought they meant oncotype. But is that not what you mean?

Are you talking about tests like Guardant 360 and Foundation One?

mtspacekace - just wanted to expand on genetic versus genomic, breast cancer diagnosis and testing has a steep learning curve! Genetic testing determines whether things in your genetic makeup (mutations) cause an increased risk for cancer, and which kinds. Genomic testing is done on the tumor material itself after a diagnosis to determine whether, and which, treatments are likely to be beneficial or effective. There are different kinds of genomic testing that are available depending on the hormonal and Her2 status, and/or stage. You may have seen reference to the genomic testing OncotypeDx, which is for early stage ER+/Her2- patients to help determine whether chemo may be beneficial. The genomic test Mammaprint has a more broad application and is less restrictive on the hormonal and Her2 status, and it is also used to determine the benefit of chemo by assessing aggressiveness of the tumor fir early stagers. Genomic tests like Guardant, Caris, and Foundation One are used for advanced stage patients who are trying to determine which chemo/meds will be effective for them. Advanced stage patients are likely to have tried a number of treatments already and require more specific information about effectiveness to make an informed decision about further treatment. Genetic testing is often done at diagnosis, and usually prior to surgery, because it helps determine risk and may inform your surgeon to make a specific type of surgical recommendation, as well as recommend additional screening or treatment options, or referrals to additional specialty physicians. An example would be bi-lateral mastectomy rather than lumpectomy, and removal of ovaries if one is found to be BRCA positive. These surgeries would minimize future risk based on genetic information. Another example might be mutations that may increase colon cancer risk and prompt referral to a gastroenterologist and initiate colonoscopy earlier than the standard.

thank you specialk! There is so much to learn.

SpecialK - thank you for the explanation. I will post my Qs/fears on a few forums because I'm not sure where to post. My oncologist is out all week, but I want to be ready with good questions. Has anyone else done a genetic panel like this, checking for over 600 markers? Was it helpful? She wants me to do a genetic profile of of over 600 markers to help determine the next step. Insurance is unlikely to pay, they already denied one 1 1\2 years ago specific to BC (over 20 markers looked for,nothing found), saying it was not relevant to diagnosis or treatment. The Lab says they will work with me/ my insurance if denied, and the maximum if denied would be $500. If the results would truly be helpful, I guess it is worth it, but if is not helpful, it is a lot of money wasted and more discouragement. This is BC #3 for me,and it appears to be spreading into the skin. She thinks each cancer diagnosis is a "new" cancer rather than recurrence because of time interval or location, but admits there is no real way of knowing. She has ordered a PET to see if it picks up anything regular CTs have missed. So far CTs have not found anything in bones or organs. She thinks the treatment for BC#1 and BC#2 were successful, but I am having serious doubts. She thinks the Ibrance/Arimidex for BC#3 is no longer working, and is thinking chemo. What should I ask? I did chemo in 2016 for BC#2. If I have a genetic flaw that keeps making cancer, should I just throw in the towel? Or if the flaw is identified, would it point to a targeted treatment? Yes, I am discouraged. But what should I ask? I used to scour the internet to try and get a better undertanding and write a huge list of questions, but now I just wanat to scream.

2009 ER+ left breast. 52 yrs. Lumpectomy, Sentinel node removal, negative. Radiation 6 weeks, tamoxifen 5 years. Dense lumpy left breast, normal right

2016 ER+ left breast. Probably a new cancer, but unknown. 4 rounds TC Aug-Oct 2016, Bi-lateral (my choice) Nov 2016, no reconstruction. 2 sentinel nodes remove, negative. Anastrozole 1 mg starting May 2017. Joint issues noticed immediately. Stopped Anastrozole after 3-4 months due to joint stiffness in. After several months of no AIs, fingers were feeling better. Started tamoxifen March 2018

6/2019 ER+ R-axilla. Symptom was a very swollen Right arm. Ibrance and Arimidex. 12/2020, "rash" on right chest wall and fibrotic tissue between neck and shoulder. Punch biopsy showed BC in skin. I had noticed decrease range of motion prior but attributed it to old injury, not working out at gym because of covid, geting older and older.

moth - the Lab is CARIS, they are sending me a brochure listing markers/mutations checked, but I don't think it incudes the implications of any of the markers

BlueGirl Red State,

I think this is about the third place I've seen your same questions. I understand your anxiety, but you have gotten a lot of good information, especially in this thread.

If you are worried about cost, you should know that some of the companies that do the testing allow you to fill our a financial form online prior to doing the testing. I don't know if all of them do this, but Tempus does -- and if you are approved, and your insurance doesn't pay, you will only be liable for a small amount of $$ -- with Tempus, it's $100. And there are probably grants through Tempus, or Foundation One, or Caris that would cover the entire cost for you. You can look online, or ask your MO about this. And if Caris doesn't have this, you can ask your MO to use one of the other companies -- they are all very similar.

Good luck. And again, as I noted on one of the other threads, you should also think about getting another opinion.