Pamela, 55, married, with a son in college, went in for her annual mammogram in April and was called in for a second mammogram. She had an uneasy feeling when the radiologist came in and told her that there was something suspicious on her mammogram – maybe a precancerous lesion or ductal carcinoma in situ (DCIS) and they would need to get a biopsy. Pamela’s response, “I have never heard of DCIS.” That was the beginning of her self education. She started to research DCIS on the internet and joined Facebook groups.
Pamela’s biopsy results confirmed stage zero breast cancer, also known as DCIS. She continued her educational pursuit by meeting with three different breast surgeons to determine the best course of action for her personally. Pamela selected a breast surgeon and proceeded with the lumpectomy, which was deemed successful with clear margins. However, in her next appointment, the oncologist prescribed radiation therapy along with an anti-estrogen pill. Pamela was concerned about the side effects of radiation and remembered learning about DCISionRT, a molecular test that quantifies the risk of DCIS recurring, as well as predicts how much (if any) radiation therapy might reduce her risk of recurrence.
With no small effort, she convinced her doctor to order DCISionRT. When the results came back indicating that Pamela would not benefit from radiation therapy, the radiation oncologist said, “you need to get radiation anyway – that is the standard of care.” Pamela held her ground and reached out to Dr. Leonard Farber, board-certified Radiation Oncologist and Senior Clinical Advisor at PreludeDx, for a second opinion.
Pamela shared, “Dr. Farber was the only one in my corner and offered to speak with my care team, who were still reluctant to accept my DCISionRT results. I was worried about getting radiation when I don’t really need it, and not being able to get it again in the future. Plus, I firmly believed that the decision should be based on quantifiable information, not what someone simply believes.”
To further complicate the situation, it turned out that Pamela’s margins were not completely clear. And her oncologist would forgo radiation only if she went on anti-estrogen drugs, which were contraindicated due to her other medical issues.
Ultimately, the decision was made for Pamela to undergo a hysterectomy, which would eliminate the drug issues with an anti-estrogen drug, and then go on Tamoxifen.
“Dr. Farber and DeDe Goehler, R.N., PreludeDx’s V.P. of Reimbursement & Market Access, were fabulous. They helped my care team ‘think outside the box’ and arrive at a decision that was tailored to me instead of the blanket ‘standard of care.’”
My advice for patients is, “understand that each specialty is approaching the situation from their point of view. You must learn as much as you can, get second opinions, leverage available technology and ultimately be your own advocate. DCISionRT provided quantitative data that helped me, and my care team come to a consensus and move forward with my treatment.”
