In Italy, estimates by AIOM, the Italian Association of Medical Oncology, in 2022 we will have 55,000 cases of breast cancer. Today oncologists have at their disposal innovative techniques for diagnosis, “including advanced genomic tests that allow to personalize the therapy and improve the quality of life of patients”. Thus Giampaolo Bianchini, head of the breast pathology group of the Medical Oncology Department of the Irccs San Raffaele hospital in Milan, and Luca Licata, oncologist in the same team, on ‘Allies for Health’, the portal dedicated to medical information- scientific research carried out by Novartis, which in an editorial explain how genomic tests work and what advantages entail. Genomic tests – underline the two specialists – are diagnostic tools that allow to characterize the biology of breast cancer more accurately than can be done with conventional anatomopathological assessments, allowing to define more precisely the risk of relapse (the prognosis) and the possible need for certain treatments such as chemotherapy. These procedures are therefore able to provide the oncologist with the information necessary to define a personalized therapeutic proposal, based on the individual characteristics of the disease. These tests do not do an analysis of the tumor DNA (genome) – specify Bianchini and Licata – but an evaluation of the expression level of the mRna (transcriptome) of some specific genes. This analysis is normally performed on the tumor tissue sample taken from the patient during surgery, therefore without any need for further invasive procedures. The use of genomic tests allows us to precisely identify which women after surgery can be treated with hormone therapy alone and those who, on the other hand, need chemotherapy. They are not used in all types of breast cancer – the oncologists point out – but only in tumors that express estrogen or progesterone receptors, and which are negative for a protein called Her2 (Er + / Her2- tumors). This subgroup alone represents about 65-70% of all breast cancers, which in Italy are about 55,000 every year. However, not all of these patients are candidates for genomic testing. For example, when the standard clinical-pathological characteristics (tumor size, lymph node status, and biological characteristics evaluated by the pathologist) are very reassuring and already allow to exclude the usefulness of chemotherapy, or when the tumor has such risk factors Do not question the oncologist about the usefulness of adding the chemotherapy itself, the tests are not required. Between these two extremes, there are the patients for whom genomic testing comes into play, i.e. those for whom there is uncertainty about the benefit of chemotherapy, or those for whom standard clinical pathological factors would recommend chemotherapy, but the the use of genomic tests would make it possible to avoid it in a large proportion of them. Overall – Bianchini and Licata conclude – genomic tests are modern and extremely useful tools, which allow the concept of precision medicine to be applied to women diagnosed with breast cancer operated at an early stage, that is, to give the right drug to the patient. right, at the right time. However, genomic tests cannot replace the experience of the clinician who, in her choices, must take into account all the available factors, including the characteristics of the individual patient and her wishes. The complete article is available at: https://www.alleatiperlasalute.it/diagnosi/diagnosi-di-tumore-al-seno-e-test-genomici.
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