Oncotype DX Breast DCIS Score® Test: Impact on Radiotherapy Recommendations and Patient Decisional Anxiety

Area of Science:

• Oncology
• Genomics
• Breast Cancer Research

Background:

• Ductal Carcinoma in Situ (DCIS) treatment often involves surgery and radiotherapy (RT) to minimize local recurrence (LR).
• Radiotherapy may be overtreatment for certain patients, necessitating personalized risk assessment.
• The Oncotype DX Breast DCIS Score is a genomic assay designed to estimate individual LR risk.

Purpose of the Study:

• To evaluate the impact of the Oncotype DX Breast DCIS Score test on radiotherapy recommendations.
• To assess changes in patient anxiety and decisional conflict following Oncotype testing.
• To compare oncologists' LR risk predictions with Oncotype test results.

Main Methods:

• A study involving women aged 45+ with DCIS treated with breast-conserving surgery.
• Initial RT recommendations and LR risk predictions were made pre-testing.
• Final RT recommendations and patient-reported anxiety/decisional conflict were assessed post-testing.

Main Results:

• The Oncotype test led to changes in RT recommendations for 28% of patients.
• In 21% of cases, RT was de-escalated (changed from RT to no RT).
• Patient-reported decisional conflict and anxiety decreased after receiving Oncotype test results.

Conclusions:

• The Oncotype DX Breast DCIS Score test effectively modifies adjuvant RT decisions in nearly a third of DCIS patients.
• The genomic assay reduces treatment-related decisional conflict and anxiety.
• Discrepancies between oncologists' LR risk estimates and Oncotype predictions underscore the need for improved decision-making tools.