Acknowledging the Importance of Clinical Judgment in Breast Cancer
Fengting Yan, MD, PhD, discusses the challenge of balancing clinical judgment with genomic test results in breast cancer.
Fengting Yan, MD, PhD, a medical oncologist at the Swedish Cancer Institute in Seattle, Washington, discusses the challenge of balancing clinical judgment with genomic test results in breast cancer.
In postmenopausal patients with low-grade, low-risk breast cancer, there can be uncertainty when they have a high Oncotype DX score, a high Oncotype DX score suggesting a risk of disease recurrence. Yan highlights a recent patient of hers where their tumors heterogeneity led to discrepant scores from different tumor blocks, emphasizing the significance of clinical judgment over genomic tests.
Despite the high agreement rate between clinical judgment and genomic tests, Yan stresses the necessity of personalized discussions and clinical expertise, especially when there's a disagreement between clinical assessment and genomic test results.
TRANSCRIPTION
0:10 | We [are] taught that as oncologists, any of the biomarker [and] genomic assays do not trump our clinical decisions. So I sometimes run into the situation that—when it's a postmenopausal patient with low-grade [disease], clinically absolutely low risk, but with high Oncotype DX score higher than 25—that dilemma came, do I trust my own clinical judgment or do I trust the genomic test? And that situation sometimes can happen. Most of the time it's more an individual, personalized discussion.
0:48 | Recently, I did have a case that [where] there was heterogeneity of the tumor, and I agree with that critique. It's a patient with a really low-grade tumor, really low Ki-67 [score], and the Oncotype DX score was higher, so I had to request a second assay from a different block, and the score was lower. So the intratumor heterogeneity does exist. So this is how any assay does not replace our clinical judgment. Most of the time, more than 95% of the time, we do agree. But when the clinical judgment disagrees with the genomic test, this is when we actually advocate for a personalized discussion and also use our clinical judgment.
