If tests on the biopsy sample show that it is breast cancer, extra tests will be done to work out the factors shown here and help plan treatment. Your surgeon may suggest leaving some of these tests until the whole lump is removed and examined after surgery. The results will be included in the pathology report.
Learn more about:
Hormone receptor status
Hormones are chemicals in the body that transfer information. Both women and men produce the female sex hormones oestrogen (ER) and progesterone (PR), although the levels are lower in postmenopausal women and in men.
A hormone receptor is a protein in a cell. Most breast cancers have cells with hormone receptors that receive signals from oestrogen or progesterone, so these hormones may be helping the cancers grow. These cancers are called hormone receptor positive (ER+ and/or PR+) or hormone sensitive cancers. They are likely to respond to hormone therapy that blocks oestrogen.
HER2 status
HER2 (human epidermal growth factor receptor 2) is a protein that is found on the surface of cells. This protein causes the cells to grow and divide in an uncontrolled way.
Tumours that have high levels of these receptors are called HER2 positive (HER2+). Tumours with low levels are called HER2 negative (HER2−). Treatment with targeted therapy, such as trastuzumab (brand name Herceptin), as well as chemotherapy, is usually recommended for HER2+ breast cancer.
Triple negative breast cancer
Some breast cancers are hormone receptor negative (ER− and PR−) and HER2 negative (HER2−). These are called triple negative cancers.
Triple negative cancers do not respond to hormone therapy nor to targeted therapy aimed at HER2. However, triple negative cancers often respond well to chemotherapy.
As triple negative is a less common form of breast cancer, you may find it helpful to talk to other women with a similar diagnosis. See Support Services for peer support services.
Genomic assays
Genomic assays, also called molecular assays, are tests that look at the patterns of certain genes within the cancer cells. These patterns help predict the risk of the cancer coming back, and this information helps guide treatment. For example, if there is a low risk of the cancer coming back, you may not need chemotherapy.
The genomic assays that are currently available are only for breast cancer that is ER+ and HER2−. They include the Oncotype DX Breast Cancer Assay, EndoPredict and Prosigna. These tests can cost up to several thousand dollars and are not currently covered by Medicare or private health funds.
It is important to remember that the standard pathology tests that are done on all breast cancers often provide enough information to guide treatment plans. If you and your oncologist decide that it is worth having a genomic assay, the test you choose will depend on a number of factors, including your doctor’s experience. Your doctor can provide you with further information.
Prof Christobel Saunders, Professor of Surgical Oncology and Head, Division of Surgery, The University of Western Australia, and Consultant Surgeon, Royal Perth, Fiona Stanley and St John of God Subiaco Hospitals, WA; Dr Marie-Frances Burke, Radiation Oncologist, Medical Director, Genesis CancerCare Queensland, QLD; Kylie Campbell, Breast Care Nurse and Clinical Lead, Murraylands, McGrath Foundation, SA; Carmen Heathcote, 13 11 20 Consultant, Cancer Council Queensland, QLD; Annmaree Mitchell, Consumer; Sarah Pratt, Nurse Coordinator, Breast Service, Peter MacCallum Cancer Centre, VIC; Dr Wendy Vincent, Breast Physician, Chris O’Brien Lifehouse and Royal Hospital for Women, Randwick, NSW, and Clinical Director BreastScreen NSW, Royal Prince Alfred Hospital, NSW; A/Prof Nicholas Wilcken, Director of Medical Oncology, Westmead Hospital, and Co-ordinating Editor, Cochrane Breast Cancer Group, NSW. We also thank the health professionals, consumers and editorial teams who have worked on previous editions of this title. This booklet is funded through the generosity of the people of Australia.
View the Cancer Council NSW editorial policy.
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