Fast Five Quiz: The Recurrence Risks for Breast Cancer

Elwyn C. Cabebe, MD


February 08, 2022

The 21-gene assay is a validated tool to predict the benefit of adding adjuvant chemotherapy to further reduce the risk for breast cancer recurrence. It is based on reverse transcriptase polymerase chain reaction and integrates the expression of 16 genes known to be related to breast cancer and five reference genes. A recurrence score is generated that correlates with the likelihood of distant recurrence at 10 years. It is used clinically to determine the prognosis in women with hormone receptor–positive, HER2- disease who are treated with endocrine therapy alone by predicting locoregional and distant recurrence. This assay has also been validated to predict the benefit of adding adjuvant chemotherapy to adjuvant endocrine therapy for women with hormone receptor–positive, HER2-, node-negative breast cancer.

Patients at a higher risk for recurrence can also be identified by other multigene assays, such as the 70-gene prognostic signature, the 50-gene assay (PAM-50), and the 12-gene molecular score. Only one assay should be ordered for a specific patient and tumor because the results of the different assays may not agree and have not been prospectively compared in head-to-head studies.

Learn more about molecular profiling assays in breast cancer.

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