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094: health&wellbeing Breast Cancer Treatment: How Genomics can Help Cancer is an extremely complex disease. Each patient's cancer contains different gene expression profiles which make up the unique biology of the patient's tumour. As a result, certain patients may be more likely than others to have aggressive disease or to respond to certain therapies. If you have been newly diagnosed with early-stage breast cancer, should you discuss a personalized approach to your treatment plan with your doctor? Currently, traditional clinical and pathological measures like patient's age or tumour size and grade, offer limited insight into the underlying biology of your cancer, which makes tailoring your treatment difficult. Today, oncologists are increasingly using genomic testing to help understand patients' individual tumour biology to gain better understanding of the tumour behaviour, risk of cancer coming back, and how your tumour might respond to chemotherapy. WHAT IS GENOMICS? While genomics and genetics may sound similar and are related, each focuses on different information. Broadly speaking, genetics is the study of how inherited traits are passed from one generation to the next through the genes, and how new traits appear by way of genetic mutations or changes. A predisposition to certain types of diseases can also be passed through the genes, such as the BRCA1 gene and the BRCA2 gene which normally help control cell growth. A person who inherits an altered version of the BRCA1 and/or BRCA2 gene(s) has a higher risk of developing breast and ovarian cancer. There are breast cancer genetic tests for both the BRCA1 gene and the BRCA2 gene, but these are different from genomic tests. Genomics is the study of complex sets of genes, their functions, and how they interact with one another. Another way to think about it is as a small network of genes and how they work together to influence the tumour biology and behaviour. Knowing whether certain genes are more or less active can help doctors predict the risk of cancer returning later and help determine whether or not you will significantly benefit from a treatment like chemotherapy. A genomic test, such as the Oncotype DX® breast cancer test developed by Genomic Health, examines multiple genes in a patient's breast tumour to understand how these genes interact and influence tumour behaviour, which in turn, provides insight into a patient's prognosis and response to chemotherapy treatment. GENOMICS AND ITS ROLE IN PERSONALISING BREAST CANCER TREATMENTS RNA extraction conducted as part of the Oncotype DX testing at Genomic Health laboratory While chemotherapy can be an effective treatment for early-stage invasive breast cancer, research shows that not all women benefit equally from chemotherapy. Many factors are assessed in order to make the decision regarding whether adjuvant chemotherapy is necessary for patients with early-stage oestrogen positive (ER+) breast cancer. Conventional clinical factors including the patient's age, the size of her tumour, lymph node involvement and oestrogen or progesterone receptor positive and HER2 receptor status are all taken into account. Genomic tests, such as the Oncotype DX test, analyze multiple genes in a tumour sample to help determine the most likely outcome of the disease and make more informed decisions about the treatment with greater confidence. In fact, multiple studies across numerous countries in Asia, North America, Europe and Australia have shown While chemotherapy can be an effective treatment for early- stage invasive breast cancer, research shows that not all women benefit equally from chemotherapy. Personalizing