The New Cancer Staging Paradigm
Cancer staging has entered a new era. For the first time, the American Joint Committee on Cancer (AJCC) will include genomic diagnostics as part of the standard pathology workup for early breast cancer patients (T1-2, N0, M0) in the 8th edition of the cancer staging manual.
Inclusion of Oncotype DX
After an extensive evidence review, the AJCC has decided to include the Oncotype DX Breast Recurrence Score test in the Pathological Prognostic Staging tables to stage node-negative breast cancer patients. The Level 1 evidence supporting this decision includes prospective outcomes on over 63,000 breast cancer patients.1-5
Downstaging Early Breast Cancer
The inclusion of genomic test results into staging protocols will enable some patients to be downstaged versus traditional TNM staging criteria alone. For a patient who has an Oncotype DX Breast Recurrence Score of less than 11, a cancer that would previously have been classified as Stages IB or IIA will be effectively downstaged as Stage IA. To be eligible for restaging with Oncotype DX, the patient’s cancer must be T1-2 (<5 cm), node-negative, metastasis-negative, and must also be ER-positive and HER2-negative.
A Surgeon’s Perspective on the Evolution of Breast Cancer Staging
Anthony Lucci, M.D., Professor of Breast Surgical Oncology at MD Anderson Cancer Center puts the 8th Edition AJCC Staging Manual into historical context.
Implementing the New Criteria
Published in late 2017, the 8th Edition AJCC Staging Manual officially went into effect on January 1, 2018. However, clinicians are free to use the scientific content of the 8th Edition immediately.
AJCC Stage Groups
The new prognostic staging methodology adds biologic and genomic factors to the anatomic factors that have traditionally been used in cancer staging.
Anatomic Factors: Tumor, Node, Metastases
Clinical Prognostic Factors: Grade, HER2, ER, PR
Pathological Prognostic Factors: Oncotype DX Score <11 for T1-2, N0, M0 when available
For more information on how to stage patients using the new criteria, download the AJCC Staging manual chapter.
1 Genomic Test, 2 Points of Clarity
The Oncotype DX Breast Recurrence Score uniquely provides two points of clinical clarity. By ordering a single test, clinicians not only gain additional prognostic information useful for staging the patient, but also gain insight on the likely benefit of adjuvant chemotherapy.