Emiel J.T. Rutgers, MD, PhD; Lajos Pusztai, MD, PhD; René Bernards, PhD
Potential Financial Conflicts of Interest: Dr. Bernards is an employee of Agendia BV, which invented and developed the MammaPrint breast cancer prognosis test.
Rutgers EJ, Pusztai L, Bernards R. Are Short-Term or Long-Term Recurrence Rates More Important in Breast Cancer Screening?. Ann Intern Med. 2008;149:357. doi: 10.7326/0003-4819-149-5-200809020-00014
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Published: Ann Intern Med. 2008;149(5):357.
TO THE EDITOR:
The recent review by Marchionni and colleagues (1), which compares several multigene signatures for breast cancer prognosis, states that for the MammaPrint (Agendia BV, Amsterdam, the Netherlands) 70-gene test, “[f]ifteen percent of patients with the good-prognosis signature had recurrence by 10 years, demonstrating that when the 70-gene signature is used alone in this mixed population, the long-term risk in the good-prognosis group may not be low enough to justify forgoing chemotherapy.” At first glance, this recurrence rate (14.7%) does seem high when compared with that of the OncotypeDX test (Genomic Health, Redwood City, California), which was only 6.8% by 10 years in the low-risk group (2). However, this direct comparison is flawed because the patients analyzed by the OncotypeDX test were all treated with tamoxifen, whereas the patients analyzed with the MammaPrint test were mostly untreated (3). Because tamoxifen is known to reduce the rate of recurrences by 30% to 50% (4–6), this explains, at least in part, the differences in recurrence rates between the 2 tests.
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