Liquid biopsy and breast cancer - availability and insurance

Informative article on liquid biopsy
https://news.cornell.edu/stories/2025/06/treatment-switch-liquid-biopsy-improve-breast-cancer-outcomes
If I were deciding on treatment options now, I’d look at histology of BC cells, and risk based on the type of cells I was growing, not just statements about risk in general for dcis.
Whether there is (and how much) comedo necrosis, and microinvasion into surrounding extracellular matrix.
Whether my type of cancer is known to move mostly through the lymphatic system, vascular system, or directly into the extracellular matrix as scans tend to review the lymph system and don’t see the other type of cancer until there is a mass.
Level of Adipocytes (fat cells) in the breast and stomach area as the fat has estrogen that can feed the ER+ cancer. More studies keep coming out about the increase in fat affects cancer growth.

You didn't mention your tumor grade. Or your Oncotype DX score, which is done from testing a piece of your tumor. There is no way you, or your oncologist, can make an informed decision about your care, without it. My first breast cancer was ER PR positive HER2 negative, grade 2 stage 1. My Oncotype DX test score was only 6. The only treatment was tamoxifen. My next breast cancer in my other breast was ER PR positive HER2 negative, Stage 1, Grade 3. The Oncotype DX test score was 32. Chemotherapy was advised. I have declined based on my many pre- existing conditions. Please find out your grade. Then ask for an Oncotype DX test. It takes about 2 weeks for the test results.

Liquid biopsy is relatively new and I am not sure if it is being used for breast tissue; I know it is used for soft tissue and you would imagine if they can do a liver they could do a breast. I see my breast surgeon tomorrow and will ask.

Thanks. My diagnosis was IDC - tumor was grade 2. My Oncotype DX also came back as 32, which is in the danger zone by a few points but not oh-my-god bad.
I'm having the introductory conversation with the medical oncologist today and frankly am not looking forward to it. I have my questions lined up and am hoping for a useful conversation.

ETA: I initially thought that radiation was the least damaging of the three (rads, chemo, hormone) but my tumor's ex-area is extremely close to my chest wall (right side, 6 o'clockish) and they don't appear to offer prone position radiation. I have some minor breathing/heart issues already and am scared sh*tless of damage.

I'm just so tired of all the decision-making...I'm afraid I'm going to say 'yes' to the wrong thing and wreck the rest of my life. (face in hands)

I would so appreciate hearing anything you learn about it. Lots of conflicting data everywhere....

My breast surgeon is unaware of liquid biopsy being used to treat breast cancer. I am an academic and can perform a deeper dive (no need to pay to see info as my institution has subscriptions to major medical publications) into recent research; I'll see if I find anything under BC and liquid biopsy within the next week.

I opted to have a simple mastectomy, so no radiation was needed. I was told that with grade 3, oncotype dx 32, if I did nothing I had a 40% chance of recurrence, ( most probably stage 4). If I took 20mg. Tamoxifen, I had a 20% chance. If I did the 4 rounds of chemotherapy, and then 20mg. of Tamoxifen it would be 10%. I was told the 2 chemotherapy drugs that would be used. I looked them up. I Googled the prescribed drugs, plus ALL my various health issues. Chemotherapy + hEDS. Chemotherapy + herpes virus. Chemotherapy + EBV. Chemotherapy + Chicken pox virus. All can get activated. Chemotherapy + tricuspid valve regurgitation ( diagnosed by Transthoracic Echocardiogram). Chemotherapy + ALDH2 Enzyme Deficiency. It means I can't tolerate alcohol and many chemicals. All these conditions would negatively impact me. I know myself and the way my body reacts. I would never go back for the other 3 rounds. Meanwhile, I would not have any hair, and not any better off. I don't mean to frighten off anyone by my personal situation. I am more likely to die because of this decision. I want to tell everyone to Really know, in detail, what your experience will be based on your health conditions. It doesn't seem to matter all that much to my Oncologist, who said that I would be closely monitored and put in the hospital if needed.

Found this article on Liquid Biopsies.https://www.newyorker.com/magazine/2025/06/23/the-catch-in-catching-cancer-early

Please see above, I found an article on liquid biopsies but posted to wrong person. From New Yorker mag.

I was about to post this same article, Barb! Thank you! I think respected cancer authority, Siddhartha Mukherjee, provides a useful crash course in a complicated clinical research area which faces growing patient demand to use liquid biopsies. Patients are sharing their awareness of this potential diagnostic tool. Emphasis is on the word "potential" which this article tries to explain. I'm glad Barb could post the entire article because I would not be able to summarize it properly.

Like many of you, I also recently learned about the potential use of liquid biopsies, particularly by those with metastatic breast cancer. One can't help but be intrigued by the idea of simple blood tests to see if cancer shows up faster then the usual diagnostic workups. As I understand it, research currently prioritizes studying its application for those with metastatic cancer which makes sense. Now that clinical research money has been cut, I fear what the consequences will be for continued research in this field.

The author also notes that although identifying single genes like the BRCAs has been a game changer, polygenic risk scores, which consider combinations of genes, are another developing research area. As someone who has had two genetic tests which came out negative, but then developed breast cancer, I believe this area of polygenic testing is important.

I believe the Oncotype DX also considers various genes, but the company does not include the identification and their analysis in the score they present.