Circulating tumor DNA tests for peace of mind: Chloë Crampton
Is there a better way to monitor for cancer recurrence than ordering imaging scans or waiting for symptoms to appear? One answer might be circulating tumor DNA (ctDNA) tests—also called liquid biopsy tests—which use a blood sample to look for tiny DNA fragments shed by the cancer. A positive test indicates that tiny amounts of cancer are present in the body.
One such test, Signatera, uses a tumor sample to create a personalized set of the most frequent gene mutations found in the cancer, and then develops a customized test based on those results. The goal is to give people and their doctors better information about whether a treatment is working and gauge the likelihood of recurrence before it shows up on imaging. These tests are still under study, but some doctors use them for colorectal, lung, bladder, and breast cancer.
Chloë Crampton, an actor-turned-celebrity-chef, asked for ctDNA testing after she was diagnosed with triple-negative breast cancer in 2021. Originally from Ashdown Forest outside London, where Winnie the Pooh was based and written, Chloe lives in Los Angeles with her husband and 80-pound bernedoodle, Paddington. Here she shares her decision-making process in conversation with LBBC contributing writer Kristine Conner.
Tell us about the experience of being diagnosed with breast cancer in your early 30s. What was that like for you?
It was a bit of a shock: I am just 32 and have no family history of cancer, except for my 90-year-old granddad who was a smoker. I was washing myself in the shower and discovered a lump on the side of my left breast. I had a bad feeling and booked an appointment right away with my primary care provider. She pointed out that I’d had the COVID vaccine eight weeks before and some people were getting lumps mimicking breast cancer. She said to come back if it did not get better.
After six weeks, the lump had grown significantly. I had a mammogram and ultrasound that were suspicious and was told I needed a biopsy. Fortunately, some friends recommended the Bedford Breast Center in Beverly Hills, and I was able to get a biopsy within a few days. My surgeon said the cancer was growing quickly, and it might have been a different story if I had waited even two more weeks. My lymph nodes were negative [for cancer] and the biopsy suggested the cancer might be estrogen receptor-positive. So, I went ahead with lumpectomy on July 21, 2021.
My surgeon did get clear margins, but it was a 3.6-centimeter tumor, which is quite large, and it turned out to be triple-negative breast cancer.
What was the rest of that summer and fall like for you, and how did the pandemic complicate things?
I recovered from surgery for six weeks, then went ahead with IVF, since my husband and I haven’t had kids yet, and I knew I needed chemotherapy. Then I did four rounds of Taxotere and Cytoxan, which was all I could handle, and 20 rounds of radiation.
There was a ban on international travel until November 2021, so my family in London could not come here until then. I had my friends and my husband, and my mother-in-law was my surrogate mother. It was a struggle being without my family.
This was a pretty terrifying experience to go through during COVID. I ended up in the ER during chemo and wasn’t allowed to have anyone come into the facility. I think it was a huge life lesson I really didn’t need but got anyway! I feel like I have a superpower now, after being affected at such a young age. I am much more protective of my space and my time.
L: Chloe during scalp cooling; R: victorious in the hospital.
How did you find out about ctDNA testing, and why did you decide to pursue it?
I interviewed a lot of oncologists at places like Cedars-Sinai and UCLA. I chose an oncologist who was supportive of my doing things like acupuncture and making dietary changes during treatment. Since I had no evidence of disease after surgery, I felt I could take some time to choose rather than rush into a decision.
One of the oncologists I met had mentioned Signatera, saying it was like a liquid biopsy that could be used to monitor you. I am someone who remembers every detail from a conversation, so I went home and Googled it. Signatera seemed like an incredible new technology. When I was talking to various oncologists, the cancer therapies they described seemed tried-and-true but kind of old school. This approach felt more high-tech and up-and-coming.
When I brought it up with my current oncologist, she said that it still wasn’t clear what to do with the information from the test. Still, I felt I had to be my own advocate, so I went to the Signatera website and signed myself up.
My attitude was, “This is me and this is my diagnosis.” I pushed for it because no one cares about you more than you do. Your oncologist works for you, and while you have to listen to their advice, if something is a fit for you, you should go for it.
I wanted to start with Signatera so I could know whether or not I had ctDNA from the tumor in my body. My oncologist ultimately agreed to order it. They took my slides from the tumor and cross-coordinated it to create my test. I had my first test in September 2021 before starting chemo, and it was negative. I continue to test every three months.
How has ctDNA testing been helpful for you?
When I finished radiation a year ago, I knew there was nothing else I could take for triple-negative breast cancer. All I could do was live healthy, and get scans and close monitoring. Signatera just gives me extra comfort; it’s a nice added layer of reassurance. There is nothing worse than living with the fear every day that the cancer might come back. Testing helps me feel at peace. And I reasoned that maybe this will help the test receive FDA approval one day.
In addition to the Signatera test, I have an MRI or mammogram every six months and an annual PET scan. It turned out that the CEA blood test [a tumor marker test that looks for presence of cancer] was not a good marker for me, as it was zero even when I had cancer. My body didn't seem to know the cancer was there!
I’ve had a few scares since finishing treatment. For example, I once had an MRI check and some of the contrast lit up on my right breast. It was very stressful but turned out to be nothing. I’d had a negative Signatera test and that made me feel calmer.
I understand that there is some uncertainty about what to do if the test should come back positive. But I would take it upon myself to figure out what I wanted to do with the information. My thinking is, even if there is a sign of cancer at a microscopic level, wouldn't I rather catch it then, before it develops into a larger growth? Perhaps we could talk about doing more chemo. That was my reasoning.
What is the ctDNA testing process like?
It is pretty seamless. The phlebotomist comes to my house to draw blood, and then they send out the sample via FedEx and I get my results back in a couple of weeks.
The representative I originally spoke with checked on me throughout my chemo and the entire process. My understanding is that if your insurance won't cover it, there are ways the company can provide it at no cost to you.
What is your advice to other people who might be thinking about ctDNA testing?
Actually, I’ve been quite outspoken on social media about my breast cancer journey to help other young women in their 20s and 30s. Using my Instagram (@chloeskitchen), I documented my journey through IVF, chemo, and radiation—from what I did to deal with side effects to my decision to use cold-capping, which helped me keep most of my hair. People do contact me with questions, especially about triple-negative disease. I myself had a hard time finding women around my age who were diagnosed with this type of breast cancer.
Some people ask me about Signatera—how it works, how much it costs. Oncologists generally are not supportive of it yet, and I understand that some patients are going to follow what their doctor tells them to do. For me, I’ve found testing to be a source of reassurance. I feel it would be better for me to know if the test turns something up, so we can at least monitor it before scans show anything.
I have always been kind of a fighter. I moved to L.A. on my own at 19, and I’ve learned that life throws things at us that are pretty unexpected. But knowledge is power—and from an emotional standpoint, Signatera has helped me move on and heal.
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