Guidelines ensure accurate breast cancer test results
Effectively treating women with invasive breast cancer and preventing that cancer from spreading to other healthy tissue depends on accurately evaluating the results of three key laboratory tests, estrogen receptors, progesterone receptors (ER/PR), and HER2. A recent report, however, indicated that due to variability among institutions, a significant number of those lab tests are not always accurate.
One test examines whether a patient's tumor cells have too much HER2 protein. If they do, specific medication can be prescribed to target and destroy those cells. The other tests (ER/PR) look for cell proteins that serve as receptors for estrogen or progesterone hormones, which can help tumors grow. These hormones can be suppressed or blocked with the appropriate anti-hormone medication.
Both tests are open to more interpretation than many traditional lab procedures. As a result, the American Society of Clinical Oncology and the College of American Pathologists published a clinical practice guideline in 2007 designed to improve the accuracy of ER/PR and HER2 testing for breast cancer patients.
Working together to achieve the best outcomes for patients, St James Hospital and Health Centers and its laboratory partner, Consultants in Pathology, S.C., are in complete compliance with the ASCO/CAP 2007 published guidelines for ER/PR and HER2 testing.
"The real issue is making sure that patients are not receiving incorrect negative results, and missing out on therapies that can prevent their cancer from spreading," said pathologist Dr. Kalisha Hill.
An important factor in treating breast cancer is determining whether it is a noninvasive cancer, whiCh confines itself to the ducts or lobules, or an invasive cancer which is much more serious. Invasive cancers break through normal breast tissue barriers and invade surrounding areas, as well as spread to other parts of the body through the bloodstream and lymphatic system.
According to the American Cancer Society, approximately 178,000 patients were diagnosed with invasive breast cancer in 2007.
As the pharmaceutical industry continues to develop medications tailored to the individual Characteristics of patients and their cancers, the need for accurate interpretation of laboratory results is increased even more. However, many institutions have yet to make the investment in the technologies required to meet the ASCO/CAP 2007 published guidelines.
Because of the variability of accurate institutional ER/PR and HER2 reporting, St. James and consultants in pathology use the DAKO ChromaVision Automated Cellular Imaging System, which is a computer-assisted image analyzer for detecting the percentage of positive cells for ER/PR and detecting HER2 over expression.
"This system significantly increases the accuracy of our reporting," Hill said. "Further, each patient's biopsy is tested with positive and negative controls to ensure the most accurate result The pathologists present the results of patients' ER/PR and HER2 testing during the bimonthly Breast Cancer Care Conference at the St James Comprehensive Cancer Institute. These conferences ensure optimal communication between radiologists, surgeons, pathologists, oncologists, and radiation oncologists. This teamwork offers the highest level of care to patients and guides physicians to effectively treat the cancer."
For more information about breast cancer treatment Services offered at at St. James Hospital and Health Centers, call (708) 679- 2253.