Integration of HER-2 result into breast multi-disciplinary decision making: results of a UK audit


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Louise Li, Mark Verrill

Northern Centre for Cancer Treatment, Newcastle Upon Tyne, UK

Abstract

Integration of HER-2 result into breast multi-disciplinary decision making: results of a UK audit

Background

A recent update to recommendations for HER-2 testing in the UK [1] states that HER-2 test results at diagnosis of breast cancer should be accurate, reliable, timely and available for the multi-disciplinary meeting (MDTM). This allows HER-2 status to inform selection of appropriate systemic therapies. We have audited time to HER-2 immunohistochemical (IHC) test result across UK centres.

Method

In a North of England Cancer Network Audit, clinicians treating breast cancer were identified from a commercial mailing list and received questionnaires requesting details of logistics, timing and influence on treatment selection of HER-2. Similar questions on oestrogen receptor (ER) status were included for comparison.

Results

The first 200 responses are reported here representing all English Cancer Networks, Scotland and Wales. In 84% ER influenced referral for chemotherapy compared to 74% for HER-2. 79% reported that ER was routinely (ie. >75% of the time) available at the MDTM compared to 26% for HER-2. HER-2 was available rarely (<25% of the time) in 30% and 25-50% of the time in a further 22%. Missing HER-2 results led to extra outpatient visits in 46% of responses.

Conclusion

ER and HER-2 both influence chemotherapy decisions but the HER-2 result is frequently unavailable at the MDTM. Lack of a HER-2 result precludes the integration of the prognostic and predictive value of over-expression into MDTM decision making. Our audit supports the UK recommendation for timely testing.

References

[1] J. Clin. Pathol. published online 1 Apr 2008

Acknowledgments

This audit was supported financially by Roche Products Limited.