Johns Hopkins study challenges efficacy of hormone receptor test for breast cancer patients

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Hospitals across the nation are wasting time and money on unnecessary hormone receptor tests for breast cancer patients, according to the results of a Johns Hopkins study.

For patients diagnosed with  ductal carcinoma the most common type of noninvasive breast cancer a hormone receptor test is an automatic procedure at most institutions. After performing a needle biopsy and determining if the cancer is invasive or noninvasive, researchers tested a small tissue sample for estrogen receptors (ER) and progesterone receptors (PR). However, according to Pedram Argani, MD, a professor Johns Hopkins in Baltimore, Maryland, the hormone tests are wasteful and don’t impact treatment.

First, regardless of the results of the hormone receptor test, the next step in treatment is surgical removal of the cancerous tissue. Second, around 20 percent of surgical excisions will reveal invasive cancer, requiring a retest for the hormone receptors. Most physicians will then recommend another round of testing, even if the excision reveals only non-invasive tissue, making the initial test further redundant.

Despite all these drawbacks, the most compelling reason to drop the hormone test is the treatment’s lack of efficacy. According to Argani, while hormone blocking therapy can lower the chance of tumor recurrence, it ultimately has no effect on patient survival—it simply just an expensive medical bill.

"If you apply our local results nationally, these unnecessary initial hormone receptor tests currently come with an annual price tag of around $35 million,” Argani said. “Our results indicate that's an expense without any justification. If these tests were routinely eliminated, the savings would be substantial.”

Johns Hopkins Hospital was so compelled by these results that they dropped the routine hormone receptor screening from its practice last January, eight months before this study was published.

Read the full article at the American Journal of Surgical Pathology.