The Argument for More Selective Use of Breast Cancer Biomarker Testing

A more selective use of biomarker testing for patients with breast cancer could save millions of dollars without compromising the care they receive, according to the results of a study published in The American Journal of Surgical Pathology.

Researchers reviewed medical records for almost 200 breast cancer patients and determined that waiting to perform biomarker testing until after a patient has a full excisional biopsy could save as much as $117 million dollars in healthcare spending.

“We suggest that clinical breast cancer teams consider stopping the practice of reflex testing of core needle biopsies, because the results typically do not guide the next step in therapy,” Pedram Argani, MD, senior study author and director of the Breast Pathology Service at The Johns Hopkins Hospital, said in a statement. “A more logical, cost-effective approach would be to perform such testing only if chemotherapy before surgery is a serious consideration for that individual patient.”

Traditionally estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 biomarkers are tested for in excisional biopsy specimens when the surgeon removes a large portion of the tumor. However, there has been a shift toward testing the core biopsy, which is the initial small samples of breast cancer removed through a small needle, for these biomarkers. Negative tests in these small samples often have to be repeated later in the larger samples.

Of the patient files reviewed, biomarker testing on the core biopsy was only necessary in just 17.7% (35 patients), according to the researchers. Unfortunately, treating clinicians may not realize how much using these tests reflexively drives up costs, said Dr Argani.

“It’s our hope that people will look at this and start thinking about how to change policies,” he said. “It would be smart for most if not all medical centers to consider limiting their breast core biopsy biomarker testing to cases in which chemotherapy before surgery is a serious clinical consideration.”