Hormone and Her2 Receptor Testing in Canada

DanceSmartly

I was surprised to learn that neither my IDC tumour nor the surrounding DCIS will be tested for hormone and HER2 status following my lumpectomy; instead, the results of hormone and HER2 receptor testing done on my biopsy material will be used for treatment. Apparently this is Canadian (or at least Albertan) protocol. Wondering about other Canadian ladies' experience?

I am concerned by this because my DCIS contained expansive comedo necrosis, which I have read is often hormone receptor negative and thus may require different treatment than my IDC, which is strongly hormone receptor positive.

bravepoint

DanceSmartly - I'm in Ottawa. My only hormone and HER2 receptor testing was done following my lumpectomy. I got no results on those from the biopsy.

wrenn

Mine were tested at biopsy and surgery. I was triple neg and given the same chemo given to those with hormone positive results.

stephincanada

I am in Ontario and had the same experience as bravepoint: testing was done after the lumpectomy. I didn't receive any info about receptor status from the biopsy.

wallan

I am in Ontario too. My receptor status was after my mastectomy.

I never received any receptor status from my biopsy.

I have had BC twice now, once on each breast, and both times receptor status was after mastectomy.

walan

wrenn

I just checked my report to be sure.

Core biopsy results:

a) Invasive ductal carcinoma

b) Nottingham grade 3 (tubules 3, nuclei 3, mitoses 3)

c) ER/PR negative

d) Negative for Her-2 protein over expression

e) No ductal carcinoma in situ in this sample

f) Largest core fragment involved with tumour approximately 15mm

DanceSmartly

Thanks so much for your feedback, ladies!

I saw my surgeon yesterday in preparation for my re-excision, and he had done some research for me and confirmed that testing only the biopsy tissues for biomarkers is an Albertan protocol that was established about four years ago. Apparently, the decision was made to test biopsy tissues rather than surgery tissues in order to identify those patients who would benefit from neoadjuvant chemo (which makes sense to me). He thinks that the decision to test only biopsy tissues was based on studies that showed little difference in biomarker results between biopsy and surgery pathology, though he couldn't point me to said studies.

It seems that my treatment would be no different regardless of how my DCIS tested, so I am feeling ok with this protocol now.

Hope things are going well for all of you!

moth

Hi, I'm in BC and apparently mine will be sent for Oncotype DX testing because I fit into the criteria.

You can see the criteria here: http://www.bccancer.bc.ca/health-professionals/cli... (see Table 4)

What I'm dithering about is is the genetic testing for me because apparently I don't fit into the criteria for that so I'd have to pay for it myself.

DanceSmartly

Hi Moth,

Today I dug up the Alberta protocol (or at least what I could find of it on the internet) and discovered that apparently I don't qualify for Oncotype testing in Alberta because my pathology came back Grade 1. This is interesting to me because my surgeon has repeatedly told me that I will likely have to have chemo; he seems to be basing this on my age (I am 42) but the protocol seems to deem high risk to be <35 year old. Very interested to hear what my oncologist says when I finally get to meet her (wonder if they make you wait until surgery and pathology are completely finished before referring you to an oncologist in BC?). If she wants me to do chemo, I am going to be requesting the Oncotype DX first!

I find it ironic that I do not qualify for genetic testing as there is absolutely no family history of breast cancer in my first degree relatives - but my mother, sister and daughter all qualify now because I have been diagnosed at <50 years old!

Good luck with your Oncotype DX!

Dance

Crosbyfan1987

I am in Newfoundland and Labrador. I never got the hormone receptor status of my tumor from the biopsy. Still waiting for it from my sentinel node biopsy/lumpectomy 14 days ago.