How do they test for HER2-neu and ER/PR

rubysmom · May 2007

Hi, my mom met with her surgeon today and is scheduled for surgery this thursday(5/17). She was diagnosed with DCIS. They plan on lumpectomy and SNB. My question is how do they test for HER2-neu, ER/PR? Is it a blood work or do they test the sample of the removed tumor? Is this automatically done for all cancer tissue removed or do you have to ask them to do it? Also, the doctor doesn't do MRI's but I still want them to do it. I've heard there is a special MRI for that but will a regular MRI do the same thing? Sorry for all the questions. Thanks

roseg · May 2007

There is some controversy about it, but they don't test for her2-neu with DCIS because it's not relevant. You'd never have chemo for DCIS and the her+ is used to decide if you should get herceptin.

They test for er/pr as a part of the pathology report. You may have to ask for the er/pr testing on DCIS because some don't do it automatically, they just assume it's all er/pr+.

Rosemary44 · May 2007

It's a breast MRI, they have to set the machine up differently. Not all hospitals do this. Your dr. should know who does. Plus, you want the pictures on discs not on film if it's possible. I would want to know if there are any other lumps, and I felt more comfortable when I got the dx saying I only had the one after the MRI.

I see that the operation is soon so you won't be able to schedule an MRI now.

Kate0574 · May 2007

Hello,

Your mother will find out if she is a candidate for all options for treatment when her biopsy goes to the lab, I had a mastectomy and 19 nodes removed three were poss (on 3/30/07) and they explained after the surgery that it would take 7 days for the lab to biopsy everything and test to see if the patient is a candidate for the folloowing:

Chemo
Ratiation
Herceptin
Tamoxifin
and they diag your stage (IIB for me)

Since HER2 is the one you are asking about and as written above that is the herceptin, in my case I was a candidate for all but the herceptin but Doctor said its ok and I will take the Tamoxifin after treatment for up to 5 years, from what I was told and you would want to check her Dr but if I was pos recept for both I would still only do one of them....

Hope this helps a little and not to confusing... give my best to your mother and all will be ok... your support will help the most

Kate

trumpkin46 · June 2007

ER/PR and Her2neu results are reported by the pathologist after an examination and testing of your biopsy sample. They cannot be determined, as far as I know, by MRI. MRI can pinpoint a lesion and tell quite a bit about it, but not that.

In my case, I had a core biopsy done, and the ER/PR and Her2neu receptivity were reported on the same report as my ILC. I never had an MRI of my breasts.

trumpkin46 · June 2007

My breast cancer doc said that being Her2neu negative was actually a positive result for long term survival. We are fortunate that Herceptin is now available for people who are Her2neu positive, because until recently there was no therapy for them. But it is better to be Her2neu neg and not need this therapy.

dizzybuff38 · June 2007

Trumpkin is right, they can only test for ER/PR and Her2 status by biopsy samples from the tumour. I was ER+, Pr not done, and some 3 yrs later privately had an HER2 test, which, thankfully was negative. My Oncologist said this is a great prognosis. If your Mum is post=menopausal,ask why they are not recommending Arimidex rather than tamoxifen - a very old drug. This has a much better prognosis in preventing recurrence of bc.
Take care, your Mum and you,
Liz.

Darbysmom · June 2007

Tamoxifen is the only drug on protocol for DCIS still. The other AI's are in trials for DCIS although some medical oncologists will prescribe them for DCIS in certain instances. This is stated here on Breastcancer.Org.

dizzybuff38 · June 2007

Thanks for the info Darbysmom - I had invasive ductal cancer along with DCIS,comedo and cribriform, plus spread to the lymph nodes, and wrongly assumed all patients with breast cancer, if post menopausal, were offered Arimidex. My apologies for incorrect information.
Liz.

Jinx · June 2007

For first bc - my Her2 test was 1+ - considered negative but onc ordered a FISH test to be sure.

For the recurring cancer I had masect and they tested the recurring tumor. But I don't recall anything about Her2 with regards to the DCIS on my second path report.

Beesie · June 2007

Jinx, they don't test for HER2 with DCIS because Herceptin, which is the drug they give if you are HER2+, isn't indicated for DCIS.

aarque · June 2007

I'm pretty sure that it's done as part of the pathology after the biopsy.I was first dx in 2005 (right side) with dcis as her2/neu 3+ and ER(100%)/PR (40%)+. I was dx in 2006 with a second dcis (left side) but no determination was made because the tissue was too small.

rubysmom · June 2007

We just found out that she is Er/Pr negative. I don't think they did the Her2-neu gene test. She just had a second opinion today and she will have another surgery(#3) to get better margins.

Methusala · July 2007

hi-
I don't know much at all, but what trumpkin46 is saying sounds like what my dr. said.
if you're er/pr +, it's worse BUT they have medicine for that. If you're er/pr _ it's better, but treatment is worse. Did I say that right trumpkin? ah well, my 2 cents... which aren't worth a dime..

wallycat · July 2007

My new oncologist said something very, very odd...
He said that DCIS had not been tested previously for any hormone receptors, but just recently, some studies are testing them. He noted that most DCIS is Her2 positive...once it spreads, that status can change. I will have to ask him again if I heard that correctly.
They still would not treat DCIS with Herceptin, but I thought it was a very odd thing.

Beesie · July 2007

Wallycat, I heard the same thing about DCIS and HER2. I believe that's why they usually don't test DCIS for HER2. It comes out positive most of the time but there is no treatment because Herceptin is for HER2+ advanced BC only; and, if the HER2 status might change anyway if the DCIS becomes invasive, what's the point of testing DCIS for HER2? Mine was tested for ER and PR, but not HER2.

mbordo · July 2007

So how would they *know* most DCIS is Her-2-neu+ if they don't test for it? Did they "used to" test for it and draw that conclusion based on the % of positives?? Seems sort of strange to "assume" something like that - it seems to me there are all combinations of positive/negative among those diagnosed with BC. Also, I thought positive Her2-neu generally means more aggressive tumors - which doesn't really mesh with the DCIS profile. I had never heard this before so I'm somewhat curious!!

Mary

Beesie · July 2007

Mary,

While generally most DCIS isn't tested for HER2, there have been a number of research studies where DCIS samples have been tested for HER2. When I had my BC surgery, I signed a form that allowed my tissue samples to be used in research. So even though I didn't get HER2 results, for all I know, my sample might have been tested as part of some study. The results of these studies seem to always indicate a higher percent of HER2+ within DCIS than IDC.

Here's a reference to one study, from 2003, which mentions that 20%-30% of IDC is HER2+ vs. 50%-80% of DCIS being HER2 positive. http://www.asco.org/portal/site/ASCO/men...stractID=103376

And this article references a couple of different studies, with HER2 results for IDC ranging from 15% - 22%, vs. 48% - 56% for DCIS. http://www.annieappleseedproject.org/fromhertoher.html

The question of testing DCIS for HER2 is controversial. Here's an article that talks to the fact that the benefit of testing DCIS for HER2 is still unclear, with two recent studies providing different results and suggesting that more research is required before a conclusion can be drawn: http://www.oncology-times.com/pt/re/onco...1195628!8091!-1

mbordo · July 2007

Thanks Beesie!

You are a wealth of information - and always able to document it!

Do you do research for a living?

Mary

yemaya · December 2010

I too was diagnosed w/DCIS grade 3 and only tested for ER/PR. I came out ER pos. No testing for HER2 was done w/me.

should this change?

How do they test for HER2-neu and ER/PR

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