The following is a summary of “Annual cost-savings with the implementation of estrogen-receptor-only testing on Ductal Carcinoma in Situ specimens,” published in the FEBRUARY 2023 issue of Surgery by Gellings, et al.

Breast cancer is a complex disease with multiple subtypes, including ductal carcinoma in situ (DCIS), a non-invasive breast cancer. In DCIS, the presence of estrogen receptor (ER) is an important marker that guides treatment decisions, but the utility of testing for progesterone receptor (PR) is not well defined. Therefore, for a study, researchers aimed to assess the cost-savings associated with omitting routine PR testing in DCIS.

A retrospective cohort study was conducted at a single institution, and a comparative analysis of the National Cancer Database (NCDB) was performed to determine annual cost savings. 

The study identified 150 institutional DCIS cases with receptor data, of which 104 (69%) were ER+/PR+, 16 (11%) were ER+/PR-, and none were ER-/PR+. The omission of routine PR testing would have resulted in $18,738 saved annually. Within the NCDB, 34,100 DCIS cases had receptor data, of which 29,277 (85.9%) were ER+, 26,008 (76%) were both ER/PR+, and 211 (0.6%) were ER-/PR+. Annual national cost-savings with the omission of routine PR testing would have been $4.3 million.

The study concluded that PR testing for DCIS should be reserved only for patients with ER- DCIS undergoing breast conservation to determine the utility of adjuvant endocrine therapy. The approach would lead to significant cost savings without compromising patient care. Therefore, the study provided evidence to support the omission of routine PR testing in DCIS.

Source: americanjournalofsurgery.com/article/S0002-9610(22)00630-4/fulltext