title: HER2/neu gene determination in women screened for breast carcinoma: how screening programs reduce the skyrocketing cost of targeted therapy.
abstract: Few data on Human Epidermal Growth Factor Receptor 2 (HER2)-positive breast carcinomas have been reported for screen-detected breast carcinoma. Assessing the impact of a targeted intervention with anti-HER2 inhibitors on costs is required in order to plan for better strategies in screening programs. A total of 54,472 women were screened and 323 cases were found to be invasive cancer. We performed immunophenotypical-fluorescent in situ hybridization (FISH) analysis. Among 153 evaluable breast carcinomas, tumours displayed a 3+ scoring status 3+ in 16 (10%), 2+ in 12 (8%), 1+ in 29 (19%) and 0 in 96 (63%) of cases, respectively. All 3+ HER2+ cases and 2/12 2+ (17%) cases exhibited HER2/neu gene amplification, the remaining cases did not. In contrast to the higher incidence reported at the population level, 20-30% HER2-positive cases for metastatic carcinomas, and only 11% of the screen-detected breast carcinomas displayed HER2/neu gene amplification. Breast cancer detection by screening programs hijacks the skyrocketing cost of the use of targeted therapy in HER2-positive carcinoma.
authors.affiliation: Department of Pathology and Diagnostics, University of Verona, P.le L. Scuro n. 10, 37134 Verona, Italy. matteo.brunelli@univr.it.
authors.forename: Matteo
authors.initials: M
authors.lastname: Brunelli
authors.forename: Erminia
authors.initials: E
authors.lastname: Manfrin
authors.forename: Emilio
authors.initials: E
authors.lastname: Bria
authors.forename: Francesco
authors.initials: F
authors.lastname: Massari
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Tortora
authors.forename: Eleonora
authors.initials: E
authors.lastname: Brunello
authors.forename: Luisa
authors.initials: L
authors.lastname: Carbognin
authors.forename: Alessia
authors.initials: A
authors.lastname: Nottegar
authors.forename: Jenny
authors.initials: J
authors.lastname: Furlanetto
authors.forename: Annamaria
authors.initials: A
authors.lastname: Molino
authors.forename: Elena
authors.initials: E
authors.lastname: Fiorio
authors.forename: Marco
authors.initials: M
authors.lastname: Chilosi
authors.forename: Bharat
authors.initials: B
authors.lastname: Jasani
authors.forename: Marco
authors.initials: M
authors.lastname: Vergine
authors.forename: Lisa
authors.initials: L
authors.lastname: Marcolini
authors.forename: Dea
authors.initials: D
authors.lastname: Filippini
authors.forename: Aldo
authors.initials: A
authors.lastname: Scarpa
authors.forename: Guido
authors.initials: G
authors.lastname: Martignoni
authors.forename: Franco
authors.initials: F
authors.lastname: Bonetti
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis / Q000235:genetics* / Q000628:therapy; D002886:Chromosomes, Human, Pair 17; D003363:Cost Control; D005260:Female; D005784:Gene Amplification; D018734:Genes, erbB-2; D005820:Genetic Testing / Q000191:economics / Q000706:statistics & numerical data*; D017048:Health Care Costs; D006801:Humans; D016130:Immunophenotyping; D017404:In Situ Hybridization, Fluorescence
keywords: HER2; Screen-detected breast carcinoma; cost-effectiveness; gene amplification; screening; targeted therapy