Comment Period Opens for Updated Breast Cancer Testing Guideline

Draft recommendations that update the College of American Pathologists (CAP) and the American Society of Clinical Oncology (ASCO) 2010 guideline for estrogen (ER) and progesterone (PgR) receptor testing in breast cancer are open for public comment today through April 29, 2019.

Globally, more than 1 million women are diagnosed annually with breast cancer and receptor testing conducted on their biopsies typically discern that approximately eight in 10 of these women have ER positive breast cancer. Well-performed tests are essential to identify those patients who could benefit from endocrine therapy. And more broadly, hormone receptor status can be valuable for tumor classification and other factors that inform treatment.

Given this impact on patient care, the CAP and ASCO urge all stakeholders to review and provide feedback on the draft update: Estrogen and Progesterone Receptor Testing in Breast Cancer: ASCO/CAP Clinical Practice Guideline Update. Health systems with all levels of IHC experience including US and international laboratories are encouraged to submit comments, as well as oncologists, pathologists, surgeons, nurses, allied health professionals, and others including patient advocacy group representatives.

While the 2019 recommendations largely reaffirm earlier guidance, important differences warrant careful consideration. Specifically, the new guidance:

• Recommends additional steps to accurately address and interpret cases with low or weak ER expression.
• Recommends for cases of DCIS only, the updated draft now recommends ER testing, but PgR testing is still optional.

“This guideline addresses one of the major drivers of disease progression, so it is critical that we keep it current,” explains pathologist Kimberly Allison, MD, FCAP, co-chair of the CAP-ASCO expert panel leading the guideline update. “We do that by evaluating the clinical literature, including new evidence and emerging data, that could indicate the need for changes to clinical practice.”

The ASCO and CAP expert panel will assess feedback garnered during this open comment period to evaluate possible revisions to the updated recommendations. No official date for release of a guideline update has been set. Once the update is published, the CAP will suggest a timeline for laboratory implementation.

“The ASCO-CAP alliance continues to exemplify the strong value of interdisciplinary cancer care,” said Antonio Wolff, MD, FASCO, lead oncologist on the expert panel. “Through this

team-based evaluation of evidence, we are able to guide physicians and clinicians around the world and ultimately foster better patient care.”

Through its Clinical Guidelines Committee, ASCO develops and publishes clinical practice guidelines, provisional clinical opinions (PCOs), and guideline endorsements, providing evidence-based recommendations to serve as a guide for doctors and outline appropriate methods of treatment and care.

To read and comment on the draft guidelines, visit cap.org.

As the world's largest organization of board-certified pathologists and leading provider of laboratory accreditation and proficiency testing programs, the College of American Pathologists (CAP) serves patients, pathologists, and the public by fostering and advocating excellence in the practice of pathology and laboratory medicine worldwide. For more information, read the 2017 CAP Annual Report at CAP.ORG.