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HER2 testing in patients with breast cancer

BMJ 2012; 344 doi: (Published 11 June 2012) Cite this as: BMJ 2012;344:e3958
  1. J Michael Dixon, professor of breast surgery1,
  2. Victoria Wilson, Melville Trust research fellow1,
  3. Mark Verrill, consultant medical oncologist 2,
  4. W Fraser Symmans, professor of pathology3
  1. 1Edinburgh Breast Unit, Western General Hospital, Edinburgh EH4 2XU, UK
  2. 2Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne, UK
  3. 3University of Texas, MD Anderson Cancer Center, Texas, USA
  1. mike.dixon{at}

Must be performed in a timely manner to facilitate appropriate treatment decisions

HER2 receptor amplification or overexpression is seen in 15-20% of breast cancers and is a prognostic marker of poor outcome.1 2 The HER2 (also known as ErbB-2) receptor is a member of the epidermal growth factor receptor family of receptors, which also includes HER1 (or epidermal growth factor receptor), HER3, and HER4. This family of receptors possesses a wide range of functions related to cell growth and proliferation. These receptors join with other members of the same family to activate intracellular pathways.3 Treatment specifically targeted at HER2 has dramatically improved survival during the past decade in patients with breast cancers that overexpress HER2. However, to allow proper use of HER2 targeted drugs, results from HER2 testing need to be available in a timely manner. A recent survey of surgeons in the United Kingdom found, worryingly, that only half of patients with invasive cancer had a HER2 result available when treatment was initially discussed.4

Given the importance of HER2 as a prognostic and treatment related factor, almost all invasive cancers are now tested for the presence of HER2 overexpression.5 Various methods are used, and guidelines for testing have been produced.6 …

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