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In Reply:

Department of Surgery and Pathology, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Australia

We thank Alimonti et al for their interest in our work and for their pertinent observations. We agree that the possible impact of treatment timing according to menstrual cycle is worthy of further investigation, but do not believe that cyclical variation in receptor expression explains our observations.¹ Alimonti et al point out that estrogen receptor (ER) and progesterone receptor (PR) levels in healthy breast tissue vary cyclically. We recognize this, and it is one reason that the staining in normal tissue is not an ideal positive control.

The majority of patients in our cohort were postmenopausal. Our service is closely associated with a mammographic breast screening service, and the majority of cases in this cohort were screen detected. The target age group for screening in Australia is between the ages of 50 to 75 years. Thus, our study is primarily of postmenopausal breast cancer patients, in whom the hormonal milieu does not undergo cyclical variations. For all of our results, the trend was in the same direction—more staining in the core biopsy specimen than in the surgical specimen—strongly suggesting that the result is due to the nature of the specimen, rather than another factor that should vary equally in both directions. In addition, we have no policy regarding timing of diagnostic biopsy or surgery according to menstrual cycle, and so staining in premenopausal patients would be expected to vary in both directions if hormonal milieu when the specimen was taken was a determining factor.

We considered including a subclassification of menopausal status. However in our series of 100 patients, there were only eight patients 50 years or younger, and the Allred ER and PR score in all eight cases was equal or was higher in the core biopsy specimen than in the surgical specimen. None of the nine patients who would have had a false-negative receptor assessment, according to the surgical specimen results, were younger than 50 years. The median age of the nine patients was 64 years (range, 53 to 75 years).

We agree that cyclical variation of ER, PR, and HER-2 levels is worthy of further study. In light of our results, it is critical that such study be based on core biopsy samples, to prevent the results being confounded.

Authors' Disclosures of Potential Conflicts of Interest

The authors indicated no potential conflicts of interest.

REFERENCE

1. Mann GB, Fahey VD, Feleppa F, et al: Reliance on hormone receptor assays of surgical specimens may compromise outcome in patients with breast cancer. J Clin Oncol 23:5148-5154, 2005[Abstract/Free Full Text]

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Related Correspondence

• Can the Reliance of Hormone Receptor Assays of Surgical Specimens Be Explained by the Fluctuation of Estrogen Receptor, Progesterone Receptor, and HER-2 Protein Expression in Tumor Samples of Premenopausal Breast Cancer Patients?
  Andrea Alimonti, Gianluigi Ferretti, and Francesco Cognetti
  JCO 2005 23: 8918 [Full Text]

This Article Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Mann, G. B. Articles by Buchanan, M. R. Search for Related Content PubMed Articles by Mann, G. B. Articles by Buchanan, M. R. Related Articles Related Correspondence Social Bookmarking                            What's this?