Innovation

Molecular testing in breast cancer: A new choice for Alberta

Project Lead: Judith Hugh, University of Alberta’s Division of Anatomical Pathology


Eighty per cent of all breast cancers contain the estrogen receptor ER+, and are treated with anti-estrogen agents to prevent tumour growth. However, out of the two types of ER+ tumours only one benefits from the addition of chemotherapy to the anti-estrogens.


The current test for determining which patients need chemotherapy is Oncotype Dx. The out-of-country molecular testing costs Albertans approximately $1 million per year. Recent head-to-head comparisons show that Prosigna, a newer Health Canada-approved molecular test that can be done locally and more cost-effectively, is more accurate than Oncotype Dx at predicting recurrence; however, breaking with an international standard with extensive clinical experience is a difficult transition.


Goals

Precise and cost-effective testing to save lives

Using funds from the Alberta Laboratory for Molecular Diagnostics (ALMDx) and the Cancer Strategic Clinical Network, Hugh’s team validated the Prosigna test locally with inter-test comparisons performed on 40 tumours. This comparison test served as the basis for a Health Economic Evaluation specific to Alberta, which led to a provincial consensus supporting the switch to Prosigna both for clinical and economic reasons.


Alberta could be the first province to adopt Prosigna. As an additional benefit, the machine used for the Prosigna test also serves as the test platform for a number of other molecular laboratory tests that will help advance precision medicine in lymphoma, lung and brain cancers as well. This technology is ready for adoption and scaling, providing benefits that will expand to better treat several types of cancer.