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New test may reduce chemotherapy use in breast cancer



Wednesday 23 May 2012



A new test called IHC4 that is being considered for use on the NHS could identify patients at such low risk of their breast cancer returning after surgery that they may be spared chemotherapy, according to research published in the British Journal of Cancer today.


The study of 101 patients – conducted by scientists in the Breakthrough Breast Cancer Research Centre at The Institute of Cancer Research (ICR) and clinicians at The Royal Marsden Hospital – suggested that almost half of patients currently classified as at intermediate risk of recurrence would be downgraded to low risk by the test. This would mean they would potentially safely avoid chemotherapy and its toxic side effects.


The IHC4 test uses simple technology that is available in most treatment centres around the UK and is relevant to the treatment for patients with oestrogen receptor  positive (ER positive) breast cancer. This is the most common type of the disease, accounting for around three out of four breast cancer cases, totalling around 36,000 patients in the UK each year. While many of these patients will benefit from chemotherapy, others have very low risk disease and this molecular test will help identify this group.


Professor Mitch Dowsett, from the Breakthrough Breast Cancer Research Centre at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, said: “This is a simple, cost-effective test. This new research suggests many additional patients could be classified as at low risk, and therefore avoid chemotherapy and its toxic side effects. This could make a big difference to those patients, and also save the NHS money. It is currently being assessed by NICE for widespread use through the NHS.


“We need to extend this research with clinical and laboratory colleagues at other centres, but if the results continue to be positive then this test could be of considerable value to patients."


Professor Dowsett’s team compared the diagnosis of ER positive breast cancer patients using two current standard diagnostic tools with the new IHC4 test. They found 15 of 26 patients classified as intermediate risk by one existing test, called AoL (Adjuvant Online), would have been reclassified as low risk using IHC4. Twenty-four of 59 patients classified as intermediate risk by the second existing test, called NPI (Nottingham Prognostic Index), would have been moved to the lower-risk category using IHC4. Around 13 patients using this second test were also reclassified as high risk.


In its provisional guidance, the National Institute for Health and Clinical Excellence (NICE), the body which decides what drugs and technologies are cost effective for use in the NHS in England and Wales, considered the test to be promising. The provisional guidance recommended the IHC4 test for further research to confirm its accuracy and benefits but rejected three other tests including Oncotype DX, which was considered too expensive. IHC4 has the potential to be very cost-effective for the NHS because it uses three tests already used in breast units, with one addition. Estimates suggest it could cost around £100-£200 per test, a fraction of the £2,000 it costs to use Oncotype DX.




Media contact: Richard Purnell in the Breakthrough Breast Cancer press office on 020 7025 2432 or 07778 682 001 or email [email protected]

"Assessment of the contribution of the IHC4+C score to decision making in clinical practice in early breast cancer" with corresponding author Mitch Dowsett published online on April 24 2012 and in print on May 23 2012. doi: 10.1038/bjc.2012.166


Breast Cancer
• Breast cancer is the most commonly diagnosed cancer in the UK – nearly 48,000 women and around 300 men are diagnosed every year
• One in eight women in the UK will develop breast cancer at some point in their lifetime
• The good news is that more women than ever in the UK are surviving breast cancer thanks to better awareness, better treatments and better screening


Breakthrough Breast Cancer
Breakthrough Breast Cancer funds ground-breaking research, campaigns for better services and treatments and raises awareness of breast cancer.  Through this work the charity believes passionately that breast cancer can be beaten and the fear of the disease removed for good. Find more information at


The Institute of Cancer Research (ICR) is one of the world’s most influential cancer research institutes.

Scientists and clinicians at the ICR are working every day to make a real impact on cancer patients’ lives. Through its unique partnership with The Royal Marsden Hospital and ‘bench-to-bedside’ approach, the ICR is able to create and deliver results in a way that other institutions cannot. Together the two organisations are rated in the top four cancer centres globally.

The ICR has an outstanding record of achievement dating back more than 100 years. It provided the first convincing evidence that DNA damage is the basic cause of cancer, laying the foundation for the now universally accepted idea that cancer is a genetic disease. Today it leads the world at isolating cancer-related genes and discovering new targeted drugs for personalised cancer treatment.

As a college of the University of London, the ICR provides postgraduate higher education of international distinction. It has charitable status and relies on support from partner organisations, charities and the general public.

The ICR’s mission is to make the discoveries that defeat cancer.

For more information visit


The Royal Marsden NHS Foundation Trust

The Royal Marsden opened its doors in 1851 as the world’s first hospital dedicated to cancer diagnosis, treatment, research and education.

Today, together with its academic partner, The Institute of Cancer Research (ICR), it is the largest and most comprehensive cancer centre in Europe treating over 44,000 patients every year.  It is a centre of excellence with an international reputation for groundbreaking research and pioneering the very latest in cancer treatments and technologies. The Royal Marsden also provides community services in the London boroughs of Sutton and Merton and in June 2010, along with the ICR, the Trust launched a new academic partnership with Mount Vernon Cancer Centre in Middlesex.  

Since 2004, the hospital’s charity, The Royal Marsden Cancer Charity, has helped raise over £50 million to build theatres, diagnostic centres, and drug development units.

Prince William became President of The Royal Marsden in 2007, following a long royal connection with the hospital.

For more information, visit

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