Abstract

Point of Care Technologies in the Diagnosis of Breast Cancer in Both Resource-Rich and Poor Settings

Jane Brock, Assistant Professor, Brigham And Women's Hospital/Harvard Medical School

Breast Cancer care includes prevention, early detection, diagnostics and therapeutics. Therapeutic decisions are made based on traditional prognostic factors including tumor size, lymph node status, and factors obtained from pathological assessment including tumor grade, immunohistochemical profile of Estrogen and Progesterone Receptor (ER and PR) and Her2/neu gene amplification status. Point of care technology is not currently used in this routine pathological assessment, but there are opportunities to both expedite diagnosis and reduce costs in both resource-rich and poor settings. This presentation will discuss alternative methods of tissue biopsy handling and imaging, that can obviate the need for expensive processing equipment (that is rarely available in resource-poor settings), and can allow for rapid diagnosis, compared with traditional tissue processing (within fifteen minutes rather than > 24 hours). Tissue diagnosis by a pathologist remote from the point of care technology is also possible (pathologists are rarely available in resource-poor settings). The utility of providing a more rapid diagnosis in resource-rich settings will be increasingly apparent, as pre-treatment tumor samples are now routinely obtained to assess molecular signatures of targeted therapeutic susceptibility or resistance in the research setting. Rapid prognostic marker diagnosis, using either fresh or fixed tumor mRNA PCR, could easily replace the traditional histological evaluation for tumor grade, and ER, PR and HER2 status evaluation by immunohistochemistry on formalin-fixed, processed tissue specimens.  Such simple PCR amplification technology can provide the prognostic marker results within just a couple of hours, and can be a cheaper viable alternative for providing prognostic marker information, as it requires less skilled labor, both for the testing procedure and reading the test results, along with fewer reagents and fewer pieces of equipment overall. As such, it is