Abstract
BackgroundOrganizations that issue guidance on breast cancer recommend the use of immunohistochemistry (IHC) for providing appropriate and precise care. However, little focus has been directed to the identification of maximum allowable turnaround times for IHC, which is necessary given the diversity of hospital settings in the world. Much less effort has been committed to the development of digital tools that allow hospital administrators to monitor service utilization histories of their patients.MethodsIn this retrospective cohort study, we reviewed electronic and paper medical records of all suspected breast cancer patients treated at one secondary-care hospital of the Mexican Institute of Social Security (IMSS), located in western Mexico. We then followed three years of medical history of those patients with IHC testing.ResultsIn 2014, there were 402 breast cancer patients, of which 30 (7.4% of total) were tested for some IHC biomarker (ER, PR, HER2). The subtyping allowed doctors to adjust (56.7%) or confirm (43.3%) the initial therapeutic regimen. The average turnaround time was 56 days. Opportune IHC testing was found to be beneficial when it was available before or during the first rounds of chemotherapy.ConclusionsThe use of data mining tools applied to health record data revealed that there is an association between timely immunohistochemistry and improved outcomes in breast cancer patients. Based on this finding, inclusion of turnaround time in clinical guidelines is recommended. As much of the health data in the country becomes digitized, our visualization tools allow a digital dashboard of the hospital service utilization histories.
Highlights
Organizations that issue guidance on breast cancer recommend the use of immunohistochemistry (IHC) for providing appropriate and precise care
There is an increased mortality trend associated with breast cancer in the country [11]. Testing for these IHC biomarkers needs to be fully recognized in clinical guidelines and hospital policies, and the testing must account for the wide diversity of patient trajectories and hospital settings [12]
We have revealed in this cohort that the use of opportune IHC testing is associated with beneficial therapeutic effects on breast cancer patients
Summary
Organizations that issue guidance on breast cancer recommend the use of immunohistochemistry (IHC) for providing appropriate and precise care. Two recent cohort studies in Mexico City [8, 9] showed that 56–64% of tumors had positive hormone receptor (ER, PR) status; 16–20% had HER2 positive status; and 23–26% had triple negative status While these frequencies mirror those of other high and middle income countries, there is a troubling onset of disease among younger patients in Mexico (aged < 40), with a high prevalence of triple-negative breast cancers [10]. There is an increased mortality trend associated with breast cancer in the country [11] Testing for these IHC biomarkers needs to be fully recognized in clinical guidelines and hospital policies, and the testing must account for the wide diversity of patient trajectories and hospital settings [12]
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