her 4 measurement as a means of predicting which DCIS is more likely to recur

[Lani]

Deciding whose DCIS to excise only and whose to excise AND radiate has been controversial as they had not found criteria which led them to believe one DCIS was more likely than another to recur.

As a high percentage of DCIS is her2 positive and as some on this board started with STAGE 0 (DCIS) and progressed to Stage 4, anything which indicates which DCIS is more likely to recur may be helpful...

PS Targeted Molecular Diagnostics, which Robin P has cited often, does test her4. As this is not a black-and-white situation ie, her4 can be present and the DCIS recur and absent and the DCIS not recur this test can only give one an idea of the likelihood (greater or lesser) rather than an absolute answer in any one particular person.

Food for thought?

1: Clin Cancer Res. 2005 Mar 15;11(6):2163-8. Links
Absence of HER4 expression predicts recurrence of ductal carcinoma in situ of the breast.

Barnes NL,
Khavari S,
Boland GP,
Cramer A,
Knox WF,
Bundred NJ.
Department of Academic Surgery, South Manchester University Hospital, Southmoor Road, Wythenshawe, Manchester M23 9LT, United Kingdom.
The type 1 tyrosine kinase receptor HER2 (c-erbB2/neu) is associated with resistance to hormone therapy and poor survival in invasive breast cancer, whereas HER4 expression is associated with endocrine responsiveness. Patterns of tyrosine kinase receptor coexpression may aid prediction of recurrence risk after surgery for ductal carcinoma in situ (DCIS). Women who had undergone surgery for pure DCIS were studied. Out of 129 primary tumors, 39 had recurred and 90 had not recurred after 5 years of follow-up. Primary tumors were compared for HER2, HER3, and HER4, estrogen receptor, and Ki67 by immunohistochemistry. HER2 was expressed in 58%, HER3 in 49%, and HER4 in 63% of nonrecurrent DCIS, compared with HER2 expression in 82% (P = 0.008), HER3 expression in 71% (P = 0.04), and HER4 expression in 36% (P = 0.004) in DCIS that subsequently recurred. Dually expressing HER2/4 DCIS was more likely to be estrogen receptor positive than HER2-only-expressing DCIS (73% versus 53%; P = 0.05). HER2 expression was associated with a higher percentage and HER4 expression a significantly lower percentage of proliferating DCIS cells (median, 13.8% versus 8.4%; P = 0.001). Coexpression of HER2 with HER4 was associated with reduced recurrence compared with HER2-only positive DCIS (P = 0.003). This association remained significant when analyzing only high nuclear-grade DCIS (P = 0.015). Low nuclear grade, low proliferation rate and presence of HER4 expression were independent predictors of nonrecurrence. Potentially, HER4 expression may identify women who could avoid radiotherapy after breast-conserving surgery for DCIS.
PMID: 15788662 [PubMed - indexed for MEDLINE]

[Bev]

Is this saying if you're HER2/4 +, your're likely to be ER+? So does this mean ER+ are less likely to recur?

[Lani]

It is saying that if your DCIS is only her2+ and not her4+ it is more likely to recur than those DCIS that were both her2+ and her4 +. The latter DCIS also tended to more likely be ER+

Hope this helps!