In Sweden, the County Councils are grouped into six healthcare regions to facilitate cooperation and to maintain a high level of advanced medical care. One of them is Västra Götaland County Council with its Health Technology Assessment (HTA) Center, which aimed to work for continuous development of knowledge-based care in the region and ensure that healthcare is supported by science and evaluation. Also, it should follow up on the development of evidence-based healthcare nationally and internationally.
In June 2019, Västra Götaland HTA-Centre has published an HTA report for gene expression profiles to guide adjuvant chemotherapy in luminal, HER2-negative breast cancer. The following conclusions were provided:
- Withholding adjuvant chemotherapy in breast cancer patients with intermediate clinical risk of recurrence and low/intermediate risk according to a gene expression assay, compared with providing chemotherapy, probably results in little or no difference in overall survival within nine years (moderate certainty of the evidence)
- Withholding adjuvant chemotherapy in breast cancer patients with intermediate clinical risk of recurrence and low/intermediate risk according to a gene expression assay, compared with providing chemotherapy, can probably not exclude a small increased risk of recurrence (moderate certainty of the evidence)
This HTA on gene expression testing in patients with luminal breast cancer at intermediate clinical risk of recurrence reveals a lack of studies, comparing test versus no test, evaluating overall survival, health-related quality of life, and recurrence. The effects of avoiding adverse reactions from chemotherapy by withholding such treatment have not been studied in the patient group at issue.
See the full report in Swedish and English here