Annual cost-savings with the implementation of estrogen-receptor-only testing on Ductal Carcinoma in Situ specimens

Published:October 18, 2022DOI:


      • ER status is important in determining DCIS treatment.
      • Cost-savings with omission of routine PR testing for DCIS is $4.3 million.
      • PR testing should only be performed for ER negative DCIS.



      In DCIS, ER status is an important marker. The utility of concomitant PR testing remains unclear.


      A single-institution retrospective cohort study was performed with a comparative analysis of the NCDB to assess annual cost-savings with omission of routine PR testing. National Medicare payment standards determined PR staining costs to be $124.92.


      150 institutional DCIS cases with receptor data were identified. 104 (69%) were ER+/PR+, 16 (11%) were ER+/PR-, and none were ER-/PR+. Omission of routine PR testing would have resulted in $18,738 saved annually. Within the NCDB, 34,100 DCIS cases had receptor data: 29,277 (85.9%) patients were ER+, and 26,008 (76%) were both ER/PR+. 211 (0.6%) patients were ER-/PR+. Annual national cost-savings with omission of routine PR-testing would have been $4.3 million.


      PR testing for DCIS should be reserved only for patients with ER- DCIS undergoing breast conservation to determine the utility of adjuvant endocrine therapy.

      Graphical abstract


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