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Panel recommends improvements in estrogen testing accuracy

June 04, 2015

Washington, DC-Unreliable estrogen measurements have had a negative impact on the treatment of and research into many hormone-related cancers and chronic conditions. To improve patient care, a panel of medical experts has called for accurate, standardized estrogen testing methods in a statement published in the Endocrine Society's Journal of Clinical Endocrinology & Metabolism (JCEM).

The panel's recommendations are the first to address how improved testing methods can affect clinical care, and were developed based on discussions at an estrogen measurement workshop hosted by the Endocrine Society, AACC and the Partnership for Accurate Testing of Hormones (PATH).

Estrogen is primarily produced in the ovaries and is also produced in small amounts by the adrenal glands, which is why men as well as women have estrogen in their bodies. It is critical for fertility in women, and also plays a role in many health conditions, from precocious puberty to cancers of the breast, ovary, prostate and liver. Accurate blood tests for estrogen are necessary to diagnose patients with these conditions and ensure they receive appropriate, effective treatment. Many medical studies also rely on estrogen tests, such as research assessing the connection between estrogen levels and the risk of breast or prostate cancer.

"Accurate data on patients' estrogen levels are needed to ensure appropriate and effective patient care, reduce the need for retesting, and enable clinicians to implement the latest research in patient care," said one of the authors and co-chair of the PATH Steering Committee, Hubert Vesper, PhD. "Research studies, however, found high inaccuracies among different estrogen tests, especially when the test is measuring low estrogen levels in postmenopausal women, men and children."

The expert panel called for improving the accuracy of measurements through standardization, and recommended clinicians, researchers and public health officials support standardization programs like CDC's and other efforts to ensure estrogen measurement is accurate and consistent.

The panel also advised clinicians and researchers to consider the purpose of the test when selecting an estrogen measurement method. Clinicians and researchers currently use several methods to measure estrogen, including mass spectrometry and immunoassays. The experts agreed both methods are valid, but that one may be more effective than the other depending on the situation. For instance, mass spectrometry--the more expensive, but also more sensitive testing method--may be appropriate in people who tend to have low estrogen levels, including postmenopausal women and children beginning puberty.

Additionally, the experts recommended that medical journals require authors to fully explain the estrogen measurement testing methods used in studies. Ensuring researchers explain the processes they used will help the field move toward standardized methods.
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In addition to Vesper, other authors of the study include: L.M. Demers of Pennsylvania State University School of Medicine in Hershey, PA; S.E. Hankinson of the University of Massachusetts in Amherst, MA; S. Haymond of the Ann and Robert H. Lurie Children's Hospital of Chicago, IL; T. Key of the University of Oxford in Oxford, U.K.; W. Rosner of Columbia University in New York, NY; R.J. Santen of the University of Virginia Health Sciences System in Charlottesville, VA; F.Z. Stanczyk of the University of Southern California Keck School of Medicine in Los Angeles, CA; and R.G. Ziegler of the National Cancer Institute in Bethesda, MD.

The manuscript, "Measuring Estrogen Exposure and Metabolism: Workshop Recommendations on Clinical Issues," will be published in the June print issue of JCEM.

Founded in 1916, the Endocrine Society is the world's oldest, largest and most active organization devoted to research on hormones and the clinical practice of endocrinology. Today, the Endocrine Society's membership consists of over 18,000 scientists, physicians, educators, nurses and students in 122 countries. Society members represent all basic, applied and clinical interests in endocrinology. The Endocrine Society is based in Washington, DC. To learn more about the Society and the field of endocrinology, visit our site at http://www.endocrine.org. Follow us on Twitter at https://twitter.com/#!/EndoMedia.

Dedicated to achieving better health through laboratory medicine, AACC brings together more than 50,000 clinical laboratory professionals, physicians, research scientists, and business leaders from around the world focused on clinical chemistry, molecular diagnostics, mass spectrometry, translational medicine, lab management, and other areas of progressing laboratory science. Since 1948, AACC has worked to advance the common interests of the field, providing programs that advance scientific collaboration, knowledge, expertise, and innovation. For more information, visit http://www.aacc.org.

The Endocrine Society

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