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ORIGINAL ARTICLE
Year : 2014  |  Volume : 10  |  Issue : 1  |  Page : 26-28

Evaluation of ER, PR and HER-2 receptor expression in breast cancer patients presenting to a semi urban cancer centre in Western India


1 Rajarshee Chhatrapati Shahu Maharaj Government Medical College, Kolhapur, India
2 Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
3 Department Of Surgical Oncology, Kolhapur Cancer Centre, Kolhapur, India
4 Department of Preventive and Social Medicine, Rajarshee Chhatrapati Shahu Maharaj Government Medical College, Kolhapur, Maharashtra, India

Date of Web Publication23-Apr-2014

Correspondence Address:
Suraj B Pawar
Surgical Director, Kolhapur Cancer Centre, Kolhapur - 416 008, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.131348

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 > Abstract 

Background: Hormone receptor expression has been reported to be low in breast cancer patients from developing countries. The pattern of receptor expression from urban and rural areas is not well studied.
Materials and Methods: This is a retrospective analysis of 206 consecutive breast cancer patients presenting to a semi urban cancer centre from 2009-2010. The demographic and clinical variables included age, residential area (rural, semi urban, or urban), menopausal status, and clinical stage. The pathological variables included tumor type, the presence of ductal carcinoma in situ, lymphovascular invasion, and expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) receptors by immunohistochemical (IHC) analysis.
Results: The majority of patients were postmenopausal with the median age of 50 years. Invasive ductal carcinoma was the most common subtype (94%). The ER status was available in 101 (49.3%), PR in 99 (48.0%), and HER2 in 82 (39.8%) cases. In patients in whom this data were available, ER was positive in 44.6%, PR in 40.4%, and HER2 in 34.2%. Out of the 82 patients in whom data on all three receptors were available, 34.1% patients had triple negative tumors. Analysis of our data showed a trend toward increasing ER and PR expression with age but this was not statistically significant. The average age of menopause was between 40-50 years of age.
Conclusion: This report is an important documentation of the pathological characteristics in a predominantly rural/semi urban population of Indian breast cancer patients. Further studies from other centers with a similar background are required to confirm these results.

 > Abstract in Chinese 

印度西部近郊癌症中心乳腺癌患者的ER、PR和HER-2受体表达评估
背景:有报道在发展中国家的乳腺癌患者中激素受体表达处于低水平。来自城市和农村的(患者)受体表达的形式尚未被充分研究。
材料和方法:对2009~2010年位于近郊肿瘤中心收治的206例乳腺癌患者进行回顾性分析。人口统计学和临床变量包括年龄,居住区域(农村、近郊、城市),绝经状态和临床分期。病理学变量包括肿瘤类型,原位癌表达,淋巴转移,雌激素受体(ER),孕激素受体(PR),以及人表皮生长因子受体2(HER-2)表达感受器的免疫组化分析。
结果:入组病人中绝经后患者比例较高,平均年龄50岁。浸润性导管癌是最常见的组织学类型(94%)。ER可测的101例(49.3%),PR 99例(48.0%),HER-2 82例(39.8%)。在这些病人中,ER阳性的占44.6%,RP阳性40.4%,HER-2阳性34.2%。82例三组受体均可测得的病人中,34.1%是三阴乳腺癌。数据分析表明随着年龄增大,ER,PR的表达阳性有增长趋势,但无统计学意义。平均停经年龄是40~50岁。
结论:本文是关于印度乳腺癌患者(主要是农村、半城市人群)的一个病理学特性的重要文献。同时需要源于其它中心的类似背景的进一步研究来证实这些结果。
关键词:乳腺癌,受体,农村的


Keywords: Breast cancer, receptor, rural


How to cite this article:
Singh R, Gupta S, Pawar SB, Pawar RS, Gandham S V, Prabhudesai S. Evaluation of ER, PR and HER-2 receptor expression in breast cancer patients presenting to a semi urban cancer centre in Western India. J Can Res Ther 2014;10:26-8

How to cite this URL:
Singh R, Gupta S, Pawar SB, Pawar RS, Gandham S V, Prabhudesai S. Evaluation of ER, PR and HER-2 receptor expression in breast cancer patients presenting to a semi urban cancer centre in Western India. J Can Res Ther [serial online] 2014 [cited 2019 Sep 20];10:26-8. Available from: http://www.cancerjournal.net/text.asp?2014/10/1/26/131348


 > Introduction Top


Breast cancer is the second commonest cancer among women worldwide, and the most common cause of cancer death in women in the developed countries. [1] In India, an estimated 100,000 women are diagnosed with breast cancer with a case fatality ratio of 40%. [2] Expression of hormone receptors and the human epidermal growth factor receptor 2 (HER2) receptor has been found to be of prognostic and therapeutic importance in breast cancer. Hormone receptor expression has been reported to be lower in breast cancer patients from developing countries compared to that reported in Western populations. [3],[4],[5] However, most of these reports are from centers located in urban areas of developing countries. Because of the differences in demographic and socioeconomic profile of rural patients it is possible that the pattern of receptor expression is different in the tumors of these women. [6]

We undertook a retrospective analysis of breast cancer patients presenting to a cancer centre in a rural/semi urban region of Western India to evaluate the receptor expression pattern in the tumors of these women and to compare this to published literature from urban centers.


 > Materials and Methods Top


This is a retrospective analytical study that included consecutive patients of breast cancer presenting to a semi urban Cancer Centre during the years 2009-2010. The Medical Records Department was requested to provide the case charts of all patients diagnosed with breast cancer during this period. Information on demographic characteristics and pathological variables were abstracted from the case charts into a previously designed case record form. The demographic and clinical variables included age, residential area (rural, semi urban, or urban), menopausal status, and clinical stage. The pathological variables included tumor type, presence of ductal carcinoma in situ, lymphovascular invasion and expression of estrogen receptor (ER), progesterone receptor (PR), and the human epidermal growth factor receptor 2 (HER2) as determined by immunohistochemical staining using standard techniques. A few patients also had fluorescent in situ hybridization (FISH) testing for HER2 amplification that was recorded in the form. Any ambiguity in the report was resolved through discussion with the pathologists.

The data were entered and analyzed in SPSS version 17.0.


 > Results Top


A total of 206 patients with breast cancer were reported in our Cancer Centre during this period. The baseline characteristics of patients are shown in [Table 1]. The median age was 50 years (range 19-88).The majority of patients were in the age group 35-70 years (86.4%) and were postmenopausal (n = 128, 64%). Approximately half (n = 107, 52.2%) were residents of rural areas. Invasive ductal carcinoma was the most common subtype (n = 158, 94%), followed by invasive lobular carcinoma (n = 5, 3%) and others (n = 5, 3%). The ER status was available in 101 (49.3%), PR in 99 (48.0%), and HER2 in 82 (39.8%) cases. This was because many patients did not report back to the Centre after their tumor blocks were referred to an outside laboratory for immunohistochemistry and/or FISH.
Table 1: Patient characteristics

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The number of patients with ER positive (n = 45, 44.6%), PR positive (n = 40, 40.4%), and HER2 positive (n = 28, 34.2%) disease are shown in [Table 2]. Of the 82 patients in whom all three receptor reports were available, 28 (34.1%) were triple negative, defined as lack of expression of all three receptors. We have also analyzed the receptor expression by the age of the patients [Table 3]. There was a trend towards higher ER positivity in older patients (≥50 years) compared to younger ones (<50 years) (50.9% vs 37.5% respectively, P = 0.229) while there was a trend toward higher HER2 receptor positivity in younger (<50 years) compared to older (≥50 years) patients (36.2% vs 29.5%, respectively, P = 0.362). Triple negative breast cancer seemed to be similarly prevalent in older (≥50 years) and younger (<50 years) patients (31.8% vs 36.8%, P = 0.649). Lymphovascular invasion was present 47.6% of patients.
Table 2: Receptor expression pattern in all patients

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Table 3: Receptor expression pattern in different age groups

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We also analyzed the association of menstrual status with age. All women older than 50 years were postmenopausal and all women younger than 40 years were premenopausal. Of the 70 patients between ages of 40 and 50 years, 45.7% were premenopausal and 54.3% were postmenopausal. We further explored the association of receptor expression with the menopausal status [Table 4]. In postmenopausal versus premenopausal women, the rate of ER positivity was 48.4% versus 40.5%, PR positivity 41.0% versus 38.9% and HER positivity 35.8% versus 33.3%.
Table 4: Receptor expression in different menopausal groups

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 > Discussion Top


In this study, we evaluated the receptor expression profile in the tumors of 206 breast cancer patients who were diagnosed and operated at a semi urban cancer centre in India during 2009-2010. A little over half of the patients were from rural background. As seen in many other studies, the median age of patients was younger by about a decade compared to the West. [7],[8] This is likely to be due to the demographic profile of India where only 7% of the population is above the age of 60. [9] The proportion of tumors with receptor expression is different from that in Western countries. Overall, less than half of our patients were shown to have ER and/or PR expression compared to approximately 70-75% in the West. [10],[11],[12] One of the reasons for the lower fraction of hormone receptor positive tumors could be the lower average age of our patient population. The trend for receptor expression in our data shows that ER and PR expressions gradually increase with increasing age and HER2 and triple negative phenotype decrease with advancing age, although they are not statistically significant because of small numbers. Another important finding from our study is that the average age of menopause in a predominantly rural or semi urban population of Indian women is between 40-50 years of age. We could not calculate the exact median age at menopause because this was not recorded in the case charts. The age at menopause in our population has implications for the choice of endocrine therapy in patients with hormone receptor positive tumors.

Our study has a number of weaknesses. The most important is that data on ER, PR, and HER2 expression were not available in all patients. This reinforces the fact that standardized pathology infrastructure is lacking in many parts of our country. Furthermore, there was no external validation of the receptor expression in a Central or National reference laboratory. Our study has not reported on the treatment delivered and outcome in the analyzed population; therefore, the prognostic and/or predictive implications of these receptor expression patterns are unknown.

Despite these drawbacks, this report is an important documentation of the pathological characteristics, including the receptor expression patterns, in a predominantly rural or semiurban population of Indian patients. Further studies from other parts of India with a similar background are required to confirm these results.

 
 > References Top

1.Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin 2011;61:69-90.  Back to cited text no. 1
    
2.Sankaranarayanan R, Swaminathan R, Jayant K, Brenner H. An overview of cancer survival in Africa, Asia, the Caribbean and Central America: The case for investment in cancer health services. IARC Sci Publ 2011;162:257-91.  Back to cited text no. 2
    
3.Ghosh J, Gupta S, Desai S, Shet T, Radhakrishnan S, Badwe RA, et al. Estrogen, progesterone and HER2 receptor expression in breast tumors of patients, and their usage of HER2-targeted therapy, in a tertiary care centre in India. Indian J Cancer 2011;48:391-6.  Back to cited text no. 3
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4.Miller BA, Hankey BF, Thomas TL. Impact of sociodemographic factors, hormone receptor status, and tumor grade on ethnic differences in tumor stage and size for breast cancer in US women. Am J Epidemiol 2002;155:534-45.  Back to cited text no. 4
    
5.Sughayer MA, Al-Khawaja MM, Massarweh S, Al-Masri M. Prevalence of hormone receptors and HER2/neu in breast cancer cases in Jordan. Pathol Oncol Res 2006;12:83-6.  Back to cited text no. 5
    
6.Dey S, Soliman AS, Hablas A, Seifeldin IA, Ismail K, Ramadan M, et al. Urban-rural differences in breast cancer incidence by hormone receptor status across 6 years in Egypt. Breast Cancer Res Treat 2010;120:149-60.  Back to cited text no. 6
    
7.Forouzanfar MH, Foreman KJ, Delossantos AM, Lozano R, Lopez AD, Naghavi M, et al. Breast and cervical cancer in 187 countries between 1980 and 2010: A systematic analysis. Lancet 2011;378:1461-84.  Back to cited text no. 7
    
8.Agarwal G, Pradeep PV, Aggarwal V, Yip CH, Cheung PS. Spectrum of breast cancer in Asian women. World J Surg 2007;31:1031-40.  Back to cited text no. 8
    
9.Census of India. Office of the Registrar General and Census Commissioner, India 2011 Census Data. Available from: http://www.censusindia.gov.in/2011-prov-results/data_files/india/Final_PPT_2011_chapter 3.pdf. [Last accessed on 2012 Aug 26].  Back to cited text no. 9
    
10.Slamon DJ, Clark GM, Wong SG, Levin WJ, Ullrich A, McGuire WL. Human breast cancer: Correlation of relapse and survival with amplification of the HER2/neu oncogene. Science 1987;235:177-82.  Back to cited text no. 10
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11.Rhodes A, Jasani B, Balaton AJ, Barnes DM, Miller KD. Frequency of oestrogen and progesterone receptor positivity by immunohistochemical analysis in 7016 breast carcinomas: Correlation with patient age, assay sensitivity, threshold value and mammographic screening. J Clin Pathol 2000;53:688-96.  Back to cited text no. 11
    
12.Dent R, Trudeau M, Pritchard KI, Hanna WM, Kahn HK, Sawka CA, et al. Triple-negative breast cancer: Clinical features and patterns of recurrence. Clin Cancer Res 2007;13:4429-34.  Back to cited text no. 12
    



 
 
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  [Table 1], [Table 2], [Table 3], [Table 4]



 

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