Frequency and covariates of molecular subcategories of breast carcinoma - a referral tertiary care center study in Khyber Pakhtunkhwa, Pakistan
DOI:
https://doi.org/10.55629/pakjpathol.v35i2.814Abstract
Objective: To assess the frequency of different molecular subcategories of breast cancer and establish correlations with clinical and pathological features at a tertiary care center in Khyber Pakhtunkhwa, Pakistan.
Material and Methods: This cross-sectional study was conducted at CMH, Peshawar, Pakistan (a tertiary care center of Khyber Pakhtunkhwa, serving as a referral center for Bannu, Mardan, Nowshera, Risalpur, Landikotal, and Kohat city) from January 2021 to December 2022. Non-probability consecutive sampling technique was used to collect breast cancer samples i.e., biopsies, lumpectomies, and mastectomies of 161 cases. Immunohistochemistry was applied to all cases using polyclonal antibodies for ER, PR, HER2, and Ki-67 stains by DAKO envision method. All the cases were classified into four molecular subtypes of breast carcinoma (Luminal A, Luminal B, Her2 enriched, and triple-negative) according to the 2011 St Gallen consensus report.
Results: In this study, 161 patients were enrolled, with a mean age of 51.20±13.20 yrs (range: 22 to 75 yrs). The distribution of molecular subtypes revealed Luminal A as the most prevalent (29.9%), followed by Luminal B (26.7%), Her2 enriched (25.5%), and Triple negative (18.0%). Luminal A subtype predominantly affected individuals aged 31-50 yrs and 51-70 yrs, while Luminal B was more common in the 51-70 yr age group. Her2 enriched subtype was prevalent among the elderly, whereas the Triple-negative subtype impacted younger individuals. Invasive ductal carcinoma was notably the most frequent subtype among Luminal A and Luminal B cases.
Conclusion: Our study found that the Luminal A subtype occurred in 48 cases (29.9%), followed by Luminal B with 43 cases (26.7%). We identified a notable association between increasing age and breast cancer incidence in this study.
Keywords: Breast cancer, Histological characteristics, Molecular classification, Treatment strategies
References
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021; 71(3): 209-49. DOI: https://doi.org/10.3322/caac.21660
Breast cancer statistics in Pakistan 2021 [updated 4th April. Available from: https://gco.iarc.fr/today/ data/factsheets/populations/586-pakistan-fact-sheets.pdf.
Tsang JYS, Tse GM. Molecular classification of breast cancer. Adv Anat Pathol. 2020; 27(1): 27-35. DOI:https://doi.org/10.1097/pap.0000000000000232
Maass SWMC, Boerman LM, Verhaak PFM, Du J, de Bock GH, Berendsen AJ. Long-term psychological distress in breast cancer survivors and their matched controls: A cross-sectional study. Maturitas. 2019; 130: 6-12.
DOI: https://doi.org/10.1016/j.maturitas.2019.09.003
Özmen V, Özmen T, Doğru V. Breast Cancer in Turkey; An analysis of 20.000 patients with breast cancer. Eur J Breast Health. 2019; 15(3): 141-6.
DOI: https://doi.org/10.5152/ejbh.2019.4890
Pandit P, Patil R, Palwe V, Gandhe S, Patil R, Nagarkar R. Prevalence of Molecular subtypes of breast cancer: A single institutional experience of 2062 patients. Eur J Breast Health. 2019; 16(1): 39-43. DOI: https://doi.org/10.5152/ejbh.2019.4997
Azam M, Aslam M, Basharat J, Mughal MA, Nadeem MS, Anwar F. An empirical study on quality of life and related factors of Pakistani breast cancer survivors. Sci Rep. 2021; 11(1): 24391.
DOI: https://doi.org/10.1038/s41598-021-03696-9
Shah A, Haider G, Abro N, Bhutto S, Baqai TI, Akhtar S, et al. Correlation between age and hormone receptor status in women with breast cancer. Cureus. 2022; 14(1): e21652.
DOI: https://doi.org/10.7759%2Fcureus.21652
Ullah Z, Khan MN, Din ZU, Afaq S. Breast cancer awareness and associated factors amongst women in Peshawar, Pakistan: A cross-sectional study. Breast Cancer (Auckl). 2021 22; 15: 11782234211025346.
DOI: https://doi.org/10.1177/11782234211025346
Akbar F, Siddiqui Z, Waheed MT, Ehsan L, Ali SI, Wiquar H, et al. Spectrum of germline pathogenic variants using a targeted next generation sequencing panel and genotype-phenotype correlations in patients with suspected hereditary breast cancer at an academic medical centre in Pakistan. Hered Cancer Clin Pract. 2022 16; 20(1): 24. DOI:https://doi.org/10.1186/s13053-022-00232-2
Pandit P, Patil R, Palwe V, Gandhe S, Patil R, Nagarkar R. Prevalence of molecular subtypes of breast cancer: A single institutional experience of 2062 patients. Eur J Breast Health. 2019; 16(1): 39-43. DOI: https://doi.org/10.5152/ejbh.2019.4997
Widiana IK, Irawan H. Clinical and subtypes of breast cancer in indonesia. Asian Pacific J Cancer Care. 2020; 5(4): 281-5.
DOI:https://doi.org/10.22034%2FAPJCP.2018.19.1.161
Zhang L, Huang Y, Feng Z, Wang X, Li H, Song F, et al. Comparison of breast cancer risk factors among molecular subtypes: A case-only study. Cancer Med. 2019; 8(4): 1882-92.
DOI: https://doi.org/10.1002/cam4.2012
Dokcu S, Caparlar MA, Başçeken Sİ, Eroglu A. Distribution anclinicopathological characteristics of breast cancer molecular subtypes in Turkish women. Eur J Clin Med. 2022; 3(6): 14-20.
DOI:https://doi.org/10.24018/clinicmed.2022.3.6.220
Mthembu JG, Bhuiyan M. Profile of molecular subtyping of breast cancer and clinicopathological features in Mankweng Hospital breast oncology clinic, Limpopo Province, South Africa. S Afr Med J. 2021; 111(11b): 1132-5.
DOI: https://doi.org/10.7196/samj.2021.v111i11b.16104
Tsoutsou PG, Vozenin MC, Durham AD, Bourhis J. How could breast cancer molecular features contribute to locoregional treatment decision making?. Crit Rev Oncol Hematol. 2017 1; 110: 43-8. DOI:https://doi.org/10.1016/j.critrevonc.2016.12.006
Hashmi AA, Aijaz S, Khan SM, Mahboob R, Irfan M, Zafar NI, et al. Prognostic parameters of luminal A and luminal B intrinsic breast cancer subtypes of Pakistani patients. World J Surg Oncol. 2018; 16(1): 1-6. DOI: https://doi.org/10.1186/s12957-017-1299-9
Feng Y, Spezia M, Huang S, Yuan C, Zeng Z, Zhang L, et al. Breast cancer development and progression: Risk factors, cancer stem cells, signaling pathways, genomics, and molecular pathogenesis. Genes Dis. 2018; 5(2): 77-106.
DOI: https://doi.org/10.1016/j.gendis.2018.05.001
Tsang JYS, Tse GM. Molecular classification of breast cancer. Adv Anat Pathol. 2020;27(1):27-35. DOI:https://doi.org/10.1097/pap.0000000000000232
Llombart-Cussac A, Cortés J, Paré L, Galván P, Bermejo B, Martínez N, et al. HER2-enriched subtype as a predictor of pathological complete response following trastuzumab and lapatinib without chemotherapy in early-stage HER2- positive breast cancer (PAMELA): An open-label, single-group, multicentre, phase 2 trial. Lancet Oncol. 2017; 18(4): 545-54.
DOI:http://dx.doi.org/10.1016/S1470-2045(17)30021 -9
Fragomeni SM, Sciallis A, Jeruss JS. Molecular Subtypes and local-regional control of breast cancer. Surg Oncol Clin N Am. 2018; 27(1): 95-120.
DOI:https://dx.doi.org/10.1016%2Fj.soc.2017.08.005
Al-Thoubaity FK. Molecular classification of breast cancer: A retrospective cohort study. Ann Med Surg. 2020; 49: 44-8.
DOI: https://doi.org/10.1016/j.amsu.2019.11.021
Newman LA, Kaljee LM. Health disparities and triple-negative breast cancer in African American women: a review. JAMA Surgery. 2017; 152(5): 485-93.
DOi: https://doi.org/10.1001/jamasurg.2017.0005
Yin L, Duan JJ, Bian XW, Yu SC. Triple-negative breast cancer molecular subtyping and treatment progress. Breast Cancer Res. 2020 Dec;22:1-3.
DOI: https://doi.org/10.1186/s13058-020-01296-5
Zhao S, Zuo WJ, Shao ZM, Jiang YZ. Molecular subtypes and precision treatment of triple-negative breast cancer. Ann Transl Med. 2020; 8(7): 499.
DOI: https://doi.org/10.21037/atm.2020.03.194
Fragomeni SM, Sciallis A, Jeruss JS. Molecular subtypes and local-regional control of breast cancer. Surgical Oncol Clin. 2018; 27(1): 95-120.
DOI: https://doi.org/10.1016%2Fj.soc.2017.08.005
Lundgren C, Bendahl PO, Borg Å, Ehinger A, Hegardt C, Larsson C, et al. Agreement between molecular subtyping and surrogate subtype classification: A contemporary population-based study of ER-positive/HER2-negative primary breast cancer. Breast Cancer Res Treat. 2019; 178: 459-67. DOI: https://doi.org/10.1007/s10549-019-05378-7
Widiana IK, Irawan H. Clinical and subtypes of breast cancer in Indonesia. Asian Pacific J Cancer Care. 2020; 5(4): 281-5.
DOI:https://doi.org/10.31557/apjcc.2020.5.4.281-285
Paramita S, Raharjo EN, Niasari M, Azizah F, Hanifah NA. Luminal B is the most common intrinsic molecular subtypes of invasive ductal breast carcinoma patients in East Kalimantan, Indonesia. Asian Pac J Cancer Prev. 2019; 20(8): 2247.
DOI: https://doi.org/10.31557/apjcp.2019.20.8.2247
Sohail S, Alam SN. Breast cancer in pakistan - awareness and early detection. J Coll Physicians Surg Pak. 2007 Dec;17(12):711-2.
Badar F, Faruqui ZS, Uddin N, Trevan EA. Management of breast lesions by breast physicians in a heavily populated South Asian developing country. Asian Pac J Cancer Prev. 2011; 12(3): 827-32.
Banning M, Hafeez H. A two-center study of Muslim women's views of breast cancer and breast health practices in Pakistan and the UK. J Cancer Educ. 2010; 25(3): 349-53.
DOI: https://doi.org/10.1007/s13187-010-0051-8
Bottorff JL, Grewal SK, Balneaves LG, Naidu P, Johnson JL, Sawhney R. Punjabi women's stories of breast cancer symptoms: Gulti (lumps), bumps, and Darad (pain). Cancer Nurs. 2007; 30(4): E36-45.
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