Breast Cancer Mini Symposium:
Pregnancy associated breast cancer: An institutional experience
Original Article
Departments of Medical Oncology, 1Surgical Oncology, and 2Radiation Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India Correspondence to: Dr. Vinod Raina, E‑mail: [email protected]
Gogia A, Deo SVS1, Shukla NK1, Mohanti BK2, Raina V
Abstract
BACKGROUND: Pregnancy‑associated breast cancer (PABC) has been defined as breast cancer diagnosed during pregnancy or within 1 year of
delivery. There is a paucity of data on PABC from India. The aim of our study was to assess the clinical‑pathological parameters and outcome of PABC at Institute Rotary Cancer Hospital, All India Institute of Medical Sciences. MATERIALS AND METHODS: We screened approximately 3,750 cases registered from January 2001 to December 2012 and found 26 cases of PABC. Patients’ records were obtained from the computer database using International Classification of Diseases code (C‑50). RESULTS: The median age was 26 years (range 20‑35). The median duration of symptoms was 11.5 months. The American Joint Committee on Cancer stage distribution was Stage I ‑ 1, Stage II ‑ 3, Stage III ‑ 14 and in Stage IV ‑ 8 patients. Median clinical tumor size is 5.5 cm. Four patients were presented with the inflammatory breast cancer. Positive family history was elicited in three patients. Twenty‑one patients were diagnosed after delivery, two patients in the first trimester, two patients in the second trimester and three patients in the third trimester. Estrogen receptor (ER), progesterone receptor (PR) negativity and human epidermal growth factor receptor 2 (HER2/neu) positivity was 56% and 38%, respectively. Nearly, 40% of patients had a high‑grade tumor and 70% had pathological node positivity. With a median follow‑up of 33 months, 3 years relapse free survival and overall survival was 40% and 50% respectively. Bone was the most common site for systemic relapse. CONCLUSIONS: PABC constituted 0.7% of all breast cancer patients. It is associated with advanced stage at presentation. Half of them were ER/PR negative and one‑third was HER2/neu positive. Key Words: Breast cancer, outcome, pregnancy
Introduction Breast cancer is one of most common cancer during the pregnancy along with melanoma and cervical cancer. [1] Pregnancy‑associated breast cancer (PABC) has been defined as breast cancer diagnosed during pregnancy or within 1 year of delivery. [2] Most of women of PABC present with larger tumors and have a higher incidence of lymph node metastasis at diagnosis. [3] The reason might be due to a delay in diagnosis, secondary to the engorgement and physiologic hypertrophy of the pregnant or lactating breast. Significant controversy exists in the literature, regarding the impact of pregnancy on prognosis. Previous studies have shown that after adjusting for age and stage, survival rates are similar in both pregnant and non‑pregnant women.[4,5] On the other hand, some studies pointed out the opposite results.[6] Recently, published meta‑analysis has shown that PABC is independently associated with poor over‑all survival and disease free survival.[7] Until date, there has been no published study from India on PABC. The aim of the present study was to analyze the clinical and pathological characteristics and outcome of PABC. Materials and Methods We screened approximately 3,750 cases registered from January 2001 to December 2012 and found 26 cases of PABC. Patient’s records were obtained from the computer database using International Classification of Diseases code (C‑50). Tumor staging was carried out according to the American Joint Committee on Cancer 7 th edition. Histological grading was performed using the Scarff‑Bloom‑Richardson (SBR) histological system. Access this article online Quick Response Code:
Website: www.indianjcancer.com DOI: 10.4103/0019-509X.138285 PMID: *******
Indian Journal of Cancer | April–June 2014 | Volume 51 | Issue 2
Immunohistochemical testing to determine estrogen (ER) and progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2/neu) receptor status was performed using standard procedures and stained with the monoclonal antibodies (1:400; Thermo, USA) for ER, PR and (1:100; Thermo, USA) for HER2/neu respectively. Nuclear staining> 1% of tumor cell was considered as positive for ER and PR. Patients were considered HER2‑positive if immunohistochemistry (IHC) was 3+ or Fluorescence in situ hybridization (FISH) was amplified (more than 6 copies of HER2/neu gene or HER2/neu: CEP17 ratio of more than 2) by Dako Hercep Test. FISH test was performed when IHC was 2+ and it was considered positive, when amplified. Triple negative breast cancer was defined as negativity for ER, PR and HER2/neu (IHC score 0 or 1+ or FISH non‑amplified). Relapse free survival (RFS) (non‑metastatic patients) was defined as the time period from diagnosis to the occurrence of relapse (loco‑regional/systemic) or metachronous breast cancer. Overall survival (OS) was calculated from the date of diagnosis to the date of death and patients were censored on last follow‑up. Baseline categorical variables were analyzed using Chi‑square test or Fisher’s exact test. Non‑categorical variables were analyzed using t‑test or Mann‑Whitney test. RFS, PFS and OS were determined by Kaplan Meier survival curves. Estimates were considered statistically significant for values of P
Pregnancy associated breast cancer: An institutional experience
Original Article
Departments of Medical Oncology, 1Surgical Oncology, and 2Radiation Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India Correspondence to: Dr. Vinod Raina, E‑mail: [email protected]
Gogia A, Deo SVS1, Shukla NK1, Mohanti BK2, Raina V
Abstract
BACKGROUND: Pregnancy‑associated breast cancer (PABC) has been defined as breast cancer diagnosed during pregnancy or within 1 year of
delivery. There is a paucity of data on PABC from India. The aim of our study was to assess the clinical‑pathological parameters and outcome of PABC at Institute Rotary Cancer Hospital, All India Institute of Medical Sciences. MATERIALS AND METHODS: We screened approximately 3,750 cases registered from January 2001 to December 2012 and found 26 cases of PABC. Patients’ records were obtained from the computer database using International Classification of Diseases code (C‑50). RESULTS: The median age was 26 years (range 20‑35). The median duration of symptoms was 11.5 months. The American Joint Committee on Cancer stage distribution was Stage I ‑ 1, Stage II ‑ 3, Stage III ‑ 14 and in Stage IV ‑ 8 patients. Median clinical tumor size is 5.5 cm. Four patients were presented with the inflammatory breast cancer. Positive family history was elicited in three patients. Twenty‑one patients were diagnosed after delivery, two patients in the first trimester, two patients in the second trimester and three patients in the third trimester. Estrogen receptor (ER), progesterone receptor (PR) negativity and human epidermal growth factor receptor 2 (HER2/neu) positivity was 56% and 38%, respectively. Nearly, 40% of patients had a high‑grade tumor and 70% had pathological node positivity. With a median follow‑up of 33 months, 3 years relapse free survival and overall survival was 40% and 50% respectively. Bone was the most common site for systemic relapse. CONCLUSIONS: PABC constituted 0.7% of all breast cancer patients. It is associated with advanced stage at presentation. Half of them were ER/PR negative and one‑third was HER2/neu positive. Key Words: Breast cancer, outcome, pregnancy
Introduction Breast cancer is one of most common cancer during the pregnancy along with melanoma and cervical cancer. [1] Pregnancy‑associated breast cancer (PABC) has been defined as breast cancer diagnosed during pregnancy or within 1 year of delivery. [2] Most of women of PABC present with larger tumors and have a higher incidence of lymph node metastasis at diagnosis. [3] The reason might be due to a delay in diagnosis, secondary to the engorgement and physiologic hypertrophy of the pregnant or lactating breast. Significant controversy exists in the literature, regarding the impact of pregnancy on prognosis. Previous studies have shown that after adjusting for age and stage, survival rates are similar in both pregnant and non‑pregnant women.[4,5] On the other hand, some studies pointed out the opposite results.[6] Recently, published meta‑analysis has shown that PABC is independently associated with poor over‑all survival and disease free survival.[7] Until date, there has been no published study from India on PABC. The aim of the present study was to analyze the clinical and pathological characteristics and outcome of PABC. Materials and Methods We screened approximately 3,750 cases registered from January 2001 to December 2012 and found 26 cases of PABC. Patient’s records were obtained from the computer database using International Classification of Diseases code (C‑50). Tumor staging was carried out according to the American Joint Committee on Cancer 7 th edition. Histological grading was performed using the Scarff‑Bloom‑Richardson (SBR) histological system. Access this article online Quick Response Code:
Website: www.indianjcancer.com DOI: 10.4103/0019-509X.138285 PMID: *******
Indian Journal of Cancer | April–June 2014 | Volume 51 | Issue 2
Immunohistochemical testing to determine estrogen (ER) and progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2/neu) receptor status was performed using standard procedures and stained with the monoclonal antibodies (1:400; Thermo, USA) for ER, PR and (1:100; Thermo, USA) for HER2/neu respectively. Nuclear staining> 1% of tumor cell was considered as positive for ER and PR. Patients were considered HER2‑positive if immunohistochemistry (IHC) was 3+ or Fluorescence in situ hybridization (FISH) was amplified (more than 6 copies of HER2/neu gene or HER2/neu: CEP17 ratio of more than 2) by Dako Hercep Test. FISH test was performed when IHC was 2+ and it was considered positive, when amplified. Triple negative breast cancer was defined as negativity for ER, PR and HER2/neu (IHC score 0 or 1+ or FISH non‑amplified). Relapse free survival (RFS) (non‑metastatic patients) was defined as the time period from diagnosis to the occurrence of relapse (loco‑regional/systemic) or metachronous breast cancer. Overall survival (OS) was calculated from the date of diagnosis to the date of death and patients were censored on last follow‑up. Baseline categorical variables were analyzed using Chi‑square test or Fisher’s exact test. Non‑categorical variables were analyzed using t‑test or Mann‑Whitney test. RFS, PFS and OS were determined by Kaplan Meier survival curves. Estimates were considered statistically significant for values of P
