Distribution of Breast Cancer Biomarkers by Age in Iran

• Hassan Akbari

  Department of Pathology, Shahid Beheshti University of Medical Sciences, Mahdieh Hospital, Sharzad Street, Tehran, Iran And, Traditional Medicine School, Tehran University of medical Science, Enghelab Street, Tehran, Iran

• Farzad Taghizadeh Hesary

  Department of Radiotherapy-Oncology, Shahid Beheshti University of Medical Sciences, Shohada Tajrish Hospital, Qods Square, Tehran, Iran

• Laya Rahnar Nikoukar

  Tehran University of Medical Sciences, Enghelab Street, Tehran, Iran

 Background and Objectives: Breast cancer is the leading cause of cancer related death globally and presents as the most common female malignancy in Iran. Multiple factors are associated with an increased risk of developing breast cancer; for example first degree family history of breast cancer, BRCA1, 2 mutation and history of atypical hyperplasia on biopsy are the most important risk factors for developing breast cancer. Some prognostic factors are classically used that it would help us to either choosing recommended optimal treatment or recognizing the prognosis. In several studies it is shown that these factors have different patterns in age groups or histopathologic types. The aim of this study was to determine the age distribution of hormone receptors and biomarkers and determine their relation to the histopathologic types.

Methods: Data were gathered from the medical records of Baqiyatallah hospital, Tehran, Iran. Breast cancer patients whose disease was confirmed by pathologic studies and had immunohistochemical profile, were included. Estrogen receptor (ER), Progesterone receptors (PR), HER2/neu and p53 were selected as biomarkers of this study.

Results: Mean age of patients was 49.47±12.50 years (range 20 to 86). The most common histopathologic type was invasive ductal carcinoma. Distribution of ER and PR against age detected similar; ER positivity increased with age and it peaked in fifth decade of life, and PR positivity showed more regular pattern and it also peaked in fifth decade of life (p <0.05) HER2/neu positivity also had trend to increase with age and it peaked in sixth decade of life, but P53 had trend to show unimodal distribution pattern that peaked in sixth decade of life, but this findings were not statistically significant (p>0.05).

Conclusions: Our breast cancer patients were generally younger than patients round the world. The different distribution pattern of biomarkers in our studies in comparison with similar studies, may suggest different biologic behavior of breast cancer in our patients. Further studies will help illuminate this point.

Siegel R, Ward E, Brawley O, Jemal A. The impact of eliminating socioeconomic and racial disparities on premature cancer deaths. CA cancer J Clin 2011; 61: 212-36. https://doi.org/10.3322/caac.20121

Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin 2011; 61: 69-90. https://doi.org/10.3322/caac.20107

Harirchi I, Kolahdoozan S, Karbakhsh M, Chegini N, Mohseni SM, Montazeri A, et al. Twenty years of breast cancer in Iran: down staging without a formal screening program. Ann Oncol 2011; 22: 93-7. https://doi.org/10.1093/annonc/mdq303

Clemons M, Goss P. Estrogen and the risk of breast cancer. N Engl J Med 2001; 344: 276. https://doi.org/10.1056/NEJM200101253440407

Subramaniam DS, Isaacs C. Utilizing prognostic and predictive factors in breast cancer. Curr Treat Options Oncol 2005; 6: 147-59. https://doi.org/10.1007/s11864-005-0022-1

Bentzon N, Düring M, Rasmussen BB, Mouridsen H, Kroman N. Prognostic effect of estrogen receptor status across age in primary breast cancer. Int J Cancer 2008; 122: 1089-94. https://doi.org/10.1002/ijc.22892

Taneja P, Maglic D, Kai F, Zhu S, Kendig RD, Fry EA, et al. Classical and Novel Prognostic Markers for Breast Cancer and their Clinical Significance. Clin Med Insights Oncol 2010; 4: 15–34.

Gemmete JJ, Mukherji SK. Trastuzumab (Herceptin). AJNR Am J Neuroradiol 2011; 32: 1373-4. https://doi.org/10.3174/ajnr.A2619

Rastelli F, Crispino S. Factors predictive of response to hormone therapy in breast cancer. Tumor 2008; 94: 370-83.

Kheirelseid E, Boggs J, Curran C, Glynn R, Dooley C, Sweeney K, et al. Younger age as a prognostic indicator in breast cancer: A cohort study. BMC Cancer 2011; 11: 383. https://doi.org/10.1186/1471-2407-11-383

M. Elizabeth H, Hammond, Daniel F, Hayes, et al. American Society of Clinical Oncology/College of American Pathologists Guideline Recommendations for Immunohistochemical Testing of Estrogen and Progesterone Receptors in Breast Cancer: ASCO guideline. J Clin Oncol 2010; 28: 16.

Wolff AC, Hammond ME, Schwartz JN, et al. American Society of Clinical Oncology/College of American Pathologists guideline recommendations for human epidermal growth factor receptor 2 testing in breast cancer. Arch Pathol Lab Med 2007; 131: 18- 43.

Khatib OMN, Modjtabai A. Guidelines for the early detection and screening of breast cancer. East Mediterr Health J 2006; 1020-0428.

Harirchi I, Ebrahimi M, Zamani N, Jarvandi S, Montazeri A. Breast cancer in Iran: a review of 903 case records. Public Health 2000; 114: 143-5. https://doi.org/10.1016/s0033-3506(00)00324-3

Hadi N, Sadeghi-Hassanabadi A, Talei AR, Arasteh MM, Kazerooni T. Assessment of a breast cancer screening program in Shiraz, Islamic Republic of Iran. East Mediterr Health J 2002; 8: 386-92.

Kermani IA. Variation of tumor markers in 277 breast cancer cases. Asian Pac J Cancer Prev 2004; 5: 291-3.

Vahdaninia M, Montazeri A. Breast cancer in Iran: a survival analysis. Asian Pac J Cancer Prev 2004; 5: 223-5.

Mousavi SM, Montazeri A, Mohagheghi MA, Jarrahi AM, Harirchi I, Najafi M, et al. Breast cancer in Iran: an epidemiological review. Breast J 2007; 13: 383-91. https://doi.org/10.1111/j.1524-4741.2007.00446.x

Anderson WF, Pfeiffer RM, Dores GM, Sherman ME. Comparison of age distribution patterns for different histopathologic types of breast carcinoma. Cancer Epidemiol Biomarkers Prev 2006; 15: 1899-905. https://doi.org/10.1158/1055-9965.EPI-06-0191

Eppenberger-Castori S, Moore DH, Jr., Thor AD, Edgerton SM, Kueng W, Eppenberger U, et al. Age-associated biomarker profiles of human breast cancer. Int J Biochem Cell Biol 2002; 34: 1318-30. https://doi.org/10.1016/S1357-2725(02)00052-3

Quong J, Eppenberger-Castori S, Moore D, 3rd, Scott GK, Birrer MJ, Kueng W, et al. Age-dependent changes in breast cancer hormone receptors and oxidant stress markers. Breast Cancer Res Treat 2002; 76: 221-36. https://doi.org/10.1023/A:1020886801674

Alvarez Goyanes RI, Escobar Perez X, Camacho Rodriguez R, Orozco Lopez M, Franco Odio S, Llanes Fernandez L, et al. Hormone receptors and other prognostic factors in breast cancer in Cuba. MEDICC Rev 2010; 12: 36-40.

Parise CA, Bauer KR, Caggiano V. Variation in breast cancer subtypes with age and race/ethnicity. Crit Rev Oncol Hematol 2010; 76: 44-52. https://doi.org/10.1016/j.critrevonc.2009.09.002

Pourzand A, Fakhree MB, Hashemzadeh S, Halimi M, Daryani A. Hormone receptor status in breast cancer and its relation to age and other prognostic factors. Breast Cancer (Auckl) 2011; 5: 87-92.

Lin C-H, Lu Y-S, Huang C-S, Kuo K-T, Wang C-C, You S-L, et al. Prognostic molecular markers in women aged 35 years or younger with breast cancer: is there a difference from the older patients? J Clin Pathol 2011; 64: 781-7. https://doi.org/10.1136/jclinpath-2011-200064

Homaei-Shandiz F, Ghavam-Nassiri MR, Sharifi N, Homaei-Shandiz AH, Taghizadeh-Kermani A, Torshizi SA, et al. Evaluation of the relationship between human epidermal growth factor receptor-2/neu (c-erbB-2) amplification and pathologic grading in patients with breast cancer. Saudi Med J 2006; 27: 1810-4.

Fakheri TN, B. Fadakar, Gh. The relationship between p53 and some clinical pathologic factors and steroid receptor in breast cancer. Journal of Guilan University of Medical Sciences 2006; 15: 1-6.

Najafi BF, T. Fadakar, Gh. The relationship between HER2 and other pathologic diagnostic criteria in breast cancer. Journal of Guilan University of Medical Sciences 2005; 15: 21-7.

Akbari M, Souri. 5-year survival in breast cancer patients referred to 2 hospitals in Tehran. Hakim 2006; 9: 39-44.

• PDF