ABSTRACT

Corresponding Author:
Dr. B. Raj Siddharth,
MGM, Hospital, Warangal.
E-mail: dr.rajsiddharth@gmail.com

ABSTRACT

Breast carcinoma is the second most common carcinoma in women and account for 22% of all female cancers, which is more than twice the prevalence of cancer in women at any other site. Recent information suggests that globally after lung cancer, the carcinoma of the breast is the second leading cause of cancer related death and is the most common cancer among women excluding the non-melanoma skin cancers. India accounts for nearly six percent of deaths due to breast cancer in the world and also that one out of every 22 women in India are diagnosed with breast cancer every year.

The aim of this study is to determine the role of oestrogen receptor [ER] and progesterone receptor [PR] status in choice of treatment for further management of patients with breast carcinoma from December 2013 to June 2015, Medical College Warangal. Evaluation of ER and PR status with core needle biopsy and post-surgical histological specimen. Correlation of ER and PR status incidence with other prognostic factors: a) Patient age, b) Age at menarche, c) Age at menopause, d) Parity of patient, e) Tumor size, f) Number of lymph nodes.

METHODS

This study was carried out on patients admitted in the General Surgery Department, MGM Hospital, from December 2013 to June 2015, has been approved by local research ethical committee.

RESULTS

A low incidence of ER-positive and high incidence of ER-negative tumours. A higher incidence of poorly differentiated and a lower incidence of well-differentiated tumours, tumour grade was independent of age, menopausal status, histopathology and stage.

CONCLUSION

The women with oestrogen and progesterone receptor positive status can opt for hormonal therapy, which will be beneficial for them. The women with oestrogen and progesterone receptor negative status, hormonal therapy will be ineffective.

KEYWORDS

Carcinoma Breast, Oestrogen Receptor, Progesterone Receptor.

INTRODUCTION

Breast carcinoma is the second most common carcinoma in women and account for 22% of all female cancers, which is more than twice the prevalence of cancer in women at any other site.¹ Recent information suggests that globally after lung cancer, the carcinoma of the breast is the second leading cause of cancer related death and is the most common cancer among women excluding the non-melanoma skin cancers.² India accounts for nearly 6% of deaths due to breast cancer in the world and also that one out of every 22 women in India are diagnosed with breast cancer every year.³ Contrary to the West, where it is more common in the elderly, it is more common at a younger age in the Indian women, who present themselves in advanced stage with poor prognostic feature and have worse outcome when compared to their counterparts in the Western Countries.⁴

Oestrogen plays a central role in regulating growth kinetics of a variety of cells of epithelial linings, most importantly in the breast and endometrium. Breast cancer patients whose lesions contain both oestrogen receptor [ER] and progesterone receptor [PR] have the best probability of remission following hormonal therapy (Approaching 70%) than the group of patients whose lesions contain either receptor alone (Approximately 30%) or very low levels of both receptors (Approximately 10%). It has been shown that tumours expressing ER and PR tend to be better differentiated and low-grade tumours. ER negative status has been shown to be predictive of recurrence of low-stage tumours independent of tumour grade, while negative PR status is associated with a significant risk of lymph node metastasis independent of other clinicopathologic factors.^1,2,3

It has been reported that the less differentiated Grade III and IV tumours showed significantly lower levels of oestrogen and progesterone receptors in infiltrating ductal and lobular carcinoma irrespective of age. Patients younger than 53 years of age with Grade II and III infiltrating ductal carcinoma also had significantly lower levels of oestrogen receptors, but not of progesterone receptors when compared with those patients older than 53 years of age.⁵

The oestrogen receptor is probably the most powerful predictive marker due to the genomic instability, molecular heterogeneity and clonal evolution. The treatment of breast cancer can be difficult as each case is different from the other. In breast cancer, to date relatively few markers have been reported to have established predictive power and of relevance are the well-known markers the Oestrogen Receptor (ER) and the Progesterone Receptor (PR) for selecting endocrine-sensitive breast cancers and human epidermal growth receptor HER-2 for identifying breast cancer patients with metastatic disease, who may benefit from the use of monoclonal antibodies.

The oestrogen receptor is probably the most powerful predictive marker in breast cancer management, both in determining prognosis and in predicting response to hormone therapies. Progesterone receptor is also a widely used marker, although its value is less well established. Accordingly, in the West the Immunohistochemistry (IHC) testing for Oestrogen and Progesterone Receptors (ER/PR) is now recommended as mandatory in invasive breast cancer and optional in ductal carcinoma in situ (DCIS).³

OBJECTIVES OF THE STUDY

1. Evaluation of ER and PR status with core needle biopsy and post-surgical histological specimen.
2. Correlation of ER and PR status incidence with other prognostic factors.
3. Patient age.
4. Age at menarche.
5. Age at menopause.
6. Parity of patient.
7. Tumour size.
8. Number of lymph nodes.

MATERIAL AND METHODS

1. Source of Data

This study was carried out on patients admitted in the General Surgery Department, MGM Hospital, from December 2013 to June 2015; 40 patients with breast carcinoma not treated by chemotherapy, radiotherapy, hormonal therapy were included.

1. Method of Collection of Data

The clinical information like age of the patient, age at menarche, age at menopause, parity of the patient, tumour size and number of lymph nodes were collected. The histological grading was done according to the modified Scarff-Bloom-Richardson histological grading. The Oestrogen Receptor and Progesterone Receptor immunohistochemical staining were done on the specimen and it was evaluated based on this factor to reach a prognostic conclusion.

Inclusion Criteria

• Female patients with infiltrating duct carcinoma of breast that have been sent for histological grading and ER-PR including core needle biopsy.

Exclusion Criteria

• Male patients.
  • Those who have undergone any chemoreduction treatment.

METHOD

History

Each patient’s detailed history was taken, specially concerning their age, age of menarche, age of menopause, parity.

Examination

The patient is examined in detail. Both the breasts are examined, especially the tumour size and lymph nodes are noted.

Histopathology

The surgical specimen or the biopsy specimen is sent for grading as per Modified Scarff Bloom Richardson and immunohistochemistry for oestrogen and progesterone receptors.

RESULT

This study was carried out on patients admitted in the Department of General Surgery, MGM Hospital, Warangal, from December 2013 to June 2015; 40 patients with breast carcinoma not treated by chemotherapy, radiotherapy, hormonal therapy were included.

Here, the patient who took part in the study were from 35 to 70 yrs. of age, maximum people were in the age group of 45-50 yrs. The specimen from these women were sent for oestrogen and progesterone receptor status analysis. The mean age of the patients in the study is 48 yrs. and standard deviation is +/-3.6.

p=0.462

Here, the oestrogen receptor positivity/negativity is compared with the age of patient. A definitive positive correlation cannot be made as number of patients as a whole is more in the age group of 45-50 yrs; still in the above considered patients, receptor positivity is persisting as the age increases. The statistical analysis is done using Fisher exact test, according to which the p value is 0.462 which is not significant.

p=0.402

In case of the progesterone receptor, the negativity is maximum seen in 45-50 yrs. The study is done using the Fisher exact test and the p value is 0.402, which makes the analysis insignificant.

p=0.590

The study is done using the age, at which the women have attained their menarche and their oestrogen receptor status to find if there is any variation in the positivity/negativity at oestrogen receptor and age of menarche. The statistical analysis is done with Fisher exact test. The p value is 0.590, which makes it insignificant.

p=0.999

Here, the patient’s age at menarche is compared with the progesterone receptor status. Most of the women attained their menarche at the age of 14 and most of them were progesterone negative. They were 17 in number. The statistical analysis was made using Fisher exact test. The p value was found to be 0.999, hence it was insignificant.

p= 0.191

Here the study is done between the parity of the patient and the oestrogen receptor, which shows that among 8 nulliparous women in the study they were all oestrogen negative, as the parity has increased the oestrogen positivity has increased. The study was done using Fisher exact test and the p value 0.191 and it was insignificant.

p=0.155

Here the study is done between the parity of the patients and the progesterone receptor, among the 8 nulliparous women they were all progesterone negative. The study is done using Fisher exact test. The p value was 0.155 and it was to be insignificant.

p=0.044

Here the study is done between the tumour size and the oestrogen receptor status, in this study most of the women had tumour in the range of 2-5 cms and as the size of the tumour increased the oestrogen receptors negativity has increased. The statistics analysis is done using Fisher exact test and the p value was found to be 0.044, hence the study was found to be significant.

p= 0.044

Here the tumour size and the progesterone receptor status is compared; most of the tumour are in the range of 2-5 cms and they are mostly progesterone negative and as the size increases the receptors are negative. The study is done using the Fisher exact test and the p value is found to be 0.044 and it is found to be significant.

p= 0.008

Here the lymph node size and the oestrogen receptor status is compared; in most of the cases the lymph node numbers were between 4 and 10 and they were mostly oestrogen receptor negative. The study was done with Fisher exact test and p value was found to be 0.008 which is highly significant.

p= 0.044

Here the lymph node number and the progesterone receptor status is compared; most of the women had 4 to 10 lymph nodes and they were mostly progesterone negative. The study was made using Fisher exact test and the p value was found to be 0.044 and is significant.

p=0.025

Here the grade of the tumour is compared with the oestrogen receptor status; in this study most of the cases were Grade 2 and they showed oestrogen receptor negative and the negativity is found to increase with increase in grade of the tumour. The statistical analysis is done using the Fisher exact test, which shows p value is 0.025 which makes the association between grade and oestrogen receptor significant.

.

p=0.250

CONCLUSION

This was a prospective study and based on the study, the following conclusion can be arrived at,

• The oestrogen and progesterone receptor positive cases.
• Well differentiated.
• Less aggressive.
• Low lymph node metastasis.
  • The oestrogen and progesterone, both negative or one of them negative.
  • Moderately to poorly differentiated.
  • More chances of lymph node metastasis.
  • More aggressive.
    • The presence or the absence of these oestrogen or progesterone receptors will help people with breast cancer to decide on the type of treatment to be undertaken.

The women with oestrogen and progesterone receptor positive status can opt for hormonal therapy, which will be beneficial for them. The women with oestrogen and progesterone receptor negative status, hormonal therapy will be ineffective.

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