Abstract
BackgroundBreast cancer is the most frequent malignancy among women in Eastern Morocco. In this paper, we provide the first report on molecular breast cancer subtypes in this region. This is the largest population–based study on breast cancer among Moroccan women.MethodsWe analyzed 2260 breast cancer cases diagnosed at the Hassan II Regional Oncology Center between October 2005 and December 2012. Clinico-pathological and therapeutic features were studied. Molecular subtypes were determined and their associations with the clinico-pathological characteristics of the tumors were examined.ResultsThe mean age at diagnosis was 48.7 years ±11.4. Invasive ductal carcinoma was the predominant histological type (77.1%), followed by lobular invasive carcinoma (15.3%). The mean size of breast tumors was 3.5 cm ± 1.96, and 84% of our patients are diagnosed with tumors of more than 2 cm. Histological grade II tumors were the most frequent (70.4%), followed by advanced histological grade (18%). Lymph node positive tumors were observed in 64.8% of cases and 29.3% of patients had distant metastasis. Most tumors were hormone receptor-positive (73%) and 28.6% were HER2 positive. 86.1% of patients with hormone receptor-positive breast cancer were given hormone therapy, while 68.9% of patients with HER2+ breast cancer received targeted therapy with Herceptin. Luminal A was the commonest molecular subtype, followed by Luminal B, Triple Negative and HER2. The highest prevalence of premenopausal patients was observed in Triple Negative subtype (72.2%), followed by HER2 (64.1%), Luminal B (62.2%), and Luminal A (55.1%). Luminal B subtype had a poorer prognosis than Luminal A. Compared with Triple Negative, HER2 subtype tend to spread more aggressively and is associated with poorer prognosis.ConclusionsUnlike Western countries, breast cancer occurs at an earlier age and is diagnosed at a more advanced stage in Eastern Morocco. In this region, hormone receptor-positive tumors are predominant and so the majority of breast cancer patients should benefit from hormone therapy. HER2 subtype presents an aggressive tendency, suggesting the importance of anti-HER2 therapy. This study will contribute in developing appropriate screening and cancer management strategies in Eastern Morocco.
Highlights
Breast cancer is the most frequent malignancy among women in Eastern Morocco
The present retrospective study was based on all female breast cancer cases that were registered at the Hassan II Regional Oncology Center (ROC), since it was created in October 2005 until December 2012
A total of 2406 new cases of female breast cancer were registered at the ROC since it was created in October 2005 until December 2012. 27 cases were in situ breast cancer and were eliminated (1.2% of total) because this study was restricted to invasive breast cancer. 119 cases for which IHC data were not available were excluded from the study
Summary
Breast cancer is the most frequent malignancy among women in Eastern Morocco. In this paper, we provide the first report on molecular breast cancer subtypes in this region. In 2000, a molecular classification of breast cancer based on gene expression profiles was proposed for the first time by Perou and his colleagues [7,8,9,10,11]. At least four breast cancer subgroups can be identified: Luminal A and Luminal B (which are positive for the hormone receptors), HER2 (which overexpresses the HER2 growth factor), and Basal-like (which is triple negative: estrogen receptor-negative (ER-), progesterone receptornegative (PR-), and HER2-negative (HER2-). The identification of these breast cancer molecular subgroups provides important information on the prognosis and the response to treatment of the disease. Immunohistochemical analysis was used as an alternative to determine the molecular subtypes of breast cancer and their distribution in several populations
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