Abstract
ObjectivesThe study was aimed to determine the distribution of various breast cancer molecular subtypes in Saudi Arabia. Further, association between these subtypes and different epidemiological features was assessed.MethodsA retrospective study was conducted between January 2012 and December 2018, at the King Abdul Aziz University Hospital. A total of 740 cases of breast cancer, using immunohistochemistry, were classified into 4 major molecular subtypes: luminal A, luminal B, HER2-positive, and triple negative. Chi-squared test was performed to evaluate the relationship between these subtypes and clinico-pathological features.ResultsLuminal A (58.5%) subtype was the most prevalent, followed by triple negative (16%), luminal B (14%), and HER2-positive (11.5%). The average age of the patient at the time of diagnosis was found to be 49 years with an average tumor size of 3.2 cm. Out of all cases, 85% of cases were ductal, while 11.4% were lobular. 66.6% showed axillary lymph node metastases. While, 77% of lobular carcinomas were found almost exclusively in the luminal A and triple negative tumor subtype, 69.5% had modified radical mastectomy.ConclusionsLuminal A tumor was the most prevalent subtype, while HER2-positive was the least prevalent. Luminal A tumors were mostly associated with lobular carcinomas. HER2-positive and triple negative tumors showed higher histological grade and larger tumor size at the time of diagnosis. These tumors were commonly found in women below the age of 50 years. Carcinoma-in-situ was less prevalent in HER2-positive tumors. Furthermore, a strong association was observed between axillary lymph node status and molecular subtypes.
Highlights
Breast cancer is a heterogeneous disorder representative of numerous subcategories of several cellular compositions, molecular alterations as well as clinical behavior
It is worthy to note that the incidences of breast cancer is lower in Kingdom of Saudi Arabia (KSA) as compared to the worldwide average, but it represents a significant fraction of the cancer related fatality in women [1]
We examined the association between the molecular subtypes and age at diagnosis, tumor size, histopathological subtype, grade, presence of foci of in situ carcinoma, and nodal status using Chi-squared test for categorical variables
Summary
Breast cancer is a heterogeneous disorder representative of numerous subcategories of several cellular compositions, molecular alterations as well as clinical behavior. In the United States (US), an estimate of about a quarter of million new cases of BC were recorded in the year 2014, which in turn accounted for about 14% of all the new cancer cases [2]. In the Saudi women, breast cancer is the most common malignancy and accounts for about a quarter of the newly diagnosed cancer in females [4]. It is worthy to note that the incidences of breast cancer is lower in KSA (age standardized rate per 100,000 is 29.6) as compared to the worldwide average (age standardized rate per 100,000 is 43.1), but it represents a significant fraction of the cancer related fatality in women [1]. Molecular subtypes of breast cancer based on histological grade and lymph node metastases, are strong prognostic and predictive factors. Immunohistochemical analyses of tumors on the basis of status of ER, PR, and HER2 is used in clinical practice, and this method is
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