Breast Cancer In Indian Women Research Articles

Neoadjuvant pertuzumab, docetaxel, carboplatin, and trastuzumab (PTCH) regimen in patients with HER2 positive early, locally advanced, and oligometastatic breast cancer: Real-world Indian experience.

e12556 Background: Pertuzumab/docetaxel/carboplatin/trastuzumab (PTCH) regimen constitutes one of the standard neoadjuvant treatments in human epidermal growth factor receptor-2 (HER2) positive breast cancer. The real-world outcomes of its use from the Indian sub-continent are lacking. Methods: We retrospectively reviewed the medical records of 114 HER2-positive BC patients presenting with nonmetastatic or oligometastatic disease and treated with a uniform PTCH regimen in a neoadjuvant setting at the All India Institute of Medical Sciences, New Delhi, India, between Jan 2015 to May 2023. Total six cycles of PTCH [pertuzumab (840 mg loading followed by 420 mg), docetaxel (75 mg/m2), carboplatin (AUC 6), trastuzumab (8 mg/kg loading followed by 6 mg/kg) q21 days] were administered with primary GCSF prophylaxis. The primary outcome was invasive disease-free survival (iDFS). The secondary outcomes included pathological complete response (pCR) rates, overall survival (OS), and toxicity. Adjuvant trastuzumab is used for patients achieving pCR, while for patients not achieving pCR option of adjuvant trastuzumab emtansine (T-DM1) or trastuzumab was decided based on patient affordability. Results: One hundred and fourteen (114) patients were included with a median age of 47 years (range, 23-70). Overall, 52 (45.6%) patients had hormone-positive disease and 73 (64.01%) were premenopausal. Forty patients (35.08%) had stage II, 62 (54.38%) had stage III, and 12(10.5%) had oligometastatic disease. Sixty-one (53.5%) patients underwent breast conservation surgery and pCR was observed in 62 (54.38%) cases. With a median follow-up of 31 months, the 3-year iDFS was 81.5% and overall OS was not reached. Median iDFS was 33 months in patients with node-positive disease and was not reached in patients with node-negative disease. Three-year iDFS was 68.1% in patients who achieved pCR and 49.8% in those who did not achieve pCR (p=0.001). Grade 3/4 toxicity was seen in 26.7% of patients which caused dose modification and interruption in 13.9% of patients. The most common grade 3/4 toxicity was diarrhea in16 (14.03%) cases and thrombocytopenia in 11 (9.6)% cases . Febrile neutropenia was seen in 4 (3.5%) patients. Four patients (3.5%) had a reversible decrease in cardiac left ventricular ejection fraction. Conclusions: In a real-world context, PTCH is an effective and safe anthracycline-free regimen for use in curative (adjuvant and neoadjuvant) setting for HER2 positive breast cancer in Indian women Using neoadjuvant PTCH may improve pCR and obviate the need for adjuvant T-DM1 after surgery making it a cost-effective strategy in limited recourse setting. The survival outcomes were significantly better among those with node-negative disease and among those who achieved a pCR.

Menstrual and reproductive factors associated with risk of breast cancer among Indian women: a cross sectional study from National Family Health Survey, 2019-21

BackgroundThe breast cancer is common cancer in women globally. The risk of breast cancer is strongly associated with women’s menstrual and reproductive factors that have been established in different countries. Therefore present study was aim to explore the association between menstrual and reproductive factors and the risk of breast cancer screening in Indian women.MethodsThe present study data has been used fifth round of the National Family Health Survey (NFHS-V) with 724,115 women in aged 15–49 in 2019-21. The self-reported ever screened of breast cancer for women aged 30–49 was the main outcome variable of the study. Logistic regression models were used to estimate odds ratios and 95% confidence intervals for breast cancer by menstrual and reproductive factors adjusted for potential confounders.ResultsLate menarche (OR = 2.20, 95% CI: 1.48–3.28), irregular menstrual cycle (OR = 1.29, 95% CI: 1.08–3.53)), delay age at first birth (OR = 1.93, 95% CI: 1.11–3.04) and contraceptive pill used (OR = 1.11, 95% CI: 0.74–2.10) were significantly associated to increases the uptake of screening breast cancer. While, a higher number of birth (OR = 0.52, 95% CI: 0.10–1.03), and long duration of breast-feeding practice (OR = 0.75, 95% CI: 0.63–0.91) were reduced to participate for screening breast cancer.ConclusionThe results of the study confirm the role of menstrual and reproductive factors in breast cancer in Indian women. Therefore, our findings are imperative for developing breast cancer prevention strategies and better preparedness. Creating awareness and providing knowledge on cancer could be key strategies for the reduction of breast cancer in Indian reproductive age group women.

Association of hormonal and reproductive risk factors with breast cancer in Indian women: A systematic review of case-control studies.

The incidence of breast cancer in India has seen a rapid increase in recent years. Hormonal and reproductive risk factors for breast cancer have been affected by socioeconomic development. Studies on breast cancer risk factors in India are limited by the small sample size and specific geographical area. The current systematic review was carried out to assess the association of hormonal and reproductive risk factors with breast cancer in Indian women. A systematic review of MEDLINE, Embase, Scopus, and Cochrane database of systematic reviews were done. Relevant case-control studies published in peer-reviewed indexed journals were analyzed for hormonal risk factors such as age at menarche, menopause, and first childbirth; breastfeeding; abortion; and oral contraceptive pills use. Younger age (<13 years) at menarche was associated with high risk (odds ratio 1.23-3.72). Other hormonal risk factors with strong association were age at first childbirth and menopause, parity, and duration of breastfeeding. Abortion and the use of contraceptive pills did not have a clear association with breast cancer. Hormonal risk factors have a higher association in premenopausal disease and estrogen receptor-positive tumors. There is a strong association between hormonal and reproductive risk factors and breast cancer in Indian women. The protective effect of breastfeeding is related to the cumulative duration of breastfeeding.

Prospective evaluation of Tactile Breast examination by Visually Impaired for early detection of breast cancer in Indian women

Prospective evaluation of Tactile Breast examination by Visually Impaired for early detection of breast cancer in Indian women

A real-world experience of TCH (docetaxel/carboplatin/trastuzumab) regimen in early, locally advanced and oligometastatic HER2 positive breast cancer from tertiary care center in North India.

e12505 Background: In HER2 positive breast cancer, TCH is a safe and efficacious anthracycline free regimen used as both adjuvant and neoadjuvant modality. Three is scarcity of data regarding its long term safety and efficacy from India. Methods: This retrospective study comprised of 210HER2 positive breast cancer female patients treated with TCH [docetaxel (75mg/m2), carboplatin (AUC=6) and trastuzumab (8mg/kg loading followed by 6mg/kg) q 21 days with GSF prophylaxis] protocol for 6 cycles at our centre between Jan 2014 and Dec 2021. All eligible patients received maintenance trastuzumab, hormonal therapy and radiotherapy as per institutional protocol. The information regarding baseline clinico-demographic characteristics, treatment details, outcomes and toxicities were collected and evaluated. Results: The median age was 49 years (23-72), 113 (53.8%) were post-menopausal and 100 (47.6%) were Estrogen receptor/Progesterone receptor positive. Sixty-eight (32.4%) patients were stage I and II, 112 (53.3%) stage III and 30 (14.3%) were oligometastatic. TCH regimen was given as neoadjuvant chemotherapy (NACT) in 130 (61.9%) patients and as adjuvant chemotherapy in 80 (38.1%) patients. Of the patients receiving NACT, 114 (87.6%) patients underwent surgery. Twenty-two (19.3%) patients underwent breast conservation surgery and 92 (80.7%) underwent modified radical mastectomy. Over the study period, 62 (29.5%) patients had progression of the disease and 22 (10.5%) patients died. With a median follow up of 31.9 months, 3-year disease free survival (DFS) was 63.5% and overall survival (OS) was 90.8%. Median DFS was 31 months in patients with node positive disease and was not reached in patients with node positive disease. Of the patients who received NACT, pathologic complete response (pCR) was recorded in 42 (36.8%) patients. Three-year DFS was 59.1% in patients who achieved pCR and 44.8% in those who did not achieve pCR. Any grade 3/4 toxicity was seen in 26.7% patients which caused dose modification in 13.9% patients. The most common grade 3/4 hematological toxicity was anemia (15.1%) and thrombocytopenia (10.4%), while non-hematological toxicity was diarrhea (11.6%). Febrile neutropenia was seen in 4 (1.9%) patients. Four patients (1.9%) had reversible decrease in cardiac left ventricular ejection fraction. Conclusions: Anthracycline free TCH regimen is an effective and safe regimen for use in curative (adjuvant and neoadjuvant) setting for HER2 positive breast cancer in Indian women with outcomes comparable to the anthracycline based regimens reported in literature.

Genomic approach to identify association of environmental bisphenol-A (BPA) in daily use plastics as molecular disruptors in breast cancer

PurposeThe present study was aimed to investigate the association of Bisphenol-A (BPA) and MDM2 SNP309 polymorphism with the risk of breast cancer in Indian women. MethodsBlood samples from breast cancer patients and healthy controls were analyzed by using UV visible spectrophotometry for structural changes in blood components by BPAQ. MDM2 SNP309 polymorphism was investigated by using TETRA ARMS-PCR. ResultsOn comparing control groups, there is an increased mean absorbance at a range of 250 nm to 300 nm and 360 nm to 450 nm in breast cancer patients. The allele frequencies of case subjects (T, 0.47; G, 0.53) were significantly different from those of control subjects (T, 0.66; G, 0.34) (p = 0.011). The proportion of GG genotype of the SNP309 in breast cancer patients (28.88%) was significantly higher than that of control groups (13.33%). With TT genotype as reference, the genotypes (TG + GG) containing G allele as dominant form in breast cancer patients (OR, 2.80; 95% CI, 1.12–7.00); p = 0.025) were significantly associated with breast cancer. ConclusionsThe results revealed that there is an association between active metabolite of Bisphenol-A and MDM2 SNP309 G variant with the risk of breast cancer in Indian population.

Evaluation of Nitric Oxide, Endothelial Nitric Oxide Synthase and Lipid Profile in Breast Cancer: A Case-control Study

Introduction: Breast cancer accounts for 25% of all female cancer cases in India. Although, lipids and free radicals like Nitric Oxide (NO) have been related to breast cancer, but its pathogenesis remains controversial. Aim: To estimate NO, endothelial NO Synthase (eNOS) and lipid profile in serum of breast cancer patients and also to determine their possible role in patients of breast cancer in Indian women. Material and Methods: This was a hospital-based case-control study conducted for a period of 24 months from July 2012 to June 2014 in Dr VM Government Medical College, Solapur, with a total of 100 women (50 breast cancer cases and 50 healthy age matched controls) of age group 35-65 years. Fasting venous blood samples were collected. Biochemical parameters analysed in the study were serum NO, serum eNOS, serum Total Cholesterol (TC), serum Triglycerides (TG), serum High Density Lipoprotein (HDL) and serum Low Density Lipoprotein (LDL). Results were expressed as mean±Standard Deviation (SD) and Student’s unpaired t-test was used to compare the pairs of means. Results: There was no difference in mean age between cases (49.73±8.16 years) and controls (48.23±8 years). Serum levels of NO, eNOS, TC, TG and LDL were significantly higher in cases than in controls (55.92±6.54 µmol/L v/s 49.58±6.74 µmol/L for NO; 175.4±22.92 U/mL v/s 148.6±9.77 U/mL for eNOS; 271±9.16 mg/dL v/s 177.58±6.41 mg/dL for TC; 180.70±8.48 mg/ dL v/s 107.57±8.98 mg/dL for TG ; 177.39±6.21 mg/dL v/s 98.16±8.90 mg/dL for LDL). However, serum HDL levels did not showed significant difference in case group (57.55±6.40 mg/dL) when compared with control group (57.15±5.35 mg/dL). Conclusion: The present study demonstrated that high serum levels of NO, eNOS and lipids are associated with breast cancer and thereby suggests that increased NO, eNOS and abnormal lipid profile may have a role in pathogenesis of breast cancer.

Risk Factor Associations of Breast Cancer Among Women Attending Out-Patients Department of the Hospital: A Case vs. Control Study

Breast cancer is the first most common cancer in Indian women. The main factors that influence risk of breast cancer include being a woman and getting older, sociodemographic factors, family history of cancer, OCP, etc. The aim of the study was to report the sociodemographic factors, habits, personal history, clinical presentation of women and analyze risk factors with breast cancer in comparison with without breast cancer. This study is based on data collection from women (N = 606) from out-patients department of a regional cancer hospital who attended the Centre during the study period. Data analysis for 606 women showed the overall mean age of the participants was 39.32 ± 9.79 (mean ± SD) years with most (46.6%) of them belonging to the age group of 40–49 years. Most of them (39.6%) complain about feeling lumps inside the breast. Age at menarche starts at the age below 13 years, early marriage, parity more than 4, taking oral contraceptive pills as a method of contraception, do not feed to their child, most of them are housewife’s and have a family history of breast cancer. Age at menarche starts at the age below 13 years, early marriage, parity more than 4, taking oral contraceptive pills as a method of contraception, do not feed to the child and family history were highlighted as significant risk factors for breast cancer in Indian women. Hence, effective methods with routine organized screening programs are recommended to detect early breast cancer.

Risk factor stratification in breast cancer - a tertiary care analysis

Breast cancer is a very common malignancy diagnosed in India and is the most common cancer in women in India. The morbidity and mortality burden of malignancy in India ranks one of the highest in the world. India has a network of cancer registries, a process which has expanded since the 1960s and has new initiatives such as cancer atlas and online software programmes. The burden of breast cancer is on the rise in both developed and developing countries. The objectives were to identify and study the risk factors for breast cancer among women attending Saveetha Medical College and Hospital, Chennai and to study the association between risk factors and breast cancer. The case control study was conducted on 110 cases and 110 controls. A semi-structured questionnaire was used to collect information. Statistical Analysis was done using MS Excel 2007 and Chi Square test was also used. Of the parameters studied, residence, family history, parity, duration of breast feeding and oral contraceptive use were found to be associated with breast cancer and were statistically significant (p&lt;0.05). The findings suggest that positive family history, nulliparity, duration of breast feeding and OCP use may have an impact on breast cancer in Indian women. Hence screening and creation of awareness may help in decreasing mortality.

Socio-demographic factors and clinical presentation of women attending Cancer Detection Centre, Kolkata for breast examination

Breast cancer is the most common cancer in Indian women.The aim of the study was to report the sociodemographic factors, habits, personal history, gynecological and obstetric history, the clinical presentation of Indian women, and analyze those factors with the diagnosis of breast cancer.This study is based on retrospective data collection from case files of women who attended the Cancer Detection Centre during January1995-September 2016.Data analysis for 1196 women showed 31.5% aged between 26 and 35 years; 90.7% were Hindus; 61.3% school-educated; 77.0% housewives/unemployed; 80.6% married and 98.2% were non-vegetarian. Physical activity, medical history and gynecologic history of menarche, menstrual type, menopause, marital age, and breast feeding history had a strong correlation with clinical diagnosis (p<0.05). About 8.4% of the total population was diagnosed with breast cancer using smear cytology, FNAC, mammography, and USG.Age, lack of proper education, marital status, food habit, physical activity, age of menarche, menstrual type, menopause, marital age, and breastfeeding history were highlighted as significant risk factors of breast cancer in Indian women. Smears from nipple discharges, FNAC, mammography, and USG are effective methods for breast cancer detection in low-cost setting where routine organized screening programs are not available.The study will identify important risk factors among women in the Eastern region of India. Thus, background information of patients can be used to emphasize the importance of organizing breast cancer screening while making public health policies and implementing breast cancer control programs.

Study of Gene Expression Profiles of Breast Cancers in Indian Women

Breast cancer is the most common cancer among women globally. In India, the incidence of breast cancer has increased significantly during the last two decades with a higher proportion of the disease at a young age compared to the west. To understand the molecular processes underlying breast cancer in Indian women, we analysed gene expression profiles of 29 tumours and 9 controls using microarray. In the present study, we obtained 2413 differentially expressed genes, consisting of overexpressed genes such as COL10A1, COL11A1, MMP1, MMP13, MMP11, GJB2, and CST1 and underexpressed genes such as PLIN1, FABP4, LIPE, AQP7, LEP, ADH1A, ADH1B, and CIDEC. The deregulated pathways include cell cycle, focal adhesion and metastasis, DNA replication, PPAR signaling, and lipid metabolism. Using PAM50 classifier, we demonstrated the existence of molecular subtypes in Indian women. In addition, qPCR validation of expression of metalloproteinase genes, MMP1, MMP3, MMP11, MMP13, MMP14, ADAMTS1, and ADAMTS5 showed concordance with that of the microarray data; wherein we found a significant association of ADAMTS5 down-regulation with older age (≥55 years) of patients. Together, this study reports gene expression profiles of breast tumours from the Indian subcontinent, throwing light on the pathways and genes associated with the breast tumourigenesis in Indian women.

Use of animation video in surgical decision-making for treatment of early breast cancer in Indian women.

Introduction:Surgical decision-making in early breast cancer is difficult for the patient and also for the treating clinician, especially when the patient is not completely aware of the available options. Adjuncts such as animation video with case scenarios can be helpful in this regard. We used an animation video to help in decision-making and evaluated the effect of such adjunct in Indian women with early breast cancer.Materials and Methods:An animation video of running time of 4 min and 11 s was shown to forty patients with early breast cancer, who filled in a patient satisfaction multimedia questionnaire at the end of the animation.Results:Seventeen (42.5%) patients underwent breast-conserving surgery (BCS) while the rest 23 (57.5%) patients underwent the mastectomy. All forty patients were satisfied with the animation video. The mean score of the utility of the video to improve understanding of the disorder, better organization of treatment, stimulated interest in the relations, and saved unnecessary discussion was 88.50, 88.50,88.3, and 90.3, respectively. Age and literacy status did not significantly affect the scores.Discussion:All the patients found the video useful and most patients made the decision on the first attempt. Patients’ perspective about BCS is influenced by the fear of recurrence, fear of multiple surgeries, complications, and also the counseling provided by the surgeon.Conclusion:In this situation, such animation videos provide an unbiased view on the operative procedure and help in decision-making.

Breast Cancer in Indian Women: Genetic Risk Factors and Predictive Biomarkers

AbstractBreast cancer is the most common cancer among Indian women with a significant increase in incidence in young women. To identify risk factors for breast cancer in young women, study of BRCA1 and BRCA2 germ line mutations was done in a cohort of 204 Indian breast cancer patients. The study showed a total of 18 mutations in 2.94% of the tested patients, 44% BRCA1 and 78% BRCA2 mutations were found unique to the Indian population. Association of low penetrance genes mainly CYP17, VDR gene and AR-CAG repeat polymorphisms with breast cancer risk showed CYP17 A2 and VDR Poly-A L as high risk alleles, the risk of developing breast cancer among women carrying three high-risk alleles is 4.68 (95% confidence interval [CI]: 0.77–28.0; p for trend = 0.10) compared with women carrying none. CYP17 A2 allele was also found associated with development of breast cancer at young age and can also serve as a target for therapy. Betel quid chewing has been found as a significant and independent risk factor for developing breast cancer in North East Indian women which induces genetic alterations leading to breast carcinogenesis. Studies to assess the predictive role of various tumor markers showed that expression of p-glycoprotein in pretreatment biopsy predicts a poor clinical response to neoadjuvant chemotherapy (NACT) in patients having locally advanced breast cancer. The chemotherapy-induced toxicity (vomiting and alopecia) correlated significantly with clinical and immunohistochemical response (reduction in bcl2/bax ratio) and were found to be a cost-effective and reliable predictor of response to NACT. Androgen receptor (AR) has been identified as independent predictive marker for response to NACT in locally advanced breast cancer cases and can serve as novel therapeutic target for triple negative breast cancers.

Epidemiology of Breast Cancer in Indian Women: Population and Hospital Based study

BACKGROUND: Breast Cancer is a leading cause of mortality and ranked apex among females all over the world. Early detection and diagnosis of breast cancer may reduce the increasing burden of the disease. With this background, a Population and Hospital based cancer registries have been studied to understand the epidemiology of breast cancer trends in India.OBJECTIVE: The objective of this study is to gather information provided in different cancer registries and analyze the epidemiology of breast cancer statistics in India.METHODS: Age Adjusted Rate, Age Specific Rate and Mortality Incidence Ratio has been considered as evaluation metric.RESULTS: In this study it has been observed that the Age Adjusted Rate and Mortality rate of Breast Cancer has been reported as 25.8 and 12.7 per 100,000 women respectively.CONCLUSION: Additional awareness &amp; screening programs early diagnosis and treatment facilities can only significantly improve the breast cancer’s clinical picture in India.

Clinical profile of triple negative breast cancer in Indian women: Long term follow-up study.

e13109Background: Triple negative breast cancer (TNBC) is defined as the lack of expression of estrogen, progesteron and HER2 receptors. Out of all the breast cancer diagnosed annually nearly 17 pe...

Knowledge, attitude and practice of breast self examination (BSE) among female health workers of selected Hospitals of Dakshina Kannada District, Karnataka

Background: The prevalence of breast cancer in Indian women is around 20% of all cancers. Health care professionals can play an significant part in teaching women. Early detection and screening is important to identify the preventive diseases. Aim: This study aimed to determine the knowledge, attitude and practice of Breast Self Examination (BSE) among female health workers. Method: This cross sectional survey was conducted among 210 health care workers from 2 different hospitals Karnataka state, India. Self administered questionnaire was used to obtain information such as demographic characteristics, knowledge, attitude and practice regarding Breast Self Examination. Statistical Analysis: Descriptive and inferential statistics was used by using SPSS 16 version. Result: Around 127 (60.47%) of participants had an average knowledge about Breast Self Examination. Utmost 193 (91.90%) have a favorable attitude towards Breast Self Examination. Majority of 68.09% (143 out of 210) have performed Breast Self Examination. Though knowledge regarding Breast Self Examination was average, only 143 (68.09%) of them practiced BSE. Conclusion: There is need to continue education programs and training sessions frequently to sensitize more people towards practicing BSE. Health care workers need to emphasize on practicing BSE more to generate awareness & periodic screening.

Epidemiology of breast cancer in Indian women.

Breast cancer has ranked number one cancer among Indian females with age adjusted rate as high as 25.8 per 100,000 women and mortality 12.7 per 100,000 women. Data reports from various latest national cancer registries were compared for incidence, mortality rates. The age adjusted incidence rate of carcinoma of the breast was found as high as 41 per 100,000 women for Delhi, followed by Chennai (37.9), Bangalore (34.4) and Thiruvananthapuram District (33.7). A statistically significant increase in age adjusted rate over time (1982-2014) in all the PBCRs namely Bangalore (annual percentage change: 2.84%), Barshi (1.87%), Bhopal (2.00%), Chennai (2.44%), Delhi (1.44%) and Mumbai (1.42%) was observed. Mortality-to-incidence ratio was found to be as high as 66 in rural registries whereas as low as 8 in urban registries. Besides this young age has been found as a major risk factor for breast cancer in Indian women. Breast cancer projection for India during time periods 2020 suggests the number to go as high as 1797900. Better health awareness and availability of breast cancer screening programmes and treatment facilities would cause a favorable and positive clinical picture in the country.

Associations of CYP1A1 gene polymorphisms and risk of breast cancer in Indian women: a meta-analysis

AbstractReported associations of CYP1A1 polymorphisms with breast cancer have been inconsistent. In this meta-analysis examining breast cancer associations of three CYP1A1 polymorphisms (M1, M2 and M4) among Indian women may yield information that may be of clinical and epidemiological use for this particular demography. We searched MEDLINE using PubMed and Embase for association studies. From seven published case-control studies, we estimated overall associations and applied subgroup analysis to explore differential effects. All three polymorphisms exhibited overall increased risk, significant in M1 (OR 1.61–1.65, p = 0.04) and M4 (OR 2.02–3.92, p = 0.02–0.04). Differential effects were observed only in the M1 polymorphism where M1 effects were significant in South Indians (OR 2.20–4.34, p &lt; 0.0001) but not the North population, who were at reduced risk (OR 0.64–0.77, p = 0.03–0.55). These populations were not materially different in regard to M2 and M4 as did the women stratified by menopausal status. In this meta-analysis, M1 and M4 effects may render Indian women susceptible, but may be limited by heterogeneity of the studies. Differential effects of the M1 polymorphism in breast cancer render South Indians susceptible compared to those in the North.

Tailored approach to management of bilateral breast cancer in Indian women

Introduction: Bilateral breast cancer BCC is relatively uncommon with an overall incidence of 5–20% in women with early breast cancer. They are divided into synchronous if cancers are detected simultaneously or within 6 months of each other and metachronous if they are detected more than 6 months apart from each other. Family history and hereditary cancers multicentricity and lobular histology are some of the factors associated with BCC. In this background, we sought to evaluate the incidence, clinicopathological profile, and management of women with bilateral primary breast cancer at our institute. Materials and Methods: We retrospectively reviewed the medical records of women who underwent surgery for BCC at the breast services unit at our institute from October 2010 to April 2015. The clinicopathological profile and outcomes were analyzed using SPSS 22 software and appropriate statistical tests. Results: Out of 1330 women who underwent surgery for early breast cancer between October 2010 and April 2015, 44 were bilateral. Twenty-eight were synchronous and 16 were metachronous. Mean age of the presentation of patients was 53 years (range 30–79 years). The histological type were same in 82.14% of synchronous tumors and 87.5% of metachronous tumors (P = 0.496). The grades were similar in 42.85% of synchronous tumors and 56.25% of metachronous lesions (P = 0.294). The stage concordance among synchronous tumors was 39.28%, whereas it was 60% among metachronous lesions (P = 0.164). Conclusions: The management of BCC is complex and has to be tailored to the individual based on characteristics of index and second tumor, prior therapy, adjuvant treatment, and risk stratification. Moreover, the concordance of receptor expression is higher in synchronous cancers than metachronous cancers.

A Comparison of Clinical Features, Pathology and Outcomes in Various Subtypes of Breast Cancer in Indian Women.

Breast cancer is often classified into subtypes using immunohistochemical markers. These subtypes have distinct biological behaviour. This study was conducted with the aim of estimating the distribution of various subtypes of breast cancer in Indian population based on immunohistochemistry markers and to determine the clinical features, pathology and outcomes of these subtypes of breast cancer. A retrospective study was undertaken and all patients of breast cancer over a 5 year period were included. These patients were divided into 4 subgroups depending on the presence or absence of immunohistochemical markers: i) Luminal A (ER/PR+, Her 2 neu-); ii) Luminal B (ER/PR+, Her 2 neu+); iii) Her 2 enriched (ER-/PR-, Her 2 neu+) and; iv) Triple negative (ER-, PR-, Her2 neu-). Clinical and pathological features and survival were compared between patients in the 4 subgroups. Luminal A subgroup had majority of patients (43.8%). Patients in Luminal B, Her 2 enriched, and Triple negative subgroups were 14.8%, 16.1% and 25.3%. Median follow-up of patients was for 34 months. Luminal A subgroup patients were more likely to be postmenopausal and have smaller and lower grade (I/II) tumours with better survival (OS-91.06%). Patients in the Triple negative subgroup were more likely to be premenopausal (p-value 0.036, odds ratio 0.611, CI 0.394-0.949), have larger and higher grade (III) tumours with worse overall survival (OS-88.46%, odds ratio 1.32, 95%CI 0.602-2.39). Her 2 enriched group patients had bad prognostic features like larger size of tumour and higher grade of tumour and worst survival among all the subgroups (OS-85.07%, odds ratio 1.78, 95% CI 0.767-4.163). However, these outcomes were not statistically significant for the subgroups. A retrospective study was undertaken of breast cancer patients in India, according to subtypes based on immunohistochemistry. Luminal A had prognostic features and survival which was better as compared to other subgroups (Luminal B, Her 2 enriched and Triple negative). Incidence of patients with Triple negative breast cancer was higher in the premenopausal period. Patients with Her 2 enriched breast cancer had the worst survival among all the subgroups.