A study of BMI status and estrogen- progesterone receptors in patients with carcinoma of breast

Syed Aezaz Quryshi^1*, Ramdas Rai²

¹Resident, ²Professor, Department of Surgery, Yenepoya Medical College, Mangalore, Karnataka, INDIA.

Email: aezaz89@yahoo.com

Abstract         Introduction: Breast carcinoma is the second most common carcinoma in women and account for 22 % of all female cancer, which is more than twice the prevalence of cancer in women at any other site. Aims and Objective: To Study BMI Status and estrogen- Progesterone Receptors in Patients with Carcinoma of Breast. Methodology: This study was carried out on patients coming to the Department of Surgery in Yenepoya Medical College Hospital from October 2013 to October 2015. Around 50 patients with breast carcinoma not treated by chemotherapy, radiotherapy, and hormonal therapy were included. The clinical information like age of the patient, age of menarche, age of menopause, parity of the patient, tumor size and number of lymph nodes and BMI were collected. The statistical analysis done by Fisher Exact test. Result: Maximum people were in the age group of 45 -50yrs.The specimen from these women were send for estrogen and progesterone receptor status analysis. The mean age of the patients in the study is 48 yrs. Most of the patients with tumors were seen with BMI in the range of 18-25. Majority of which were ER Negative. There is decreasing trend of ER Negative tumors as the BMI increases (Fischer exact test and the p value is 0.025, which is significant).Most of the patients were seen in the range of 18-25. Majority of which were PR Negative. There is decreasing trend of PR Negative tumors as the BMI increases. (By Fischer exact test the p value is 0.821which is not-significant). Conclusion: BMI is more co related with ER rather than PR and there is decreasing trend of ER as BMI increases and hence disease prognosis is also decreases.

Keywords: BMI Status, estrogen- Progesterone Receptor, Carcinoma of Breast.

INTRODUCTION

Breast carcinoma is the second most common carcinoma in women and account for 22 % of all female cancer, which is more than twice the prevalence of cancer in women at any other site¹. Recent information suggests that globally following lung cancer, 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 cancers². 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 year³. 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 counter-parts in the western countries⁴. Estrogen plays a central role in regulating growth kinetics of a variety of epithelial linings, most importantly in the breast and endometrium. Breast cancer patients whose lesions contain both estrogen 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 tumors expressing ER and PR tend to be better-differentiated and low-grade tumors. ER negative status has been shown to be predictive of recurrence of low stage tumors, independent of tumor grade, while negative PR status is associated with a significant risk of lymph node metastasis independent of other clinic pathologic factors^1,2,3. It has been reported that the less differentiated Grade III and IV tumors showed significantly lower levels of estrogen 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 estrogen receptors, but not of progesterone receptors, when compared with those patients older than 53 years of age.⁵

MATERIAL AND METHODS

This study was carried out on patients coming to the Department of Surgery in Yenepoya Medical College Hospital from October 2013 to October 2015. Around 50 patients with breast carcinoma not treated by chemotherapy, radiotherapy, and hormonal therapy were included. The clinical information like age of the patient, age of menarche, age of menopause, parity of the patient, tumor size and number of lymph nodes and BMI were collected. The histological grading was done according to the modified Scarf-Bloom-Richardson histological grading. The Estrogen Receptor and Progesterone Receptor immunohistochemical staining were done on the specimen and it was evaluated based on this factor to reach a prognostic conclusion. Female patients with infiltrating duct carcinoma of breast that have been sent for histological grading and ER, PR including core needle biopsy were included into study while Male patients, Those who have undergone any chemo radiation treatment were excluded from the study. The statistical analysis done by Fisher Exact test.

RESULT

Table 1: Age and no.of patients with carcinoma

Here the patient who took part in the study were from 30 to 70 yrs. of age, maximum people were in the age group of 45 -50yrs.The specimen from these women were send for estrogen and progesterone receptor status analysis. The mean age of the patients in the study is 48 yrs. and standard deviation is +/- 8.0

Table 2: Comparing BMI to ER Status BMI

Most of the patients with tumors were seen with BMI in the range of 18-25. Majority of which were ER Negative. There is decreasing trend of ER Negative tumors as the BMI increases. The statistical analysis is done using Fischer exact test and the p value is 0.025, which makes it significant.

Table 3: Comparing BMI to PR status BMI

Most of the patients were seen in the range of 18-25. Majority of which were PR Negative. There is decreasing trend of PR Negative tumors as the BMI increases. The statistical analysis is done using Fischer exact test and the p value is 0.821which makes it insignificant.

DISCUSSION

In 1985 a second growth factor was discovered which is the HER-2 or erb- B2/neu Protein⁶. It is used for prognostic purposes in node-negative patients to assist in theselection of adjuvant chemotherapy because response rates appear to be better with doxorubicin-based adjuvant chemotherapy in patients with tumors that over express HER-2/neu, and as baseline information in case the patient develops recurrent disease that may benefit from anti–HER-2/neutherapy (transtuzumab). Patients with tumors that overexpress HER-2/neumay benefit if transtuzumab is added to paclitaxel chemotherapy.⁷ There are two main steroid receptors estrogen(ER) and progesterone (PR) receptors. These hormone estrogen and progesterone play a major role in breast cancer especially the estrogen, its metabolites and progesterone enable in the development and progression of breast cancer. The risk for breast cancer is due to the duration of exposure to estrogen. In case of postmenopausal women it is the duration of exposure to estrogen and progesterone in the hormone replacement therapy, which increases the chance for cancer by 26 %. There are two main steroid receptors estrogen(ER) and progesterone (PR) receptors. The estrogen and progesterone sensitive receptors are cytosolic, glycoprotein present in breast and certain tumor tissue. This is an important prognostic indicator. The tissue for receptor study is sent at low temperature in ice flask. It is assessed by quantitative analysis (frozen -700 ). If value is more than 10 units (f/mols) per n gram of tissue is called estrogen receptor positive status.60% of the post-menopausal cases are usually estrogen receptor positive and premenopausal cases are 30% positive %. The determination of estrogen and progesterone receptor status used to require biochemical evaluation of fresh tumor tissue. Now, estrogen and progesterone receptor status can be measured in archived tissue using immunohistochemical techniques. Hormone receptor status also can be measured in specimens obtained with fine-needle aspiration biopsy or core-needle biopsy. Tumor positive for hormonal receptors hormonal therapy including tamoxifen is more beneficial. Tumors positive for both receptors have a response rate of >50%, tumors negative for both receptors have a response rate of <10%, and tumors positive for one receptor but not the other have an intermediate response rate of 33%. This can help guide treatment planning, hence testing for estrogen and progesterone receptors should be performed on all primary invasive breast cancer specimens.^8,9,10,11 In our study we have found that Most of the patients with tumors were seen with BMI in the range of 18-25. Majority of which were ER Negative. There is decreasing trend of ER Negative tumors as the BMI increases. The statistical analysis is done using Fischer exact test and the p value is 0.025, which makes it significant. Most of the patients were seen in the range of 18-25. Majority of which were PR Negative. There is decreasing trend of PR Negative tumors as the BMI increases. The statistical analysis is done using Fischer exact test and the p value is 0.821which makes it insignificant. Lu et al. ¹² showed that among white women, but not among black women, obese subjects (BMI ≥ 30.0 kg/m2) had a greater risk of all-cause mortality and breast cancer-specic mortality than those with BMI of 20 to 24.9 kg/m2. In Chinese populations, overweight and obesity (BMI ≥25.0 kg/m2) have to be found to be associated with reduced DFS and OS ¹³. Likewise, overweight or obese women with breast cancer (BMI≥25.0 kg/m2) were found to have a signicantly shorter 10-year DFS and OS, compared with those with lower BMI. Maehle et al.¹⁴ demonstrated that the associations of obesity, lymph node status and prognosis in breast cancer patients are dependent on ER and PR status. In agreement with these results, our data revealed that BMI was an independent prognostic factor for both DFS and OS in patients with hormone receptor-positive breast cancer, but not in those with hormone receptor-negative tumours.

CONCLUSION

BMI is more co related with ER rather than PR and there is decreasing trend of ER as BMI increases and hence disease prognosis is also decreases as prognosis of the Ca- Breast mostly co- related with ER receptors.

REFERENCES

1. Birrell SN, Hall RE, Tilley WD. Role of the androgen receptor in human breast cancer. 1998; 3:95-103.
2. Payne SJ, Bowen RL, Jones JL, Wells CA. Predictive markers in breast cancer the present. Histopathology.2008; 52:82-90.
3. Ferlay J, Bray F, Pisani P. and Parkin DM. GLOBOCAN 2002. Cancer Incidence, Mortality and Prevalence Worldwide. IARC Cancer Base No. 5, version 2.0. IARC Press, Lyon, 2004.
4. Tewari M, Krishnamurthy A, Shukla HS. Predictive markers of response to neoadjuvant chemotherapy in breast cancer. Surg Oncol. 2008; 7:301-311.
5. Mohammed HR, Lakatua DJ, Haus E, Yasmineh WJ. Estrogen and progesterone receptors in human breast cancer. Correlation with histological subtype and degree of differentiation in University of Minnesota Cancer Cytopathology -CA: a Cancer Journal for Clinicians.2006; 58:1076-81.
6. Burstein HJ, Harris JR, Marrow M. Malignant Tumors of the Breast. Devita 8th edition 2008; 43.2: 1606-12.
7. Bland I K, Beenken WS, Copeland E M.The Breast Schwartz Text Principles of Surgery 9th edition 2008; 15:453-94.
8. Breasted JH: The Edwin Smith Surgical Papyrus. Chicago: University of Chicago Press,. Classics of MedicineLibrary, vol. III.1930; 405.
9. Celsus AC: De Medicina, Vol II. Loeb Classical Library Ed, Book V. Cambridge: Harvard University Press, 1935; p. 131.
10. Beenken SW, et al: History of the therapy of breast cancer, in Bland and Copeland (Eds): The Breast: Comprehensive Management of Benign and Malignant Disorders. Philadelphia: Saunders. 2004; p 5.
11. Moore C: On the influence of inadequate operations on the theory of cancer. R Med Chir Soc. 1867; 1:244.
12. Lu Y, Ma H, Malone KE, et al. Obesity and survival among black women and white women 35 to 64 years of age at diagnosis with invasive breast cancer. J ClinOncol 2011; 29:3358-3365.
13. Tao MH, Shu XO, Ruan ZX, et al. Association of overweight with breast cancer survival. Am J Epidemiol 2006; 163: 101-107.
14. Emens LA. Trastuzumab: targeted therapy for the management of HER-2/neu- overexpressing metastatic breast cancer. Am J Ther? 2005; 12:243–253.