Twenty-two patients (18 female and four male) with duct carcinoma of the breast were selected from the Department of Pathology, National Cancer Institute, Cairo University. The diagnosis was based on the recent WHO classification. Some of the well-characterized biomarkers used for the assessment of breast cancer were used: the hormonal receptor status (ER and PR status), which is used for patients candidate for hormonal therapy; the Her-2/neu status, which is important for herceptin therapy; and TOP2A, which is a therapeutic target for anthracycline treatment.
The mean age of SBC patients was 52.5 years, which is comparable to that in other reports 23,24; however, this figure is slightly lower than that report in other studies from Western countries 25,26. The mean age of FBC patients was 49.5 years, which is slightly lower than that in other reports 27,28; this could be explained by considering breast cancer in Egyptian patients (both SBC and FBC) as a biologically more aggressive disease compared with what has been encountered in western studies 24. The frequency of premenopausal women was higher among FBC patients than in SBC patients, whereas the frequency of postmenopausal women was higher among SBC patients than in FBC patients. These results are similar to those reported in other studies 27–29 but are in contrast to those reported by D’Eredita et al. 28, who reported no difference between FBC and SBC patients.
There was a statistically significant difference as regards tumor size between the two groups, with a larger tumor size observed among FBC patients, which is in accordance with the results of some studies 28,29 but is in contrast with those of others 27–30 who found no significant difference between the two groups. A highly significant difference was observed between the two groups as regards tumor grade, with a higher grade among FBC patients, which confirms the presence of more aggressive tumors among patients with a genetic predisposition. These results are in accordance with those of some studies 29,30 but are in contrast with those of another study 28 in which no significant difference between the two groups was found. There was no significant difference between FBC and SBC patients as regards the lymph node status, which is in agreement with the results of other studies 28–30 but is in contrast with the study by Veronesi et al. 29, who reported that FBC patients tended to have positive lymph node affection.
There was a highly significant difference among FBC and SBC patients, with a lower ER expression in the FBC group (P=0.001). Other studies have also shown low levels of ER expression in FBC patients 29–31. It is known that ER expression is inversely correlated with tumor grade 32: FBC patients who showed a higher tumor grade than SBC patients would therefore be predicted to be more ER negative. There was a significant difference between FBC and SBC patients (P=0.02) as regards the expression of PR, with a lower expression among FBC patients compared with SBC patients (25 vs. 50%); these results are in accordance with those of other studies 29,30–33. As regards Her-2/neu protein expression, the incidence of its expression in FBC patients (33.3%) compared with SBC patients (30%) showed no statistical difference (P=1.00), which is in agreement with the results of other studies 31–33.
Finally, we conclude that FBC tumors seem to be more aggressive compared with SBC tumors. Our study suggests that TOP2A gene amplification seems to occur in both FBCs and SBCs, however with a higher frequency in FBCs, together with the finding that TOP2A gene amplification may occur independent of Her-2/neu amplification. Thus, we suggest this parameter be determined on a routine basis in patients with breast cancer in general, and especially when FBC is suspected. Moreover, a combined approach using IHC and FISH can optimize Her-2/neu testing for breast carcinoma patients, especially in patients with IHC-equivocal tumors.
There are no conflicts of interest.
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