How Hormone Therapy could change the lives of Breast Cancer patients in India?

Breast cancer is the second most common cancer in Indian women. The incidence is more in urban than rural women. According to a GLOBOCAN report for the year 2012, the incidence of Breast Cancer in women in India was 144,937. Over 70, 218 women died of breast cancer in India in 2012.

For every 2 women newly diagnosed with breast cancer, one lady is dying of it.

Breast Cancer, like many other cancers is curable if detected early. While there are several risk factors, breast cancer can happen to anyone. There are multiple reasons why Breast Cancer is diagnosed in India in the later stages: Fear, Social Stigma, Shyness on part of the women and an overall lack of awareness of the disease.

There is no one way to prevent breast cancer but we can detect it early and treat adequately. One of the bigger challenges in India is lack of data and research that can contribute effectively to prognosis and treatment decisions.

Surgery, Radiotherapy, Chemotherapy and Hormone therapy are the 4 modalities of treatment of Breast Cancer.Every patient of breast cancer needs to be treated individually and pathology reports play a significant part.

One of the areas where data based analysis has been minimal is in the arena of Hormone Therapy.

One major way of defining a type of breast cancer is whether or not it is:

• ER positive (Estrogen Receptor)
• PgR Positive (Progesterone Positive)
• HER2 neu positive (Receptive to Protein Her 2 Neu, which is produced by cancer cells)
• Triple negative, that is not positive to receptors for estrogen, progesterone, or HER2

If a patient’s breast cancer’s cells have a significant number of receptors for either estrogen or progesterone, the cancer is considered hormone-receptor positive and likely to respond to hormone/endocrine therapies.

Endocrine therapies for breast cancer are treatments usually taken after surgery, chemotherapy, and/or radiation are finished. They are designed to help prevent recurrence of the disease.

Study Overview

There are several literatures in the west that show higher positivity for ER Pgr and Her 2 neu. However Indian investigations show much lesser percentage ranging from 32% to 58%. Also studies in India have been limited to minimal sample size. Another important factor that greatly affects the results is adherence or non-adherence to stringent quality protocols. Right from fixation of the sample to the choice of fixative and various other guidelines need to be followed meticulously to arrive at a high quality study and a reliable report.

Metropolis Healthcare Study

We carried out a retrospective analysis of 3500 breast cancer patients for ER, PR, CerbB2 receptor expression for the last 3 years i.e. 2012, 2013 and till September 2014. SOPs were circulated amongst all surgeons & laboratories for ideal fixation especially with special respect to 1. Cold Ischemic time 2. Total fixation time 3. Choice of fixative. The IHC was carried out using manual & automated staining with standard clones after grading on H & E. The ASCO/CAP guidelines for reporting ER, PgR& Her 2 neu were applied & complimented with a Quick score.

Result: Of the 3500 cases – 68% were ER positive, 61% PgR positive & 27% positive for Her 2 neu. Triple negative cases were 16%. These figures are in concordance with the quality stringent labs in the world & the US CAP recommendations. Although there have been a few reports of closely similar data from India, most of the Indian data shows a lower positivity percentage and has been analyzed on a smaller patient cohort. This is probably the largest cohort of its type.

Why is this study important?

This study is evidence that more breast cancer patients in India are amenable to hormonal & targeted therapy. However due to lack of research, evidence and awareness, this path has not been approached in a big way

How is Hormone Therapy useful to Breast cancer patients?

• Hormone therapy can reduce the risk of early-stage hormone-receptor-positive breast cancers coming back (recurring) after surgery.
• Hormonal therapy medicines can also be used to help shrink or slow the growth of advanced-stage or metastatic hormone-receptor-positive breast cancers.
• It is also a less painful alternative to chemotherapy