Her2 Negative Pr/er Positive Breast Cancer
Hi All
just wondering if there is anyone in the chat who has HER2 neg, PR/ER positive BC like me? I have a 17mm lump in my left breast and surgery planed for Tues this week
I would love to hear from anyone who has been or is going through the same as me
Thank you
Hi Lucy,
I had Her2neg breast cancer and surgery in 2019. It’s very scary the thought of the surgery but such a relief when it is over and to know the cancer has been removed. I recovered quickly too, your team and the breast nurses look after you very well. There’s lots of support on here too
Best wishes
Hi Silver
Thanks for your message. Your right, the idea of surgery is scary and the possibility of the results from the lab on analysis and lymph nodes after scary too, I just hope nothing changes in the diagnosis I already have as I’ve heard this can happen as free surgery
Was yours hormone positive too?
What Are The Symptoms Of Breast Cancer
The most common symptom of most breast cancers is a lump in the breast. A painless, hard mass with irregular edges is most likely cancer, but breast cancers can also have a lump that is soft and tender to the touch. Other possible symptoms in the first three stages of breast cancer include:
- Change in the size and shape of the breast
- Asymmetry in the breast compared to the other
- Skin dimpling or other abnormal changes in the breastâs skin
What This Means For Patients
Because the results of ER and PR testing can make a difference in a persons treatment and chance of recurrence, it’s important that these tests are accurate. This guideline was developed to help both doctors and laboratories know how to improve the accuracy of ER and PR testing for those with breast cancer. Understanding the ER/PR status of the primary tumor and any distant or recurrent tumors can help doctors make sure that patients receive the appropriate treatment and avoid side effects of a treatment that may not work. Use this guideline to talk with your doctor about the accuracy of your ER and PR test results and what that means for your treatment.
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What Are The Symptoms Of Secondary Breast Cancer
severe or ongoing headaches. a dry cough or feeling of breathlessness. feeling much more tired than usual. pain in your bones, for example in the back, hips or ribs, that doesnt get better with pain relief and may be worse at night. Find out more about the symptoms of secondary breast cancer. Click the image below for a downloadable infographic
Gene Expression Profiling Data Scaling And Merging
The datasets used in our study were generated using diverse microarray platforms and originating from different laboratories. We used normalized log2 for single-channel platforms and log2 in dual-channel platforms. Hybridization probes were mapped to Entrez Gene ID. When multiple probes mapped to the same GeneID, we used the probe with the highest variance in the dataset under study. We scaled and centered expression values for each gene to have a mean of zero and standard deviation of one in the dataset, prior to merging the data from the different datasets. The complete dataset contains data on 4,111 patients . For the genome-wide analyses, we limited the analysis to the 3,666 patients with valid data from at least 80% of the genes.
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Pr Pathway In Breast Cancer
A hallmark of precancerous lesions and mammary tumors is an increase in the proportion of proliferating ER/PR-positive cells during breast carcinogenesis61 and then a switch from a paracrine to an autocrine mode of regulation by steroid hormones. Cells expressing both ER and the Ki67 proliferation-associated antigen increased during breast tumorigenesis. Is it the essential step from hyperplasia to ductal carcinoma in situ or invasive breast cancer? Is it the essential process for hormone-negative breast carcinogenesis? Previous research indicated that breast cancer with the harmful breast cancer 1 variant is more likely to be hormone receptor negative, and BRCA1-driven triple-negative breast cancer has been shown to arise from luminal progenitors.62,63 BRCA1 can inhibit PR transcriptional activity by ubiquitination, leading to PR degradation and epigenetic silencing of target promoters.64
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Additional file 1: Table S1: Description of gene expression microarray datasets used in the analyses. Table S2. Results of genome-wide survival analysis stratified by ER status. Columns 3 and 4 present the Wald-test statistic for prognostic association in ER- and ER+ breast cancer, respectively. Columns 5 and 6 present the adjusted P-value for the prognostic association in ER- and ER+ breast cancer, respectively. Columns 7 and 8 present the negative log10 of the adjusted P-values . Table S3. Disease-free survival analysis. Table S4. NHS survival analysis including and excluding endocrine therapy. Table S5. Survival analysis with combined receptor status.
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Are There Any Risks To The Test
You may have a little bruising or bleeding at the biopsy site. Sometimes the site gets infected. If that happens, you will be treated with antibiotics. A surgical biopsy may cause some additional pain and discomfort. Your health care provider may recommend or prescribe medicine to help you feel better.
How Are Breast Tumors Tested For Her2
Either a test called an immunohistochemistry test or fluorescence in situ hybridization test is used to find out if cancer cells have a high level of the HER2 protein.
See Testing Biopsy and Cytology Specimens for Cancer and Understanding Your Pathology Report: Breast Cancerto get more details about these tests.
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How Is The Stage Determined
The staging system most often used for breast cancer is the American Joint Committee on Cancer TNM system. The most recent AJCC system, effective January 2018, has both clinical and pathologic staging systems for breast cancer:
- The pathologic stage is determined by examining tissue removed during an operation.
- Sometimes, if surgery is not possible right away or at all, the cancer will be given a clinical stage instead. This is based on the results of a physical exam, biopsy, and imaging tests. The clinical stage is used to help plan treatment. Sometimes, though, the cancer has spread further than the clinical stage estimates, and may not predict the patients outlook as accurately as a pathologic stage.
In both staging systems, 7 key pieces of information are used:
- The extent of the tumor : How large is the cancer? Has it grown into nearby areas?
- The spread to nearby lymph nodes : Has the cancer spread to nearby lymph nodes? If so, how many?
- The spread to distant sites : Has the cancer spread to distant organs such as the lungs or liver?
- Estrogen Receptor status: Does the cancer have the protein called an estrogen receptor?
- Progesterone Receptor status: Does the cancer have the protein called a progesterone receptor?
- HER2 status: Does the cancer make too much of a protein called HER2?
- Grade of the cancer : How much do the cancer cells look like normal cells?
In addition, Oncotype Dx® Recurrence Score results may also be considered in the stage in certain situations.
What Do The Test Results Mean
The results of HER2 testing will guide you and your cancer care team in making the best treatment decisions.
It is not clear if one test is more accurate than the other, but FISH is more expensive and takes longer to get the results. Often the IHC test is done first.
- If the IHC result is 0, the cancer is considered HER2-negative. These cancers do not respond to treatment with drugs that target HER2.
- If the IHC result is 1+, the cancer is considered HER2-negative. These cancers do not usually respond to treatment with drugs that target HER2, but new research shows that certain HER2 drugs might help in some cases .
- If the IHC result is 2+, the HER2 status of the tumor is not clear and is called “equivocal.” This means that the HER2 status needs to be tested with FISH to clarify the result.
- If the IHC result is 3+, the cancer is HER2-positive. These cancers are usually treated with drugs that target HER2.
Some breast cancers that have an IHC result of 1+ or an IHC result of 2+ along with a negative FISH test might be called HER2-low cancers. These breast cancers are still being studied but appear to benefit from certain HER2-targeted drugs.
Triple-negative breast tumors dont have too much HER2 and also dont have estrogen or progesterone receptors. They are HER2-, ER-, and PR-negative. Hormone therapy and drugs that target HER2 are not helpful in treating these cancers. See Triple-negative Breast Cancer to learn more.
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Oncotype Dx Gene Expression Analysis
The Oncotype DX assay is a quantitative RT-PCR assay used to measure the expression of 21 genes in FFPE breast cancer tissues. We used the Oncotype DX assay to evaluate ER/PR receptor status at the RNA level and calculate the breast cancer RS result to evaluate the association between HR status and clinical outcomes in our cohort. The RS result is derived within the Oncotype DX assay via a validated algorithm that compares the expression of the 16 cancer-related genes and five control reference genes to clinical outcomes of breast cancer ~ 6,000 patients in the NSABP and TAILORx clinical trials . The RS result is stratified into three risk categories for poor patient outcomes: low , intermediate and high . This result was compared to the expression levels of individual HER2, ER and PR genes, and patient samples phenotyped according to pre-defined gene expression levels for positive, equivocal or negative IHC staining correlation . Expression level 11.5 units of HER-2 is categorised as high/positive 10.711.4 units: equivocal/indeterminate and < 10.7 units: negative . Similarly, expression of ER and PR is categorised as high/positive 6.5 units and 5.5 units, respectively .
Three Aromatase Inhibitors Are Approved For Use By The Us Food And Drug Administration : Anastrozole Letrozole And Exemestane
All three aromatase inhibitors have known side effects. The most common is bone and joint pain. Other side effects women report include fatigue, dizziness, hot flashes, and weight gain. All of these side effects can affect your quality of life, and you may be able to tolerate some more than others. If you find the side effects are keeping you from taking the hormone therapy that you were prescribed, you can talk to your doctor about switching to one of the other aromatase inhibitors. You can also discuss switching to tamoxifen.
In June 2014, ASCO updated its hormone treatment guidelines. The new guidelines incorporate new research findings, including a large study that found that 10 years of tamoxifen was more effective than five years of tamoxifen followed by a placebo.
The new treatment guidelines for women with hormone-sensitive breast cancer are:
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How Long Will It Take For Results
Hormone receptor status testing is not available in every laboratory. It requires experience and special training to perform and interpret. A healthcare practitioner will often send a sample to a reference laboratory and it may take several days to weeks before the results are available. It is recommended that testing be done by a lab that follows the American Society of Clinical Oncology/College of American Pathologists Guideline Recommendations to avoid inaccurate results.
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What Do The Hormone Receptor Test Results Mean
Test results will give you your hormone receptor status. It will say a tumor is hormone receptor-positive if at least 1% of the cells tested have estrogen and/or progesterone receptors. Otherwise, the test will say the tumor is hormone receptor-negative.
Hormone receptor-positive breast cancer cells have either estrogen or progesterone receptors or both. These breast cancers can be treated with hormone therapy drugs that lower estrogen levels or block estrogen receptors. Hormone receptor-positive cancers tend to grow more slowly than those that are hormone receptor-negative. Women with hormone receptor-positive cancers tend to have a better outlook in the short-term, but these cancers can sometimes come back many years after treatment.
Hormone receptor-negative breast cancers have no estrogen or progesterone receptors. Treatment with hormone therapy drugs is not helpful for these cancers. These cancers tend to grow faster than hormone receptor-positive cancers. If they come back after treatment, its often in the first few years. Hormone receptor-negative cancers are more common in women who have not yet gone through menopause.
Triple-positive cancers are ER-positive, PR-positive, and HER2-positive. These cancers can be treated with hormone drugs as well as drugs that target HER2.
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Breast Cancer Hormone Receptor Status
Breast cancer cells taken out during a biopsy or surgery will be tested to see if they have certain proteins that are estrogen or progesterone receptors. When the hormones estrogen and progesterone attach to these receptors, they stimulate the cancer to grow. Cancers are called hormone receptor-positive or hormone receptor-negative based on whether or not they have these receptors . Knowing the hormone receptor status is important in deciding treatment options. Ask your doctor about your hormone receptor status and what it means for you.
What Does The Test Result Mean
The results for ER receptor and PR receptor testing cover a range from low to high levels of receptor expression. Patients receive greater benefit from hormone therapy if their breast tumor has more ER receptors. Studies indicate that tumors with less receptor expression are less likely to respond to the therapies that aim to reduce stimulation of the receptors such as tamoxifen, but even low positivity may be associated with some response. The more receptors present, the more likely the response.
Guidelines recommend classifying tumors with as few as 1% positive cells as receptor positive, but for tumors with low ER expression, the decision for targeted therapy should be based on an analysis of its risks versus potential benefits. If a person’s cancer is ER-negative but PR-positive, or ER-positive but PR-negative, then the person may still benefit from hormone therapy.
If the cancer is both ER-negative and PR-negative, then the person is not likely to benefit from hormone therapy.
An individual’s response to hormone therapy will depend on a variety of factors, but typical approximate response rates include:
If there is a discrepancy between test results after testing a primary and a metastatic tumor sample, many times the ER and PR status of the metastasis can be used to guide therapy when considered in the context of the clinical scenario and your treatment goals.
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Clinical Characteristics And Survival Outcome Of Patients With Estrogen Receptor Low Positive Breast Cancer
Age at diagnosis, ER status and PR status were associated with initiation of endocrine therapy.
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ER-low patients had more aggressive clinical characteristics and worse survival outcome than ER-high patients.
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ER-low patients appeared to benefit less from endocrine therapy than ER-high patients.
Why Do I Need An Er/pr Test
You may need this test if youve been diagnosed with breast cancer. Knowing your hormone receptor status will help your health care provider decide how to treat it. If you have ER-positive, PR-positive, or HR-positive cancer, drugs that lower hormone levels or stop the hormones from fueling cancer growth can be very effective. If you have HR-negative cancer, these types of drugs wont work for you.
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Study Design And Participants
Participants were males and females aged 18 years or older with stage IIII HER2-negative breast cancer and estrogen receptor and progesterone receptor immunohistochemical nuclear staining 10% who enrolled in a multisite prospective registry protocol between March 2011 and April 2019 at 14 locations/centers. HER2 negativity was determined per ASCO/CAP guidelines,.
This study was conducted in accordance with the U.S. Common Rule and the International Ethical Guidelines for Biomedical Research Involving Human Subjects. Human investigations were performed after institutional review board approval at the University of Kansas Medical Center, and all subjects provided written informed consent.
Demographic, clinical, pathologic, and treatment information was collected, and participants were prospectively followed for recurrence and survival. Patients were categorized into two groups on the basis of ER and PR immunohistochemical expression . TNBC was defined as ER and PR expression < 1% Low-ER was defined as ER and/or PR expression 110%. Pathologic response was ascertained for patients who had undergone neoadjuvant chemotherapy pathologic complete response was defined as the absence of residual invasive disease in breast and axilla, with or without ductal carcinoma in situ .
Tests On Your Breast Cancer Cells
After a biopsy or surgery to remove breast tissue, a sample of cells is sent to the laboratory. A doctor called a pathologist does various tests on the cells. This can diagnose cancer and also show which type of cancer it is.
Some tests can also show how well particular treatments might work, such as hormone therapies or targeted cancer drugs.
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Clinicopathologic Characteristics Of The Study Population
The flowchart of selection process was shown in Supplementary Figure 1. A total of 203406 patients were included, including 133662 patients for ER+PR+HER2-, 16906 for ER+PR-HER2-, 1395 for ER-PR+HER2-, 21439 for ER-PR-HER2- and 15646 for ER+PR+HER2+, 5381 for ER+PR-HER2+, 537 for ER-PR+HER2+, and 8440 for ER-PR-HER2+. The median follow-up duration of the study population was 35 months . The clinicopathologic characteristics of each subtype were summarized in Table 1.
Table 1 Clinicopathologic characteristics of the study population .