Er Positive Breast Cancer Prognosis

How To Improve Outlook

Breast cancer is most treatableand curablewhen it’s caught early. The best way to improve your breast cancer prognosis is to get screening mammograms regularly when your healthcare providers suggest and follow up with them about any concerning symptoms.

The less advanced your cancer is when its found, the more accessible treatment is and the better your outlookno matter the subtype.

If youve already been diagnosed with triple-positive breast cancer, consider these steps to improve your outlook:

• Talk to your healthcare provider about what treatments will work for you.
• Find a specialist oncologist who works with triple-positive breast cancers.
• Consider clinical trials of new therapies.
• Know that no two breast cancers are the same.
• Connect with other people with breast cancer through support groups.
• Keep a positive outlook and take care of your mental health.
• Follow a healthy lifestylefor example, eat a nutritious diet and stay active.

Disclosure Of Potential Conflicts Of Interest

No potential conflicts of interest were disclosed.

Grant support: University of Sydney Cancer Research Fund . R.L. Balleine is a Cancer Institute New South Wales Fellow and C.L. Clarke is a Principal Research Fellow of the National Health and Medical Research Council of Australia.

The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

Note: Supplementary data for this article are available at Clinical Cancer Research Online .

Data Collection Tool And Quality

The data were collected from patients medical chart with primary breast cancer diagnosis and newly-initiating treatment at the Black Lion Specialized Hospital between January 2012 and January 2018. The data collection tool was developed from previous related literature to assemble necessary information from patients medical files. To maintain the quality of the data, training on data abstraction was given to data collectors and supervisors for 1 day before the actual data collection. Pre-test was done on registrations that were not included in the final study for consistency of understanding the review tools and completeness of data items. The collected data were reviewed and checked for completeness every day and before data entry. All completed data collection forms were examined for completeness and consistency during data management, storage, cleaning, and analysis. Three oncology nurses, who were working on the oncology unit, collected the data. The principal investigator of the study controlled the overall activity.

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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.

Kaplanmeier Curves Of Os And Bcss Before Psm

For HER2- subtype, ER+PR+ had better OS compared with ER+PR-, ER-PR+, and ER-PR- . In addition, ER+PR- showed better OS than ER-PR+ and ER-PR- . Additionally, ER-PR+ showed better OS than ER-PR- before PSM .

Figure 1 Overall survival of patients stratified by estrogen receptor , progesterone receptor and human epidermal growth factor Receptor 2 status before propensity score matching. Kaplan-Meier survival curves of overall survival. League table of comparison by log-rank test.

For HER2+ subgroup, ER+PR+ showed better OS than ER+PR- and ER-PR- , while ER+PR+ had similar OS relative to ER-PR+ . In addition, ER+PR- showed better OS than ER-PR- . However, no significant difference in OS was observed between ER+PR- and ER-PR+ . Whats more, ER-PR+ showed similar OS compared with ER-PR- . BCSS showed the same trend as OS. In addition, ER-PR+ patients showed better BCSS than ER-PR- patients before PSM .

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How Fast Does Triple

Different types of breast cancer grow at different rates. Again, each patient is unique, and it is difficult to estimate how quickly breast cancer will grow. In general, triple-negative and HER2-positive tumors are fast-growing. Hormone receptor-positive grow more slowly. The stage of cancer is also reflected in the growth rate. Cancer that has spread to other organs is more likely to continue spreading. Higher grade tumors also tend to grow faster. The patients age is a factor. Younger patients tend to have more aggressive, faster-growing tumors than older women. Lastly, some women have genetic mutations associated with a higher risk of developing breast cancer at a young age. These mutations can be associated with more aggressive forms of breast cancer that spread faster.

Risk Of Recurrence: Early And Late

Research has shown the HER2-positive early breast cancers are two to five times more likely to recur than HER2-negative tumors. Even very small HER2-positive tumors with negative lymph nodes have a much higher risk of recurrence relative to tumors that are HER2-negative. Treatment with Herceptin can cut this risk by half.

The pattern of breast cancer recurrence may also differ. Small tumors are also more likely to have a metastatic recurrence if they are HER2-positive.

Despite the fact that HER2-positive and estrogen receptor-negative tuors are more likely to recur early on than estrogen receptor-positive and HER2-negative cancers, late recurrences are much less common.

With estrogen receptor positive breast cancers, the cancer is more likely to recur after 5 years than in the first 5 years, and the risk of recurrence remains steady each year for at least 20 years following the diagnosis. In contrast, those who have HER2 positive tumors and reach their 5 year mark are much more likely to be âin the clearâ and remain recurrence free.

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Types Of Breast Cancer

There are several types of breast cancer, and any of them can metastasize. Most breast cancers start in the ducts or lobules and are called ductal carcinomas or lobular carcinomas:

• Ductal carcinoma. These cancers start in the cells lining the milk ducts and make up the majority of breast cancers.
• Lobular carcinoma. This is cancer that starts in the lobules, which are the small, tube-like structures that contain milk glands.

Less common types of breast cancer include:

• Inflammatory breast cancer is a faster-growing type of cancer that accounts for about 1% to 5% of all breast cancers.

• Pagets disease is a type of cancer that begins in the ducts of the nipple.

Breast cancer can develop in women and men. However, breast cancer in men is rare. Less than 1% of all breast cancers develop in men.

What Is Invasive Breast Cancer Versus Noninvasive Breast Cancer

Noninvasive cancer means the abnormal cells are contained in the milk ducts of the breast and lack the ability to spread to surrounding tissue or elsewhere in the body. Invasive breast cancer means the cancer has grown beyond its original location into surrounding normal breast tissue and has the potential to spread to other parts of the body.

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Why Is Knowing Hormone Receptor Status Important

Knowing the hormone receptor status of your cancer helps doctors decide how to treat it. If your cancer has one or both of these hormone receptors, hormone therapy drugs can be used to either lower estrogen levels or stop estrogen from acting on breast cancer cells. This kind of treatment is helpful for hormone receptor-positive breast cancers, but it doesnt work on tumors that are hormone receptor-negative .

All invasive breast cancers should be tested for both of these hormone receptors either on the biopsy sample or when the tumor is removed with surgery. About 3 of 4 breast cancers have at least one of these receptors. This percentage is higher in older women than in younger women. DCIS should also be checked for hormone receptors.

Hormone Receptor Expression Analysis

Oestrogen receptor and PR analysis were carried out as described . Diagnostic core biopsies were immunostained using primary antibodies for ER and PR both Novocastra Laboratories Ltd, Newcastle Upon Tyne, UK. The stained slides were scored using the Quickscore method . Cancers scoring 03 were regarded as negative whereas cases scoring 418 were regarded as positive. Adjuvant endocrine therapy decisions were made on the basis of this assessment. Subsequently, all cancers were further assessed using the ASCO/CAP guidelines for ER and PR expression and also using the Allred method with cases scoring > 2 defined as positive .

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Sample Size And Sampling Procedure

A total sample size of 368 was calculated using the power exponential formula for survival analysis using the 15-years breast cancer specific survival rate of 70% for those with ER-negative and 77% for those with ER-positive breast cancer patients.20 We assumed a 95% confidence level, 80% power, 10% of withdrawal probability, and the sample was computed using Stata version 14. The sample size allocations for exposed and non-exposed were one-to-one ratio. Then, subjects in the exposed groups were selected by consecutive sampling technique, whereas the non-exposed groups were selected using simple random sampling technique. To obtain the necessary information from both exposed and non-exposed groups, the investigator used the medical registration number of patients from the registration book.

Survival Rates For Triple

Triple-positive and other HR-positive/HER2-positive cancers are generally more aggressive and have a slightly less positive outlook than other breast cancers. However, the outlook for triple-positive breast cancer is better than it is for triple-negative breast cancer.

There is not a lot of specific data on triple-positive breast cancer prognosis. In a small study of people with triple-positive breast cancers, 5.9% died within 33 months of diagnosis.

Generally, HR-positive cancers have a better prognosis because they respond to hormone therapies. They also typically grow slower than HR-negative cancers. While they may recur, this normally does not happen for many years after treatment.

HER2-positive cancers generally have a worse prognosis than HER2-negative cancers. However, this might change with the development of targeted therapies against HER2.

According to NCI data, the five-year relative survival rate for HR-positive/HER2-positive female breast cancer is 90.7%.

NCI data is also broken down by how advanced the disease is when diagnosed:

• Cancer that is still only in the breast tissue is localized.
• Cancer that has spread to other tissues in the chest, including lymph nodes, is regional.
• Cancer that has spread to organs in other body parts is distant.

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What Is The Life Expectancy For Each Cancer Stage

Your outlook depends on the stage of your cancer when its discovered. Cancer is staged by number, starting with 0 and going to 4. Stage 0 is the very beginning and stage 4 is the last stage, also called the metastatic stage, because its when cancer has spread to other areas in the body.

Each number reflects different characteristics of your breast cancer. These characteristics include the size of the tumor and whether the cancer has moved into lymph nodes or distant organs, like the lungs, bones, or brain.

Research on survival statistics for people with breast cancer tends to separate participants into categories of women and men.

Survival statistics of women with the major subtypes of breast cancer such as ER-positive, HER2-positive, and triple-negative are grouped together. With treatment, most women with very early stage breast cancers of any subtype can expect a normal life span.

Survival rates are based on how many people are still alive years after they were first diagnosed. Five-year and 10-year survival are commonly reported.

Expert Review And References

• American Cancer Society. Breast Cancer. 2015: .
• de Boer M, van Dijck JA, Bult P, Borm GF, Tjan-Heijnen VC. Breast cancer prognosis and occult lymph node metastases, isolated tumor cells, and micrometastases. Journal of the National Cancer Institute. Oxford University Press 2010.
• Lonning PE. Breast cancer prognostication and prediction: are we making progress?. Annals of Oncology. Oxford: Oxford University Press 2007.
• Morrow M, Burstein HJ, and Harris JR. Malignant tumors of the breast. DeVita VT Jr, Lawrence TS, & Rosenberg SA. Cancer: Principles and Practice of Oncology. 10th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins 2015: 79: 1117-1156.
• Tripathy D, Eskenazi LB, Goodson, WH, et al. Breast. Ko, A. H., Dollinger, M., & Rosenbaum, E. Everyone’s Guide to Cancer Therapy: How Cancer is Diagnosed, Treated and Managed Day to Day. 5th ed. Kansas City: Andrews McMeel Publishing 2008: pp. 473-514.

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Palpation Of Cancerous Masses

Cancerous masses in the breast are often very firm, like a rock or a carrot, and have an irregular shape and size. They are often fixedthey feel like they are attached to the skin or nearby tissue so that you cant move them around by pushing on thembut can be mobile. Theyre also not likely to be painful, though they can be in some cases.

On exam, other changes may be present as well, such as dimpling of the skin or an orange-peel appearance, nipple retraction, or enlarged lymph nodes in the armpit.

One type of breast cancer, inflammatory breast cancer, does not usually cause a lump but instead involves redness, swelling, and sometimes a rash on the skin of the breast.

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What Are The Side Effects Of Hormone Therapy

The side effects of hormone therapy depend largely on the specific drug or the type of treatment . The benefits and harms of taking hormone therapy should be carefully weighed for each person. A common switching strategy used for adjuvant therapy, in which patients take tamoxifen for 2 or 3 years, followed by an aromatase inhibitor for 2 or 3 years, may yield the best balance of benefits and harms of these two types of hormone therapy .

Hot flashes, night sweats, and vaginal dryness are common side effects of all hormone therapies. Hormone therapy also may disrupt the menstrual cycle in premenopausal women.

Less common but serious side effects of hormone therapy drugs are listed below.

Tamoxifen

• breathing problems, including painful breathing, shortness of breath, and cough
• loss of appetite

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Optimizing Breast Cancer Therapy

As advances in breast cancer surgery and other modalities occur, we will continue to reevaluate whether we can de-escalate treatment approaches to lessen the burden of treatment for patients.

At MSK, we adopted the no ink on tumor consensus guideline early and conducted a study to confirm the benefits for our patients. We also pioneered the de-escalation of axillary dissection in women with invasive breast cancer and sentinel node metastasis following evidence that found no difference in overall survival or nodal recurrence between sentinel lymph node biopsy and complete axillary lymph node dissection.

The diagnosis and treatment of invasive breast cancer requires a collaborative, multidisciplinary approach. At MSK, the breast cancer team evaluates more than 4,500 new breast cancer cases and sees 3,300 surgical inpatients and outpatients annually. Our objective is to create the most effective individualized treatment plan for each patient to optimize outcomes, reduce the burden of treatment, and improve quality of life.

Monica Morrow, MD, FACS, Chief, Breast Service, Department of Surgery, and Anne Burnett Windfohr, Chair, Clinical Oncology, discuss MSKs evidence-based, leading-edge breast cancer surgical program.

Disclosure: Dr. Morrow has received honoraria from Genomic Health and Roche.

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All About Er Positive Her2 Negative Breast Cancer

About one in eight women in the United States will develop breast cancer, according to commonly used statistics.

But other reports indicate that breast cancer rates are on the decline, likely because of improved recognition, prevention, and treatment. One advancement is the ability to identify different breast cancer types based on specific molecules found in tumors. The distinction greatly aids in breast cancer treatment selection and helps doctors predict how aggressive cancers will advance.

A crucial step in the process of beast cancer evaluation is testing tumor tissue removed during a biopsy or surgery to determine if it has estrogen and progesterone receptors molecules that the hormones bind to.

Cancerous cells may have none, one, or both receptors. Breast cancers that have estrogen receptors are called ER-positive . Those with progesterone receptors are referred to as PR-positive .

In addition to hormone receptors, some breast cancers have high levels of a growth-promoting protein called HER2/neu. If a tumor has this property, it is called HER2-positive. HER2 positive cancers are more aggressive than HER2 negative cancer.

Knowing breast cancer type, leads doctors to determining best treatments.

HER2 negative cancers will not respond to treatment with drugs that target HER2, such as trastuzumab and lapatinib .

Overall, estrogen receptor-positive breast cancer is treatable, especially when diagnosed early.

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Predictors Of Breast Cancer Death By Estrogen Receptor Status

In the Cox regression analysis for the incidence of death, estrogen receptor negative women had a higher risk of mortality with an event risk of 95% compared with ER positive in the unadjusted model. And after full adjustments for age, clinical stage, baseline comorbidity, histological grade, surgical margin, node status, type of surgery, chemotherapy, hormone therapy, tumor size, histology type, and place of residence, the mortality event risk was 32% higher among ER negative women .

Sociodemographic Characteristics Of Study Participants

There was no difference under age category of less than 40 years at diagnosis of breast cancer between groups . In the present study, we did not find a significant difference in terms of menopause status between groups . There was no difference in place of residence between ER positive and ER negative women however, ER positive women were more likely to live in Addis Ababa .

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