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What Is Er Positive Breast Cancer

What Is Her2 And What Does It Mean

First-Line ER-Positive Metastatic Breast Cancer Treatments

HER2 is a protein that helps breast cancer cells grow quickly. Breast cancer cells with higher than normal levels of HER2 are called HER2-positive. These cancers tend to grow and spread faster than breast cancers that are HER2-negative, but are much more likely to respond to treatment with drugs that target the HER2 protein.

All invasive breast cancers should be tested for HER2 either on the biopsy sample or when the tumor is removed with surgery.

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.

Defining The Immune Landscape

Considering the dynamic nature of the immune system, we conducted the graph learning-based dimensionality reduction analysis using reduceDimension function to illustrate the intrinsic structure and distribution of individual patients . The discriminative dimensionality reduction with trees was used as dimension reduction method, and the maximum number of components was set to 2. After dimension reduction and ordering, the immune landscape was finally inferred by plot cell trajectory function.

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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 ishormone 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.

Limitations Of Her2 Testing

State

Before the implementation of the first 2007 ASCO/CAP HER2 testing guidelines, the number of patients with equivocal HER2 test results was rather large.

Since 2007, the quality of HER2 testing has improved the frequency of equivocal and inaccurate results has decreased. These improvements are believed to be due in part to the implementation of the testing guidelines since 2007.

With the increasing number of laboratories performing HER2 testing, uniform standards and quality control are mandatory.

The updated 2013 ASCO/CAP guidelines contain even more detailed recommendations on what physicians should discuss with their patients regarding HER2 status reasons for HER2 testing types of tests used interpretation of test results, and any potential need for re-testing in the case of disease recurrence .

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Questions To Ask Your Doctor

To learn more about estrogen and progesterone receptor testing for breast cancer, consider asking your doctor the following questions:

  • What are the results of the ER and PR tests on my tumor sample? What do they mean?

  • Does this laboratory meet the standard guidelines like those from ASCO and the CAP?

  • Has a board-certified pathologist diagnosed my cancer?

  • Do you know if this is an experienced lab and if my tissue was quickly given to the pathologist after my biopsy or surgery, as recommended by guidelines?

  • Can I obtain a copy of my pathology report ?

  • Is my ER and PR status indicated on the pathology report? Was the ASCO-CAP guideline recommendation used to define the status?

  • Based on these test results, what treatments do you recommend and why?

  • What are the possible side effects of these treatments?

Comparison Of Immunogenomic Indicators And Enriched Oncogenic Pathways Among Immune Subtypes

The breast tumor-specific potential neoantigens predicted by NetMHCpan 4.0 were available from TSNAdb , by which the mutation alternation file was filtered to compute the neoantigen load in each patient . To assess the activity of oncogenic pathways, first we constructed a compendium containing 335 genes by referring to a published article . Subsequently, we applied single sample gene set enrichment analysis on these genes to calculate enrichment scores for each pathway in each sample .

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Prognosis Life Expectancy And More

Overview

Estrogen receptor-positive breast cancer is the most common type of breast cancer diagnosed today.

According to the American Cancer Society, about 2 out of every 3 cases of breast cancer are hormone receptor-positive. Most of these cases are ER-positive, meaning that there are estrogen receptors on the surface of the cell that bind to estrogen.

This cancer typically responds to hormone therapy. Your prognosis will depend on what stage the cancer is in when youre first diagnosed and how well your body responds to treatment. ER-positive breast cancers can have a favorable outlook when theyre treated early.

Some of the decline in breast cancer mortality rates can be credited to the effectiveness of hormone therapy drugs prescribed to women with ER-positive breast cancer. Newer treatment options for ER-negative tumors are also improving prognosis and life expectancy.

If your doctor suspects breast cancer, you will likely have a biopsy to test for cancerous cells. If there is cancer, your doctor will also test the cells for characteristics that include what receptors, if any, are present on the surface of the cancer cells.

The outcome of this testing is important when making treatment decisions. What treatment options are available is highly dependent on the test results.

Hormone receptors can interact with estrogen or progesterone. Estrogen receptors are the most common. This is why ER-positive is the most common form of breast cancer.

  • stage 0 100 percent

Treatment For Pr Positive Breast Cancer

Adjuvant therapy for early stage ER-positive, HER2-negative invasive breast cancer

Most PR positive breast cancers are also ER positive, and you may be offered hormone therapy.

The benefits of hormone therapy are less clear for people whose breast cancer is only PR positive. Very few breast cancers fall into this category, but if this is the case your specialist will discuss with you whether hormone therapy is suitable.

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What Is A Hormone Receptor

In breast cancer, hormone receptors are the proteins located in and around breast cells. These receptors signal cells both healthy and cancerous to grow. In the case of breast cancer, the hormone receptors tell the cancer cells to grow uncontrollably, and a tumor results.

Hormone receptors can interact with estrogen or progesterone. Estrogen receptors are the most common. This is why ER-positive is the most common form of breast cancer.

Some people are diagnosed with progesterone receptor-positive breast cancer. The key difference is whether cancerous cells are getting growth signals from estrogen or progesterone.

Testing for hormone receptors is important in treating breast cancer. In some cases, there are no hormone receptors present, so hormone therapy isnt a good treatment option. This is called hormone receptor-negative breast cancer.

According to

There Are Two Ways To Measure The Her

The most common way to measure the HER-2 status of a potential breast cancer tumor is through an immunohistochemistry test. This will likely be part of an overall histological/pathological evaluation of the tumor.

Various tumor markers, including the HER-2 status indicators, give the pathologist a characterization of the tumor. This helps to predict the future behavior and probable responses, of the tumor to different types of treatments.

The immunohistochemistry test of the HER-2 status measures the over-expression of a particular protein and is typically given a score of 0 to +3.

The pathologist actually counts the number of receptors on the surface of the cancer cells. Indeed, the pathologist can see the cells microscopically because they are receptive to certain protein-based dyes and change color.

Scores of 0 and +1 are indicative of a negative status , whilst +2 and +3 are HER-2 positive . There is no in-between state.

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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.

What Foods To Avoid If You Have Estrogen

Er Pr Positive Breast Cancer Survival Rate

Research shows that among breast cancer cases,

  • only 5-10% were because of genetic defects.
  • 90-95% were attributable to environmental and lifestyle factors such as diet. Out of these,
  • Diet contributed to approximately 30-35%.
  • Obesity contributed to 10-20%.

Any food that increases your risk of obesity or makes you prone to inflammation triggers breast cancer, be it of any type. These include:

  • Sugary foods:

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Study Design And Population

We collected a cohort of 402 ER+/HER2 primary invasive BC patients with available follow-up , who underwent surgery from January 1998 to December 2012 at the Breast Unit of the Città della Salute e della Scienza of Torino, University Hospital of Torino in Turin, Italy. In the diagnostic setting, the cut-off value considered for ER and PgR positivity was 1%, as suggested by the St Gallen and ASCO/CAP Guideline Recommendations , and the same cut-off was adopted for AR positivity . For all cases, the following clinico-pathological data were obtained from the clinical charts and pathological reports: age, type of surgery , tumour size , histological type, tumour grade and nodal involvement. Ethical approval for this study was obtained from the Comittee for human Biospecimen Utilization . The project provided an informed consent, obtained from the patients at the time of surgery due to the retrospective approach of the study, which did not impact on their treatment. The procedure for collecting the consent was approved by the Committee for human Biospecimen Utilization . All the cases were anonymously recorded, and data were accessed anonymously.

Study flowchart. ER estrogen receptor HER2 human epidermal growth factor receptor 2 AR androgen receptor. *Three additional cases with a ratio of AR/ER2 were included for the Prosigna-PAM50 assay.

Citation: Endocrine-Related Cancer 25, 3 10.1530/ERC-17-0417

    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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    Prosigna Multigene Prognostic Assay

    Sixteen ER+/HER2 BC cases with an AR/ER ratio 2 with long follow-up and 3 additional cases collected during the routine diagnostic assessment of ER and AR were selected for Prosigna-PAM50 analysis . Briefly, tissue obtained after macrodissection of formalin-fixed paraffin-embedded tumours were processed with a Roche FFPET RNA Isolation Kit . The isolated RNA was hybridized to 58 gene-specific probe pairs, plus 6 positive and 8 negative controls , overnight at 65°C in a single hybridization reaction. The removal of excess probes, followed by binding of the probetarget complexes on the surface of a specific nCounter cartridge, was performed on the nCounter Prep Station . Finally, the nCounter cartridge with immobilized probe/target complexes was read in the nCounter Digital Analyzer . The conversion of gene expression measurements into intrinsic molecular subtypes, risk of recurrence scores and risk categories used a fully prespecified algorithm has been previously described .

    Side Effects Of Tamoxifen And Toremifene

    Treatment Overview: ER-positive Breast Cancer

    The most common side effects of tamoxifen and toremifene are:

    • Hot flashes
    • Vaginal dryness or discharge
    • Changes in the menstrual cycle

    When tamoxifen treatment starts, a small number of women with cancer that has spread to the bones might have a tumor flare which can cause bone pain. This usually decreases quickly, but in some rare cases a woman may also develop a high calcium level in the blood that is hard to control. If this happens, the treatment may need to be stopped for a time.

    Rare, but more serious side effects are also possible:

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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.

    Hormone Receptor Positive Testing: Er And Pr

    The estrogen receptor was first identified in the 1960s and with the progesterone receptor became recognized as a predictive marker for which women with breast cancer would respond to hormone treatment.

    Ligand binding assays using frozen breast tumor tissues were an early detection method for assessing hormone receptor positive cancers.

    In the last three decades, the mammographic screening program has led to a decrease in the size of detected breast cancers and an increase in the use of tumor sampling by core needle biopsy .

    The availability of specific antibodies that recognize ER in formalin-fixed, paraffin-embedded tissue is the basis for the development of immunohistochemical assays to detect ER retrospectively in small specimens.

    According to clinical studies, IHC can determine ER status and is also predictive of patient response to endocrine therapy. The ability of ER status as determined by IHC to predict hormonal therapy response is superior to that of ER status as determined by biochemical methods.

    The use of IHC to assess the ER and PR status of breast cancers in FFPE tissue sections is now a routine part of pathology practice worldwide. So, the caveat for these visual, IHC methods is that optimal fixation and a high standard of method quality assurance are necessary.

    HER2 over-expression is more common in high-grade invasive breast cancers of Grade 2 or Grade 3. Unlike ER, IHC staining should not be present in normal breast.

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    Survival Analysis Of Single Hormone Receptor

    Approximately 97% of patients with ER + PR- tumors and 88% of patients with ER-PR+ tumors received endocrine therapy. More patients with ER + PR- and ER-PR+ tumors received chemotherapy than the group with ER + PR+ tumors , but less than the group with ER-PR- tumors . Approximately 72% of patients with ER + PR- tumors received both endocrine therapy and chemotherapy, and 24.9% of patients received only endocrine therapy. In ER-PR+ tumors, 80% of patients received both chemotherapy and endocrine therapy, 8.2% of patients received only endocrine therapy and 9.4% of patients received only chemotherapy.

    With univariate analysis by Kaplan-Meier method, the survival graph of ER + PR- tumors was located between that of ER + PR+ tumors and ER-PR- tumors. The 5-year and 10-year DFS of ER + PR- tumors was 91.4% and 79.6%, respectively, and the 5-year and 10-year OS was 95.9% and 93.9%, respectively. Patients with ER-PR+ tumors had worse DFS and OS than those with ER + PR-.

    Figure 1

    Among 1,376 patients with HER2 overexpression, there was no significant difference in DFS between four subgroups , and patients with ER-PR-HER+ tumors had the worst OS . However, the 790 patients who received trastuzumab therapy had similar OS , as did the 586 patients who did not receive trastuzumab therapy .

    Figure 2Figure 3Table 2 Multivariate analysis of disease-free survival and overall survival in 1.376 women with HER2-positive breast cancer

    Less Common Types Of Hormone Therapy

    ER/PR/Her2 Receptor studies in Breast Cancer

    Some other types of hormone therapy that were used more often in the past, but are rarely given now include:

    • Megestrol acetate , a progesterone-like drug
    • Androgens , like testosterone
    • Estradiol

    These might be options if other forms of hormone therapy are no longer working, but they can often cause side effects.

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    Ar/er Ratio And Correlation With Histological And Immunohistochemical Features

    The median AR/ER ratio was 0.51. Two was the optimal AR/ER ratio that differentiated the cohort by prognosis . The characteristics of the 284 ER+/HER2/AR+ BC cases stratified by an AR/ER ratio cut-off are reported in Table 1. Of the 284 AR+/ER+ cases, 268 had an AR/ER ratio < 2 and 16 an AR/ER ratio 2 . In the descriptive analysis, patients with a higher AR/ER ratio carried larger tumours with a higher histological grade and lower PgR levels, and they frequently had more metastatic lymph nodes and had a higher number of relapse events .

      What Are The Categories Of Breast Cancer

      Breast cancers are categorized into the following groups based on the hormone receptor and HER2 status:

      • Luminal A: ER and PR positive, and HER2 negative breast cancer
      • Luminal B: ER positive, PR negative and HER2 positive breast cancer
      • HER2 positive: HR negative and HER2 positive breast cancer
      • Triple positive: ER, PR and HER2 positive breast cancer
      • Triple negative : HR and HER2 negative breast cancer

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