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Breast cancer in Iraq is associated with a unimodally distributed predominance of luminal type B over luminal type A surrogates from young to old age

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ABSTRACT

Background: Breast cancer has recently increased in post-menopausal Iraqi women. In Western countries at high-risk for breast cancer, there is a bimodal increase in estrogen receptor (ER) positive tumors with a peak of low proliferation rate luminal A over higher proliferation rate luminal B tumors after 60 years of age. The aim of this study was to analyze in Iraqi women whether shifts are occurring in immunohistochemical (IHC) surrogates of molecular breast cancer subtypes toward a high-risk profile.

Methods: Age specific and age standardized womens breast cancer incidence was estimated for the years 2006 through 2012. IHC results of ER, PR, HER2, and Ki67 testing were analyzed on the breast cancers of 125 Arabic and 725 Kurdish women by frequency of distribution and by age.

Results: Between 2006 and 2012, age standardized incidence of breast cancer in Iraq increased from 30 to 40/100,000 women with the increase specifically occurring in women ≥ 60 years old (P < 0.001). Breast cancers in Kurdish women ≥ 60 years old may also have increased (P = 0.047) with urban exceeding rural rates by 2:1. For both Kurdish and Arabic women, there was a marked predominance of luminal B tumors at all ages in which luminal B and luminal A tumors were asymmetric skewed toward older age but with no late luminal A age peak.

Conclusions: Older Iraqi women do not show the bimodal shift toward higher rates of luminal A breast cancers seen in the West. The modest increase in age standardized incidence of breast cancer in Iraqi is being seen specifically in older women and may be better attributed to a trend for care in urban cancer centers rather than changing tumor characteristics.

No MeSH data available.


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Age specific incidence of luminal A and luminal B tumorsLegend: Polynomial regression plots showing a predominance of luminal B at all ages over luminal A tumors. There is no late luminal A peak that exceeds the incidence of luminal B tumors
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Fig4: Age specific incidence of luminal A and luminal B tumorsLegend: Polynomial regression plots showing a predominance of luminal B at all ages over luminal A tumors. There is no late luminal A peak that exceeds the incidence of luminal B tumors

Mentions: Figure 2 shows that luminal B/HER2- tumors began to be seen at an earlier age than Luminal A tumors, but both subtypes were closely nested over the entire range of young to old age with no suggestion of a late luminal A peak. Luminal B/HER2+ tumors had a significantly earlier peak than the other subtypes (P < 0.01). Although Luminal B/HER2+ tumors represented only 28% of all luminal B tumors, the earlier age contributed to all luminal B tumors being found at a significantly earlier age than luminal A tumors (P = 0.04) but with no significant difference in age between luminal A and luminal B/HER2- tumors (P = 0.19). Figure 3 plots age specific incidence per 100,000 women for the major subtypes. The peak incidence of all cancers was about 60 years of age but then declined markedly from 60 to 80 years old. The decline includes luminal A and luminal B subtypes with the incidence of luminal B exceeding that of luminal A at all ages (Fig. 4).Fig. 3


Breast cancer in Iraq is associated with a unimodally distributed predominance of luminal type B over luminal type A surrogates from young to old age
Age specific incidence of luminal A and luminal B tumorsLegend: Polynomial regression plots showing a predominance of luminal B at all ages over luminal A tumors. There is no late luminal A peak that exceeds the incidence of luminal B tumors
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5383947&req=5

Fig4: Age specific incidence of luminal A and luminal B tumorsLegend: Polynomial regression plots showing a predominance of luminal B at all ages over luminal A tumors. There is no late luminal A peak that exceeds the incidence of luminal B tumors
Mentions: Figure 2 shows that luminal B/HER2- tumors began to be seen at an earlier age than Luminal A tumors, but both subtypes were closely nested over the entire range of young to old age with no suggestion of a late luminal A peak. Luminal B/HER2+ tumors had a significantly earlier peak than the other subtypes (P < 0.01). Although Luminal B/HER2+ tumors represented only 28% of all luminal B tumors, the earlier age contributed to all luminal B tumors being found at a significantly earlier age than luminal A tumors (P = 0.04) but with no significant difference in age between luminal A and luminal B/HER2- tumors (P = 0.19). Figure 3 plots age specific incidence per 100,000 women for the major subtypes. The peak incidence of all cancers was about 60 years of age but then declined markedly from 60 to 80 years old. The decline includes luminal A and luminal B subtypes with the incidence of luminal B exceeding that of luminal A at all ages (Fig. 4).Fig. 3

View Article: PubMed Central - PubMed

ABSTRACT

Background: Breast cancer has recently increased in post-menopausal Iraqi women. In Western countries at high-risk for breast cancer, there is a bimodal increase in estrogen receptor (ER) positive tumors with a peak of low proliferation rate luminal A over higher proliferation rate luminal B tumors after 60&nbsp;years of age. The aim of this study was to analyze in Iraqi women whether shifts are occurring in immunohistochemical (IHC) surrogates of molecular breast cancer subtypes toward a high-risk profile.

Methods: Age specific and age standardized womens breast cancer incidence was estimated for the years 2006 through 2012. IHC results of ER, PR, HER2, and Ki67 testing were analyzed on the breast cancers of 125 Arabic and 725 Kurdish women by frequency of distribution and by age.

Results: Between 2006 and 2012, age standardized incidence of breast cancer in Iraq increased from 30 to 40/100,000 women with the increase specifically occurring in women&thinsp;&ge;&thinsp;60&nbsp;years old (P&thinsp;&lt;&thinsp;0.001). Breast cancers in Kurdish women&thinsp;&ge;&thinsp;60&nbsp;years old may also have increased (P&thinsp;=&thinsp;0.047) with urban exceeding rural rates by 2:1. For both Kurdish and Arabic women, there was a marked predominance of luminal B tumors at all ages in which luminal B and luminal A tumors were asymmetric skewed toward older age but with no late luminal A age peak.

Conclusions: Older Iraqi women do not show the bimodal shift toward higher rates of luminal A breast cancers seen in the West. The modest increase in age standardized incidence of breast cancer in Iraqi is being seen specifically in older women and may be better attributed to a trend for care in urban cancer centers rather than changing tumor characteristics.

No MeSH data available.


Related in: MedlinePlus