Abstract
In the last two decades, India has witnessed a substantial increase in the incidence of breast cancer and associated mortality. Studies on the prevalence of molecular subtypes of breast cancer in India have reported inconsistent results. Therefore, we conducted a systematic review of observational studies to document the prevalence of molecular subtypes of breast cancer. A complete literature search for observational studies was conducted in MEDLINE and EMBASE databases using key MeSH terms ((molecular classification) OR (molecular subtypes)) AND (breast cancer)) OR (breast carcinoma)) AND (prevalence)) AND (India). Two reviewers independently reviewed the retrieved studies. The screened studies satisfying the eligibility were included. The quality of included studies was assessed using the selected STROBE criteria. The overall pooled prevalence of luminal A, luminal B, HER2-enriched, and triple-negative breast cancer (TNBC) subtypes of breast cancer were 0.33 (95% CI 0.23–0.44), 0.17 (95% CI 0.12–0.23), 0.15 (95% CI 0.12–0.19), and 0.30 (95% CI 0.27–0.33), respectively. Subgroup analyses were performed by mean age of patients, time period, region, and sample size of the study. Among molecular subtypes of breast cancer, luminal A was the most prevalent subtype followed by TNBC, luminal B, and HER2-enriched subtypes. The overall prevalence of TNBC in India is high compared to other regions of the world. Additional research is warranted to identify the determinants of high TNBC in India. Differentiating TNBC from other molecular subtypes is important to guide therapeutic management of breast cancer.
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References
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68:394–424
Printzcancer C (2017) Breast cancer mortality rates decline internationally, with some major exceptions. Cancer 123:1085
Weigelt B, Baehner FL, Reis-Filho JS (2010) The contribution of gene expression profiling to breast cancer classification, prognostication and prediction: a retrospective of the last decade. J Pathol 220:263–280
Perou CM, Sørlie T, Eisen MB (2000) Molecular portraits of human breast tumours. Nature 406:747–752
Asthana S, Chauhan S, Labani S (2014) Breast and cervical cancer risk in India: an update. Indian J Public Health 58:5–10
Gupta A, Shridhar K, Dhillon PK (2015) A review of breast cancer awareness among women in India: cancer literate or awareness deficit? Eur J Cancer 51:2058–2066
Leong SPL, Shen Z-Z, Liu T-J, Agarwal G, Tajima T, Paik N-S, Sandelin K, Derossis A, Cody H, Foulkes WD (2010) Is breast cancer the same disease in Asian and Western countries? World J Surg 34:2308–2324
Sandhu GS, Erqou S, Patterson H, Mathew A (2016) Prevalence of triple-negative breast cancer in India: systematic review and meta-analysis. J Glob Oncol 2:412–421
Allison KH, Hammond MEH, Dowsett M (2020) Estrogen and progesterone receptor testing in breast cancer: American Society of Clinical Oncology/College of American Pathologists Guideline Update. Arch Pathol Lab Med 144:545–563
Wolff AC, Hammond ME, Schwartz JN (2007) American society of clinical oncology/College of American Pathologists guideline recommendations for human epidermal growth factor receptor 2 testing in breast cancer. Arch Pathol Lab Med 131:18–43
Ghosh J, Gupta S, Desai S (2011) Estrogen, progesterone and HER2 receptor expression in breast tumors of patients, and their usage of HER2-targeted therapy, in a tertiary care centre in India. Indian J Cancer 48:391–396
Ambroise M, Ghosh M, Mallikarjuna VS, Kurian A (2011) Immunohistochemical profile of breast cancer patients at a tertiary care hospital in South India. Asian Pac J Cancer Prev 12:625–629
Verma S, Bal A, Joshi K, Arora S, Singh G (2012) Immunohistochemical characterization of molecular subtypes of invasive breast cancer: a study from North India. Apmis 120:1008–1019
Zubeda S, Kaipa PR, Shaik NA (2013) Her-2/neu status: a neglected marker of prognostication and management of breast cancer patients in India. Asian Pac J Cancer Prev 14:2231–2235
Rao C, Shetty J, Kishan Prasad HL (2013) Morphological profile and receptor status in breast carcinoma: an institutional study. J Cancer Res Ther 9:44–49
Singh R, Gupta S, Pawar S, Pawar R, Gandham S, Prabhudesai S (2014) Evaluation of ER, PR and HER-2 receptor expression in breast cancer patients presenting to a semi urban cancer centre in Western India. J Can Res Ther 10:26–28
Nigam J, Yadav P, Sood N (2014) A retrospective study of clinico-pathological spectrum of carcinoma breast in a West Delhi, India. South Asian J Cancer 3:179–181
Nandi M, Mahata A, Mallick I, Achari R, Chatterjee S (2014) Hypofractionated radiotherapy for breast cancers--preliminary results from a tertiary care center in eastern India. Asian Pac J Cancer Prev 15:2505–2510
Lakshmaiah KC, Das U, Suresh TM (2014) A study of triple negative breast cancer at a tertiary cancer care center in southern India. Ann Med Health Sci Res 4:933–937
Jana D, Sarkar DK, Ganguly S, Banerjee A, Manna AK, Mandal S (2014) Can molecular subtyping replace axillary nodal status as prognostic marker in breast cancer? Indian J Surg Oncol 5:282–289
Sharma M, Sharma JD, Sarma A (2014) Triple negative breast cancer in people of North East India: critical insights gained at a regional cancer centre. Asian Pac J Cancer Prev 15:4507–4511
Sen S, Gayen R, Das S, Maitra S, Jha A, Mahata M (2012) A clinical and pathological study of triple negative breast carcinoma: experience of a tertiary care centre in eastern India. J Indian Med Assoc 110:686–689,705
Patnayak R, Jena A, Rukmangadha N (2015) Hormone receptor status (estrogen receptor, progesterone receptor), human epidermal growth factor-2 and p53 in South Indian breast cancer patients: a tertiary care center experience. Indian J Med Paediatr Oncol 36:117–122
Chatterjee D, Bal A, Das A, Singh G (2015) Proliferation rate and breast cancer subtype, but not ALDH1 expression, predict pathological response to neoadjuvant chemotherapy in locally advanced breast cancer. Virchows Arch 467:303–310
Nabi MG, Ahangar A, Wahid MA, Kuchay S (2015) Clinicopathological comparison of triple negative breast cancers with non-triple negative breast cancers in a hospital in North India. Niger J Clin Pract 18:381–386
Akhtar M, Dasgupta S, Rangwala M (2015) Triple negative breast cancer: an Indian perspective. Breast Cancer (Dove Med Press) 7:239–243
Kumar N, Patni P, Agarwal A, Khan MA, Parashar N (2015) Prevalence of molecular subtypes of invasive breast cancer: a retrospective study. Med J Armed Forces India 71:254–258
Mane A, Khatib KI, Deshmukh SP, Nag SM, Sane SP, Zade BP (2015) A comparison of clinical features, pathology and outcomes in various subtypes of Breast Cancer in Indian Women. J Clin Diagn Res 9:Pc01–Pc04
Doval DC, Sharma A, Sinha R (2015) Immunohistochemical profile of breast cancer patients at a tertiary care hospital in New Delhi, India. Asian Pac J Cancer Prev 16:4959–4964
Saha S, Ganguly S, Sarkar DK, Hazra A (2016) Clinicopathological characteristics of patients of certain molecular subtypes and elevated postoperative cancer antigen 15.3 levels and its correlation with menopausal status. Indian J Pathol Microbiol 59:172–176
Shrivastav S, Bal A, Singh G, Joshi K (2016) Tumor angiogenesis in breast cancer: pericytes and maturation does not correlate with lymph node metastasis and molecular subtypes. Clin Breast Cancer 16:131–138
Subbiah S, Gopu G, Senthilkumar P, Muniasamy P (2017) Molecular subtypes as a predictor of response to neoadjuvant chemotherapy in breast cancer patients. Indian J Cancer 54:652–657
Anand A, Singh KR, Kumar S, Husain N, Kushwaha JK, Sonkar AA (2017) Androgen receptor expression in an Indian breast cancer cohort with relation to molecular subtypes and response to neoadjuvant chemotherapy-a prospective clinical study. Breast Care (Basel) 12:160–164
Kunikullaya S, Poddar J, Sharma A, Patel S (2017) Pattern of distant metastasis in molecular subtypes of carcinoma breast: an institutional study. Indian J Cancer 54:327–332
Khare S, Singh SS, Irrinki S (2018) (18)F-Fluorodeoxyglucose positron emission tomography/computed tomography features in locally advanced breast cancer and their correlation with molecular subtypes. Indian J Nucl Med 33:290–294
Kumar RV, Panwar D, Amirtham U (2018) Estrogen receptor, progesterone receptor, and human epidermal growth factor receptor-2 status in breast cancer: a retrospective study of 5436 women from a regional cancer center in South India. South Asian J Cancer 7:7–10
Govind Babu K, Anand A, Lakshmaiah KC, Lokanatha D, Jacob LA, Suresh Babu MC et al (2018) Correlation of BMI with breast cancer subtype and tumour size. Ecancermedicalscience 12:845
Rashmi S, Kamala S, Murthy SS, Kotha S, Rao YS, Chaudhary KV (2018) Predicting the molecular subtype of breast cancer based on mammography and ultrasound findings. Indian J Radiol Imaging 28:354–361
Wadasadawala T, Mondal M, Paul SN (2018) Should molecular subtype be recommended as one of the selection criteria for accelerated partial breast irradiation? Preliminary results from an Asian cohort. J Contemp Brachytherapy 10:47–57
Pandit P, Patil R, Palwe V, Gandhe S, Patil R, Nagarkar R (2020) Prevalence of molecular subtypes of breast cancer: a single institutional experience of 2062 patients. Eur J Breast Health 16:39–43
Vandenbroucke JP, von Elm E, Altman DG, Gøtzsche PC, Mulrow CD, Pocock SJ, Poole C, Schlesselman JJ, Egger M, STROBE Initiative (2007) Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Epidemiology 18:805–835
Howlader N, Cronin KA, Kurian AW, Andridge R (2018) Differences in breast cancer survival by molecular subtypes in the United States. Cancer Epidemiol Biomark Prev 27:619–626
Ma H, Lu Y, Malone KE, Marchbanks PA (2013) Mortality risk of black women and white women with invasive breast cancer by hormone receptors, HER2, and p53 status. BMC Cancer 13:225
Onitilo AA, Engel JM, Greenlee RT, Mukesh BN (2009) Breast cancer subtypes based on ER/PR and Her2 expression: comparison of clinicopathologic features and survival. Clin Med Res 7:4–13
Tubtimhin S, Promthet S, Suwanrungruang K, Supaattagorn P (2018) Molecular subtypes and prognostic factors among premenopausal and postmenopausal Thai women with invasive breast cancer: 15 years follow-up data. Asian Pac J Cancer Prev 19:3167–3174
Elidrissi Errahhali M, Elidrissi Errahhali M, Ouarzane M, El Harroudi T, Afqir S, Bellaoui M (2017) First report on molecular breast cancer subtypes and their clinico-pathological characteristics in Eastern Morocco: series of 2260 cases. BMC Womens Health 17:3
Carey LA, Perou CM, Livasy CA (2006) Race, breast cancer subtypes, and survival in the Carolina breast cancer study. Jama 295:2492–2502
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Concepts, design, manuscript preparation, and manuscript review: Pavan Kumar Jonnada, Cherukuru Sushma, Madhuri Karyampudi, and Anvesh Dharanikota
Definition of intellectual content: Pavan Kumar Jonnada, Cherukuru Sushma
Literature search: Pavan Kumar Jonnada and Madhuri Karyampudi
Data acquisition: Pavan Kumar Jonnada, Cherukuru Sushma, and Madhuri Karyampudi
Data analysis and statistical analysis: Pavan Kumar Jonnada and Anvesh Dharanikota
Manuscript editing: Cherukuru Sushma and Madhuri Karyampudi
Guarantor: Anvesh Dharanikota
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All the authors work in esteemed oncology institutes across India and belong to different specialities dealing with breast malignancies.
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Jonnada, P.K., Sushma, C., Karyampudi, M. et al. Prevalence of Molecular Subtypes of Breast Cancer in India: a Systematic Review and Meta-analysis. Indian J Surg Oncol 12 (Suppl 1), 152–163 (2021). https://doi.org/10.1007/s13193-020-01253-w
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DOI: https://doi.org/10.1007/s13193-020-01253-w