US Incidence of Breast Cancer Subtypes Defined by Joint Hormone Receptor and HER2 Status

Howlader, Nadia; Altekruse, Sean F.; Li, Christopher I.; Chen, Vivien W.; Clarke, Christina A.; Ries, Lynn A. G.; Cronin, Kathleen A.

doi:10.1093/jnci/dju055

Cited by 1,090 publications

(931 citation statements)

References 26 publications

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“…2,3,14,35 The data presented here are in accordance with the recently published US Surveillance, Epidemiology, and End Results (SEER) registry data, and with data from the UK and Canada that showed HER2 positivity rates of 14.5-15.0% in large patient cohorts. 28,36,37 Therefore, our study reflects published and realistic expectations of HER2 positivity rates in pathology institutes today.…”

Section: Er-negative/ Pgr-negativesupporting

confidence: 69%

Assessing HER2 testing quality in breast cancer: variables that influence HER2 positivity rate from a large, multicenter, observational study in Germany

Rüschoff¹,

Lebeau

Kreipe

et al. 2017

Modern Pathology

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Despite 410 years of routine human epidermal growth factor receptor 2 (HER2) testing in breast cancer, testing quality is still an issue. Guidelines recommend assessing HER2 positivity rates as a quality indicator; however, the extent to which patient-or tumor-related factors influence HER2 positivity is still unknown. The present study analyzed these influences to identify pathology centers with HER2 positivity rates unexplained by patient-or tumor-related factors. This observational, prospective study monitored routine HER2 testing at 57 institutes of pathology in Germany (January 2013-August 2014). Data collected included HER2 test result, patient-and tumorrelated factors, sample source, and method of sample retrieval. Factors influencing HER2 positivity rates were identified by multiple logistic regression. Individual center effects were assessed in an extended multiple logistic regression model by their statistical significance after adjusting for the combined effect of patient-or tumorrelated covariates and multiple testing. Analyses included 15 332 invasive breast cancer samples. Histologic grade showed the strongest influence on HER2 positivity, followed by hormone receptor status, histologic subtype, age, and nodal status (all Po 0.0001). The overall HER2 positivity rate across centers was 14.4% (range 7.1-27.3%). A statistically significant center effect on the HER2 positivity rate was identified for three centers (Po 0.05), with a trend toward a center effect for a further three (P o0.2). This study, the first of its kind, highlights that assessing HER2 testing quality with HER2 positivity rates should include standardized assessment of patient-or tumor-related characteristics to identify centers with HER2 testing quality issues more effectively. As treatment options for HER2-positive breast cancer continue to evolve, identifying the right patients is key. Overexpression of the human epidermal growth factor receptor 2 (HER2) protein or amplification of the HER2 gene occurs in~15-20% of all breast cancers. 1 HER2-positive breast cancer has a worse prognosis than HER2-negative disease, having an increased risk of recurrence and a more aggressive disease course. 2-4 HER2 is a prognostic biomarker predictive for the response to HER2-targeted therapies including the recombinant monoclonal antibodies trastuzumab and pertuzumab, and the antibody-drug conjugate ado-trastuzumab emtansine, all of which specifically target HER2 and are effective treatments for HER2-positive breast Correspondence: Professor J

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Section: Er-negative/ Pgr-negativesupporting

confidence: 69%

Assessing HER2 testing quality in breast cancer: variables that influence HER2 positivity rate from a large, multicenter, observational study in Germany

Rüschoff¹,

Lebeau

Kreipe

et al. 2017

Modern Pathology

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“…To study the clinical, demographic, and socioeconomic differences within Luminal A (HR+/HER2−) and Luminal B (HR+/HER2+) clinical breast cancer subtypes, we gathered 134,639 patients with HR+ and known HER2 receptor status from the SEER database 6. Among these patients, 118,285 (87.8%) cases were HR+/HER2− (Luminal A) (Table 1) and 16,354 (12.2%) were HR+/HER2+ (Luminal B) tumors (Table 2).…”

Section: Resultsmentioning

confidence: 99%

“…Across breast cancer subtypes, there exist demographic and socioeconomic status (SES) differences 6. Previous reports have found that differences in SES may reflect underlying differences in exposures to known breast cancer risk factors, as women with higher SES tended to have lower parity and more frequent use of exogenous hormones 7, 8, 9.…”

Section: Introductionmentioning

confidence: 99%

HER2 status and disparities in luminal breast cancers

et al. 2016

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National Comprehensive Care Network guidelines for adjuvant treatment of invasive breast cancer are based on HER2 and hormone receptor (HR) status, where HR+ disease encompasses all estrogen receptor (ER)+ and/or progesterone receptor (PR)+ tumors. We sought to explore clinical and demographic differences among patients with HR+ breast cancer subtypes, and the role of HER2 status, age, race/ethnicity, and socioeconomic status (SES) in disease risk. We evaluated breast cancer subtype distribution, defined by HR and HER2 status, using patient clinical, demographic, and socioeconomic characteristics. Differences in HR categories by demographic and tumor characteristics were examined using chi‐squared tests. Multinomial logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) to quantify associations between breast cancer HR status and demographic factors. We found that differences in HR+ (ER−/PR+ vs. ER+/PR− or ER+/PR+) tumor biology are likely clinically significant and may play a role in breast cancer, regardless of HER2 status. While clinical and patient characteristics differed within each luminal subtype, we found disparities in SES only among Luminal A (HR+/HER2−) tumors. Among HR+/HER2− cases, we observed that ER−/PR+ patients tend to live in areas of higher poverty (OR = 1.20, 95% CI = 1.03–1.40) and are 70% more likely to be aged 50 years or older. However, this pattern was not found in women with Luminal B (HR+/HER2+) disease (Poverty OR = 0.98, 95% CI = 0.76–1.27; Age OR = 1.01, 95% CI = 0.81–1.26). Racial/ethnic disparities among non‐Hispanic black and Hispanic women persisted across HR+/HER2− cases compared to non‐Hispanic white women. Our findings suggest that while race/ethnicity and SES are correlated, each plays an independent role in contributing to disease among Luminal A tumors. Further study is needed to investigate how tumor biology, race/ethnicity, and socioeconomic disparities among HR+/HER2− cases may contribute to poorer patient prognosis.

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“…(17) 22 (17) 16 (19) 3 (8) 6 (24) pT2 137 (50) 64 (49) 44 (54) 16 (41) 13 (52) pT3 22 (8) 11 (9) 7 (9) 3 (8) 1 (4) pT4 70 (25) 33 (25) 15 (18) 17 (43) Tumors were grouped into four major subclasses, based on the receptor status as follows: Hormone receptor (HR) positive HER2 negative (HR+/HER-), HR negative and HER2 positive (HR-/HER2+), HR positive and HER2 positive (HR+/HER2+), and the TNBCs (HR-/ HER2-). 43 of the 645 patients had an initial HER2 status assessed as equivocal, but were not tested further to unambiguously assess the status of HER2.…”

Section: Resultsmentioning

confidence: 99%

Analysis of Clinico-Pathological Characteristics of Indian Breast Cancers Shows Conservation of Specific Features in the Hormone Receptor Sub-Types

Mukherjee¹,

Lakshmaiah²

2016

J Integr Oncol

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Background: Clinical epidemiology studies of breast cancer in India have reported younger age at detection, presentation at a later stage with a greater proportion of Triple Negative Breast Cancer (TNBC). The aim of this study was to examine the standard clinic-pathological variables in the hormone-receptor based sub-types for patterns indicative of intrinsic differences from that reported in Western, Caucasian women.

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US Incidence of Breast Cancer Subtypes Defined by Joint Hormone Receptor and HER2 Status

Abstract: In the future, SEER data can be used to monitor clinical outcomes in women diagnosed with different molecular subtypes of breast cancer for a large portion (approximately 28%) of the US population.

Cited by 1,090 publications

References 26 publications

Assessing HER2 testing quality in breast cancer: variables that influence HER2 positivity rate from a large, multicenter, observational study in Germany

Assessing HER2 testing quality in breast cancer: variables that influence HER2 positivity rate from a large, multicenter, observational study in Germany

HER2 status and disparities in luminal breast cancers

Analysis of Clinico-Pathological Characteristics of Indian Breast Cancers Shows Conservation of Specific Features in the Hormone Receptor Sub-Types

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