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Breast Cancer Subtypes among Iraqi Patients: Identified By Their ER, PR and HER2 Status

Background: Breast cancer ranks the first among the Iraqi population since three decades and is currently forming a major public health problem being the second cause of death women. Novel management of breast cancer depends upon precise evaluation of their molecular subtypes; identified by Hormone (Estrogen and Progesterone) receptors and HER2 contents of the primary tumor.
Objective: To assess the rates of the different molecular breast cancer subtypes in the examined tissue specimens belonging to females diagnosed with breast cancer in Iraq; correlating the findings with those reported in the literature at the regional and global levels.
Patients and Methods: This retrospective study documented the findings of tissue biopsy examination belonging to 686 female patients diagnosed with breast cancer. Formalin fixed paraffin-embedded blocks were utilized to assess the availability of Estrogen receptors (ER), Progesterone receptors (PR) and HER2 expressions through semi quantitative immuno-histochemical staining technique. Breast carcinomas were classified into four main molecular subtypes: Luminal A: ER/PR(+) / HER2(-), Luminal B/Triple Positive: ER/PR(+) / HER2(+), Non-Luminal HER-2 enriched: ER/PR(-) / HER2(+) and Non-Luminal/Triple Negative: ER/PR(-) and HER2(-). Other phenotypes included: ER(+)/PR(-) / HER2(+), ER(-)/PR(+) / HER2 (+), ER (+)/PR (-) / HER2 (-) and ER (-)/PR (+) / HER2 (-).
Results: Out of the exanimated cases of breast carcinomas, the registered rates of positive ER, PR and HER2 tumor contents in this study were 67.8%, 65.3% and 29.4% respectively. The main identified phenotype was the Luminal A in 309 cases (45%). That was followed by the Triple Negative in 107 cases (15.6%) and Triple Positive/Luminal B (96 cases, 14%), while 71 cases (10.3%) were HER2 enriched. The corresponding rates of the (E+/P-/H+), (E-/P+/H+), (E+/P-/H-) and (E-/P+/H-) subtypes were 3.1%, 2.0%., 5.7% and 4.2% respectively. Differences in in the expressions of these IHC molecular markers are illustrated among different countries.
Conclusions: Due to the displayed variations in the socio-demographic characteristics and biological risk factors among patients in different populations, it is mandatory to identify the molecular marker subtypes of breast cancer expressions in order to assess the impact of management and response to therapy. The routine documentation of their patterns in the cancer registry reports and published research ensures the validity and reliability of the presented clinical data.

الخلفية: سرطان الثدي يحتل المرتبة الأولى بين السكان العراقيين منذ ثلاثة عقود، ويشكل حاليا مشكلة صحية رئيسية حيث يعتبر السبب الثاني للوفاة عند النساء. تعتمد أسس العلاج الجديدة لسرطان الثدي على التقييم الدقيق لأنواعها الفرعية الجزيئية و التي تحددها مستويات مستقبلات هرمون (الاستروجين والبروجسترون) ومحتويات  HER2 في الورم الرئيسي.

الهدف من الدراسة: تقييم معدلات مختلف الأنواع الفرعية لسرطان الثدي الجزيئي في عينات الأنسجة التي تم فحصها والتي تخص الإناث المصابات بسرطان الثدي في العراق؛ وربط النتائج مع تلك المسجلة على الصعيدين الإقليمي والعالمي

المرضى والطرق: وثقت هذه الدراسة بأثر رجعي نتائج فحص خزعة الأنسجة التي تنتمي إلى 686 مريضة مشخصة بسرطان الثدي. واستخدمت لتقييم توافر مستقبلات الاستروجين (ER)، مستقبلات البروجسترون (PR) والتعبيرات HER2 من خلال تقنية الطيخ المناعي شبه الكمي. تم تصنيف سرطان الثدي إلى أربعة أنواع فرعية جزيئية رئيسية: Luminal A:  ER/PR(+) / HER2(-), Luminal B/Triple Positive:    ER/PR(+) / HER2(+), Non-Luminal HER-2 enriched: ER/PR(-) / HER2(+) and Non-Luminal/Triple Negative:   ER/PR(-) and HER2(-). و انواع اخرى ER(+)/PR(-) / HER2(+), ER(-)/PR(+) / HER2 (+), ER (+)/PR (-)  / HER2 (-) and ER (-)/PR (+) / HER2 (-).

النتائج: من بين حالات سرطان الثدي المهددة، كانت المعدلات المسجلة لمحتوى الأورام الموجبة ER, PR و   HER2 في هذه الدراسة 67.8٪ و 65.3٪ و 29.4٪ على التوالي. وكان النمط الظاهري المحدد الرئيسي اللمعية A في 309 حالات (45٪). وأعقب ذلك السلبي الثلاثي في 107 حالات (15.6٪) وثلاثية إيجابية / لومينال B (96 حالة، 14٪)، في حين أن 71 حالة (10.3٪) كانت HER2 المخصب. وكانت المعدلات المقابلة من (E + / P- / H +)، (E / P + / H +)، (E + / P- / H-) و (E / P + / H-) فرعية 3.1٪، 2.0٪. ،   و 5.7٪ و 4.2٪ على التوالي. وتظهر الاختلافات في التعبير عن هذه العلامات الجزيئية بين مختلف البلدان.

الاستنتاجات والتوصيات: نظرا للاختلافات المعروضة في الخصائص الاجتماعية الديموغرافية وعوامل الخطر البيولوجية بين المرضى في مختلف السكان، فمن الضروري تحديد الأنواع الفرعية الجزيئية من تعبيرات سرطان الثدي من أجل تقييم تأثير الاستجابة للعلاج . ان التوثيق الروتيني لأنماط سرطان الثدي في تقارير سجل السرطان والبحوث المنشورة يضمن صحة ودقة البيانات السريرية ذات العلاقة.

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Publication Date
Sun Apr 03 2016
Journal Name
Journal Of The Faculty Of Medicine Baghdad
Ultrasound findings in prediction of breast cancer histological grade and HER2 status

Background: Breast cancer is the most frequent cancerous tumor and major cause of death from cancer between women all over the world.
Objectives: is to assess if ultrasound features of breast cancer can predict its histopathological grade and HER2 status of breast cancer for patients had their diagnosis in Oncology Teaching Hospital in Medical city complex from September 2014 to November 2015
Patients and Methods: This is retrospective study of 102 patients whom histopathologically proved breast cancer had reviewed their ultrasound findings and correlate them with histopathological grade and HER2 status.
Results: well circumscribed lesions, poorly defined and spiculated lesions are more likely to be of intermediate to high grade

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Publication Date
Sun Oct 02 2016
Journal Name
Journal Of The Faculty Of Medicine Baghdad
Evaluation of triple hormonal content (ER, PR, and HER\2neu)of breast cancer specimens obtained from breast cancer patients using tru-cut biopsy

Background: Breast cancer is the commonest type of malignancy among women worldwide and in Iraq. Tru-cut needle biopsy technique provides adequate tissue for histopathological diagnosis of suspected breast lumps and assessment of hormonal receptors (estrogen, progesterone and HER2neu) prior to surgical operation.
Objectives: To assess estrogen, progesterone andHER2neu expression using breast cancer tissue specimens obtained by tru-cut biopsy, to correlate the findings with clinicopathological parameters of known prognostic significance in breast cancer patients.
Patients and Methods: This prospective study was held within the Main Referral Center for Early Detection of Breast Tumors/Medical City Teachi

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Publication Date
Fri Jun 30 2017
Journal Name
International Journal Of Medical Research & Health Sciences
FLI1 Expression in Breast Cancer Cell Lines and Primary Breast Carcinomas is Correlated with ER, PR and HER2

FLI1 is a member of ETS family of transcription factors that regulate a variety of normal biologic activities including cell proliferation, differentiation, and apoptosis. The expression of FLI1 and its correlation with well-known breast cancer prognostic markers (ER, PR and HER2) was determined in primary breast tumors as well as four breast cancer lines including: MCF-7, T47D, MDA-MB-231 and MDA-MB-468 using RT-qPCR with either 18S rRNA or ACTB (β-actin) for normalization of data. FLI1 mRNA level was decreased in the breast cancer cell lines under study compared to the normal breast tissue; however, Jurkat cells, which were used as a positive control, showed overexpression compared to the normal breast. Regarding primary breast carcinoma

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Publication Date
Mon Oct 01 2012
Journal Name
Journal Of The Faculty Of Medicine Baghdad
Recurrent Breast Cancer Following Modified Radical Mastectomy and Risk Factors

Background: - Recurrent breast cancer is cancer that comes back following initial treatment. Risk factors of recurrence are lymph node involvement, larger tumor size, positive or close tumor margins, and lack of radiation treatment following lumpectomy, younger age and inflammatory breast cancer.
Objective: Asses the rate of recurrence for early breast cancer in Iraqi female patients, in relation to certain risk factors.
Patients and methods: A prospective study was conducted on 100 consecutive female patients, with stage I and stage II breast cancer treated by mastectomy and axillary dissection by the same team. Patients were assessed postoperatively every three months and recurrences were detected by physical examination and ultr

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Publication Date
Sun Oct 02 2016
Journal Name
Journal Of The Faculty Of Medicine Baghdad
Molecular Classification of Iraqi Breast Cancer Patients and Its Correlation with Patients’ Profile

Background: Breast cancer is a complex, multifaceted disease encompassing a great variety of entities that show considerable variation in clinical, morphological and molecular attributes.
Objective: The aim of this study to evaluate patients’ molecular profile (Estrogen receptor, Progesterone receptor, HER2/neu and Ki-67).
Patients & Methods: This is a cross-sectional descriptive study was done in Baghdad oncology teaching hospital from December 2015 to April 2016, carried on 100 breast cancer female patients with their age range from 27 to 73 years old and with their histopathology reports and (IHC) results.
Results: The highest incidence of breast cancer among patients in 5th (40-49 years) and 6th (50-59 years) decades o

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Publication Date
Wed Dec 12 2018
Journal Name
Iraqi National Journal Of Nursing Specialties
Barriers to Baseline Needs for Early Detection of Breast Cancer among Iraqi Female Patients

Background: Breast Cancer is the most common malignancy among the Iraqi population; the majority of cases are still diagnosed at advanced stages with poor prospects of cure. Early detection through promoting public awareness is one of the promising tools in its control. Objectives: To evaluate the baseline needs for breast cancer awareness in Iraq through exploring level of knowledge, beliefs and behavior towards the disease and highlighting barriers to screening among a sample of Iraqi women complaining of breast cancer. Methodology: Two-hundred samples were enrolled in this study; gathered from the National

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Publication Date
Wed Jun 01 2022
Journal Name
Baghdad Science Journal
Correlation between Serum and Tissue Markers in Breast Cancer Iraqi Patients

Breast cancer is the most prevalent malignancy among women worldwide, in Iraq it ranks the first among the population and the leading cause of cancer related female mortality. This study is designed to investigate the correlations between serum and tissue markers in order to clarify their role in progression or regression breast cancer. Tumor Markers are groups of substances, mainly proteins, produced from cancer cell or from other cells in the body in response to tumor.  The study was carried out from April 2018 to April 2019 with total number of 60 breast cancer women. The blood samples were collected from breast cancer women in postoperative and pretherapeutic who attended teaching oncology hospital of the medical city in Baghdad and

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Publication Date
Sun Apr 03 2016
Journal Name
Journal Of The Faculty Of Medicine Baghdad
Imaging and clinicopathological characteristics of breast cancer among women under the age of 40 years

Background: although breast cancer in young women is less common and often overlooked, it is still considered a major health concern.
Objectives: to evaluate the demographic, clinical, radiological and histopathological characteristics of breast cancer among a sample of Iraqi women diagnosed under the age of 40 years.
Patients and methods: a retrospective study enrolled 73 females below the age of 40 years with a history of breast cancer. All data was extracted from an established information system database designed by the Principal Investigator of the Iraqi National Breast Cancer Research Project under supervision of the International Agency for Research on Cancer (IARC) over a 4-years period from 2011 to 2014.
Results: sevent

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Publication Date
Sun Jul 03 2016
Journal Name
Journal Of The Faculty Of Medicine Baghdad
Imaging and clinicopathological characteristics of breast cancer among women under the age of 40 years

Background: although breast cancer in young women is less common and often overlooked, it is still considered a major health concern.
Objectives: to evaluate the demographic, clinical, radiological and histopathological characteristics of breast cancer among a sample of Iraqi women diagnosed under the age of 40 years.
Patients and methods: a retrospective study enrolled 73 females below the age of 40 years with a history of breast cancer. All data was extracted from an established information system database designed by the Principal Investigator of the Iraqi National Breast Cancer Research Project under supervision of the International Agency for Research on Cancer (IARC) over a 4-years period from 2011 to

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Publication Date
Thu Oct 01 2015
Journal Name
Journal Of The Faculty Of Medicine Baghdad
Prevalence of BRCA1 Oncogen Expression in Breast Cancer Specimens of Patients with Positive Family History

Background: Breast cancer is the leading female cancer worldwide and in Iraq .Some mutations, particularly in BRCA1, significantly increase the risk of the disease.
Objectives: To demonstrate the frequency of BRCA1 in a group of high risk women with “positive family history’’ of breast cancer; correlating the immune expression of BRCA1 with some parameters of known prognostic significance.
Patients and Methods: Eighty-two female patients diagnosed with breast cancer (50 familial and 32 non familial) were included in the study .The mean age of the patients was 48.07. Immunohistochemistry was performed to assess the BRCA1 oncogene expression, Estrogen Receptor (ER), Progesterone Receptor (PR), Her 2 neu contents of the tumors.<

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