Breast cancer, a formidable health challenge, has witnessed an alarming rise in India over the past decade. With a younger age of onset compared to Western countries, the Indian breast cancer landscape presents unique challenges and opportunities for early detection and targeted treatment. In this blog, we delve into the intricacies of breast cancer diagnosis through the lens of immunohistochemistry (IHC), drawing upon the expertise of Metropolis Healthcare subject matter experts.

Breast Cancer Trends in India and Globally

The incidence of breast cancer in India has been on a steady rise, with a staggering 50% increase in cases between 1965 and 1985. Recent estimates suggest that breast cancer accounts for 13.5% of all cancers and 10.6% of cancer-related deaths among Indian women. Alarmingly, the age of onset has shifted towards younger women, with a significant proportion of cases diagnosed before the age of 50.

In contrast to Western countries, where breast cancer incidence peaks in older age groups, the Indian population exhibits a unique age distribution. Metropolis team observed that the mean age of breast cancer patients in India is approximately 53.63 years, nearly a decade younger than their Western counterparts.

Also Read: Breast Cancer Warning Signs, Causes. Treatement and Early Detection

Understanding Immunohistochemistry (IHC) in Breast Cancer

Immunohistochemistry (IHC) has emerged as a powerful tool in the diagnosis and molecular classification of breast cancer. By detecting the presence or absence of specific biomarkers, IHC aids in predicting the tumour's response to various treatment modalities.

The key biomarkers assessed through IHC include estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (Her-2). The expression of these receptors provides valuable insights into the tumour's behaviour and guides the selection of appropriate targeted therapies.

Additionally, the Ki-67 proliferation index, determined through IHC, serves as a prognostic marker. Tumours with a high Ki-67 index are associated with more aggressive behaviour and poorer prognosis.

Read: What is Immunohistochemistry: Test, Cancer Detection, and Types

Study Overview and Scope

A comprehensive 7-year retrospective study was conducted, analysing 12,808 malignant breast tumour samples received at Metropolis Healthcare Ltd.'s Global Reference Laboratory in Mumbai. The study aimed to investigate the immunohistochemical markers across breast cancer patients in the Indian population and understand the association of molecular subtypes with demographics and tumour grade.

Morphological Classification of Breast Cancer

The morphological classification of breast cancer plays a crucial role in diagnosis and treatment planning. In the study, invasive duct carcinoma emerged as the dominant subtype, accounting for 93.83% of the cases. This finding aligns with global trends, where invasive duct carcinoma is the most prevalent morphological type.

Interestingly, the study also identified rare morphological subtypes, such as invasive lobular carcinoma (2.97%), invasive mucinous carcinoma (2.06%), and invasive papillary carcinoma (0.45%). The presence of these rare subtypes highlights the heterogeneity of breast cancer and the need for comprehensive diagnostic approaches.

Challenges in the Indian Breast Cancer Landscape

The Indian breast cancer landscape presents unique challenges that necessitate tailored diagnostic and treatment strategies. One of the primary hurdles is the lack of India-specific genetic biomarkers. The study by Metropolis emphasizes the urgent need to identify genetic and epigenetic markers specific to the Indian population, which could aid in early detection and targeted screening.

Socioeconomic factors and lifestyle influences also play a significant role in the Indian context. Late-stage diagnosis, limited access to advanced diagnostic facilities, and financial constraints often hinder timely intervention and optimal treatment outcomes.

Conclusion

The immunohistochemical characterization of breast cancer in India, as exemplified by the study conducted by Metropolis Healthcare Ltd., sheds light on the unique challenges and opportunities in the Indian breast cancer landscape. The rising incidence, younger age of onset, and morphological heterogeneity underscore the need for India-specific diagnostic and treatment strategies.

By embracing advanced techniques such as gene expression studies and molecular analysis, healthcare providers can pave the way for personalised medicine and improved patient outcomes. The insights gained from this study serve as a clarion call for collaborative efforts among researchers, clinicians, and policymakers to address the growing burden of breast cancer in India.

Read the original article here: https://archbreastcancer.com/test/index.php/abc/article/view/901

Reference: Barodawala S, Lila K, Chadha K, Pradhan G, Parab P, Jatale R, et al. Immunohistochemical Characterization of Breast Carcinoma:

Clinical Correlations, Molecular Subtypes, and Therapeutic Implications. Arch Breast Cancer. 2024; 11(2):108-17.