TY  - CHAP
M1  - Book, Section
TI  - Breast Cancer
A1  - Rowe, Julie H.
A1  - Gonzalez, Anneliese O.
A1  - Jafri, Syed H.
A1  - Cen, Putao
A1  - Kanaan, Zeyad
A1  - Amato, Robert J.
A1  - Rios, Adan
A1  - El-Osta, Hazem
A1  - Mohlere, Virginia
PY  - 2019
T2  - Hematology-Oncology Clinical Questions
AB  - Table  Graphic  Jump  Location|Download  (.pdf)|PrintKey  conceptBreast  cancer  is  composed  of  several  biological  subtypes.  Newly  diagnosed  breast  cancers  must  be  tested  for  estrogen  receptor  (ER)  and  progesterone  receptor  (PR)  expression  and  for  overexpression  of  human  epidermal  growth  factor  2  (HER2)  receptors.  This  information  is  critical  for  both  prognostic  and  therapeutic  purposes.1Clinical  scenarioA  51-year-old  woman  with  stage  I  breast  cancer  presents  after  lumpectomy  and  sentinel  lymph  node  biopsy  surgery  for  discussion  of  systemic  therapy.  The  ER/PR  and  HER2  neu  status  are  pending.Action  itemsThe  proportions  of  breast  cancers  with  different  receptor  phenotypes  were  evaluated  in  one  study  and  showed  the  following  case  distribution2:Hormone  receptor  (ER  and/or  PR)–positive  cancers:  80%  of  casesHER2  overexpression:  23%  of  cases  Of  these,  67%  and  32%  were  hormone  receptor–positive  and  –negative,  respectivelyER,  PR,  and  HER2–negative  (triple-negative)  cancers:  13%  of  casesThe  frequency  of  subtypes  varies  according  to  race.  Compared  with  white  women,  African-American  women  are  less  likely  to  have  hormone  receptor  (ER/PR)–positive,  HER2-negative  disease  (48%  vs.  64%,  respectively)  and  more  likely  to  have  ER/PR/HER2-negative  disease  (22%  vs.  11%,  respectively).3DiscussionER  and  PR  expression  are  prognostic  factors  for  invasive  breast  cancer,  particularly  in  the  first  5  years  after  the  initial  diagnosis.  In  addition,  patients  who  are  ER-  and/or  PR-positive  are  candidates  for  endocrine  therapy  as  neoadjuvant  or  adjuvant  treatment.  ER  positivity  is  defined  by  immunohistochemistry  (IHC)  for  ER  and  PR  in  >1%  of  tumor  cells.1HER2  overexpression  is  present  in  20%  of  patients  and  predicts  those  who  will  benefit  from  HER2-directed  therapy.  HER2  overexpression  is  detected  by  uniform  intense  membrane  staining  of  >30%  of  invasive  tumor  cells  (IHC  3+)  or  the  presence  of  HER2  gene  amplification  by  fluorescence  in-situ  hybridization  (FISH)  defined  as  a  ratio  of  HER2/CEP17  (centromeric  probe  to  chromosome  17)  ratio  ≥2.0.1Assays  for  tumor  expression  of  ER,  PR,  and  HER2  neu  have  well-established  utility  in  the  clinical  management  of  patients  with  both  early  stage  and  advanced  breast  cancer.  They  identify  tumors  for  which  endocrine  and/or  anti-HER2  therapies  are  valuable  therapeutic  options,  and  they  should  be  routinely  obtained  on  all  tumor  specimens.PearlsIHC  has  rapidly  become  the  predominant  method  for  measuring  ER  and  PR  in  clinical  practice4Due  to  variability  in  ER  and  PR  IHC  assay  caused  by  a  variety  of  factors,  national  guidelines  for  testing  have  been  developed4ReferencesNCCN  Clinical  Practice  Guidelines  in  Oncology  for  breast  cancer.  Available  at:  http://www.nccn.org.Parise  CA,  Bauer  KR,  Brown  MM,  et  al.  Breast  cancer  subtypes  as  defined  by  the  estrogen  receptor  (ER),  progesterone  receptor  (PR),  and  the  human  epidermal  growth  factor  receptor  2  (HER2)  among  women  with  invasive  breast  cancer  in  California,  1999-2004.  Breast  J  2009;  15:593-602.O’Brien  KM,  Cole  SR,  Tse  CK,  et  al.  Intrinsic  breast  tumor  subtypes,  race,  and  long-term  survival  in  the  Carolina  Breast  Cancer  Study.  Clin  Cancer  Res  2010;  16:6100-10.Hammond  ME,  Hayes  DF,  Dowsett  M,  et  al.  American  Society  of  Clinical  Oncology/College  of  American  Pathologists  guideline  recommendations  for  immunohistochemical  testing  of  estrogen  and  progesterone  receptors  in  breast  cancer.  Arch  Pathol  Lab  Med  2010;134(7):e48-72.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/25
UR  - hemonc.mhmedical.com/content.aspx?aid=1162981208
ER  -