Histological and Immunohistochemical Characteristics for Hereditary Breast Cancer Risk in a Cohort of Brazilian Women

Freitas, Renata Mendes de; Guerra, Maximiliano Ribeiro; Fayer, Vívian Assis; Campos, Angélica Atala Lombelo; Cintra, Jane Rocha Duarte; Warren, Joan; Ervilha, Rafaela Russi; Paula, Camila Damasceno de; Bustamante-Teixeira, Maria Teresa

doi:10.1055/s-0042-1743103

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Revista Brasileira de Ginecologia e Obstetrícia

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Sumário

Original Article • Rev Bras Ginecol Obstet. 44 (08) • 2022 • https://doi.org/10.1055/s-0042-1743103 copy

Histological and Immunohistochemical Characteristics for Hereditary Breast Cancer Risk in a Cohort of Brazilian Women

Características histológicas e imunohistoquímicas para risco hereditário de câncer de mama em uma coorte de mulheres brasileiras

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

The study aimed to characterize the clinical, histological, and immunohistochemical profile of women with invasive breast cancer, according to the risk for Hereditary Predisposition Breast and Ovarian Cancer Syndrome in a Brazilian population.

Methods

This is a retrospective study performed from a hospital-based cohort of 522 women, diagnosed with breast cancer treated at an oncology referral center in the Southeast region of Brazil, between 2014 and 2016.

Results

Among the 430 women diagnosed with invasive breast cancer who composed the study population, 127 (29.5%) were classified as at increased risk for hereditary predisposition to breast and ovarian cancer syndrome. There was a lower level of education in patients at increased risk (34.6%) when compared with those at usual risk (46.0%). Regarding tumor characteristics, women at increased risk had higher percentages of the disease diagnosed at an advanced stage (32.3%), and with tumors > 2cm (63.0%), with increased prevalence for both characteristics, when compared with those at usual risk. Furthermore, we found higher percentages of HG3 (43.3%) and K_i-67 ≥ 25% (64.6%) in women at increased risk, with prevalence being about twice as high in this group. The presence of triple-negative tumors was observed as 25.2% in women at increased risk and 6.0% in women at usual risk, with the prevalence of absence of biomarkers being 2.5 times higher among women in the increased risk group.

Conclusion

From the clinical criteria routinely used in the diagnosis of breast cancer, the care practice of genetic counseling for patients at increased risk of hereditary breast cancer in contexts such as Brazil is still scarce.

Keywords
breast cancer; hereditary breast and ovarian cancer syndrome; cohort studies; immunohistochemistry; genetic counseling

Variables			Usual risk		Increased risk			PR^b b prevalence ratio calculated only for valid data (95% CI)
Variables	n^* * the difference in totals (N) is due to incompleteness of information.	%	n	%	n	%	P^a a chi-square (X2) test, p< 0.05
Age at diagnosis
≥ 50 years old	299	69.5	282	93.1	17	13.4	0.000	1.00
< 50 years old	131	30.5	21	6.9	110	86.6		14.8 (9.3–23.6)
Skin color
White	311	72.3	226	74.6	85	66.9	0.16	1.00
Non-white	113	26.3	72	23.8	41	32.3		1.33 (0.98–1.80)
Education (in years)
> 8	240	55.8	158	52.0	82	64.6	0.05	1.00
≤ 8	183	42.6	139	46.0	44	34.6		0.70 (0.52–0.96)
Health service
Private	170	39.5	124	40.9	46	36.2	0.40	1.00
Public	260	60.5	179	59.1	81	63.8		1.15 (0.85–1.56)
Family history of breast cancer
Absent	299	69.5	222	73.3	77	60.6	0.01	1.00
Present	131	30.5	81	26.7	50	39.4		1.48 (1.11–1.98)
First-degree relative with breast cancer^c c first-degree relatives: parents, children, and siblings of the patient
Absent	368	85.6	267	88.0	101	79.5	0.02	1.00
Present	62	14.4	36	12.0	26	20.5		1.53 (1.09–2.14)

Variables			Usual risk		Increased risk
Variables	n^* * The difference in totals (N) is due to incompleteness of information.	%	n	%	n	%	P^a a chi-square (X2) test, p< 0.05.	PR^b b Prevalence ratio calculated only for valid data. (95% CI)
Stage at diagnosis^c c Stage at diagnosis: early stage (I); intermediate (II); advanced (III and IV).
Early stage/intermediate	320	74.4	234	77.2	86	67.7	0.04	1.00
Advanced	110	25.6	69	22.8	41	32.3		1.39 (1.02–1.88)
Histological type
Invasive lobular	34	7.9	27	9.0	7	5.5	0.51	1.00
Others	40	9.3	28	9.2	12	9.5		1.46 (0.65–3.28)
Invasive ductal	354	82.3	246	81.2	108	85.0		1.48 (0.75–2.92)
Tumor size
≤ 2cm	195	45.3	148	48.8	47	37.0	0.04	1.00
> 2cm	233	54.2	153	50.5	80	63.0		1.42 (1.05–1.93)
Compromised lymph nodes
No	219	50.9	163	53.8	56	44.0	0.07	1.00
Yes	211	49.1	140	46.2	71	56.0		1.32 (0.98–1.77)
Histological grade (HG)^d d Histological grade: HG1: well differentiated; HG2: moderately differentiated; HG3: poorly differentiated.
HG 1	90	20.9	75	24.8	15	11.8	<0.01	1.00
HG 2	162	37.7	115	38.0	47	37.0		1.74 (1.03–2.93)
HG 3	125	29.1	70	23.0	55	43.3		2.64 (1.60–4.36)
Ki67
< 25%	207	48.1	166	54.8	41	32.3	<0.01	1.00
≥ 25%	204	47.5	122	40.3	82	64.6		2.03 (1.47–2.80)
Perineural invasion
Absent	388	90.2	271	89.4	117	92.0	0.39	1.00
Present	42	9.8	32	10.6	10	8.0		0.79 (0.45–1.38)
Vascular invasion
Absent	334	77.7	234	77.2	100	78.7	0.73	1.00
Present	96	22.3	69	22.8	27	21.3		0.94 (0.66–1.35)
Inflammatory infiltrate
Absent	319	74.2	229	75.6	90	71.0	0.31	1.00
Present	111	25.8	74	24.4	37	29.0		1.18 (0.86–1.62)
Multifocality
Absent	387	90.0	276	91.1	111	87.4	0.25	1.00
Present	43	10.0	27	8.9	16	12.6		1.30 (0.85–1.97)
Multicentricity
Absent	416	96.7	295	97.4	121	95.3	0.27	1.00
Present	14	3.3	8	2.6	6	4.7		1.47 (0.79–2.75)
Intraductal component
Absent	320	74.4	228	75.2	92	72.4	0.54	1.00
Present	110	25.6	75	24.8	35	27.6		1.11 (0.80–1.53)
Hormone receptors
Present	357	83.0	268	88.4	89	70.0	<0.01	1.00
Absent	71	16.5	33	11.0	38	30.0		2.15 (1.62–2.85)
HER-2
Present	74	17.2	51	16.8	23	18.1	0.55	1.00
Absent	348	80.9	245	80.9	103	81.1		1.05 (0.7–1.53)
Biomarkers^e e Present biomarkers: HR ± and HER-2+ or HR+ and HER-2-; absent biomarkers: HR- and HER-2- (triple negative).
Present	380	88.4	285	94.0	95	74.8	<0.01	1.00
Absent	50	11.6	18	6.0	32	25.2		2.56 (1.95–3.36)

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[1] Address for correspondence Renata Mendes de Freitas, PhD, Rua José Lourenço Kelmer, s/n, Juiz de Fora, MG, Brazil (renatafreitas.mendes@gmail.com).