Epidemiological Trends of Breast Cancer: A Five-Year Analysis in a Tertiary Care Centre

: Background: Breast cancer remains a significant global health concern, necessitating ongoing epidemiological investigations to understand its patterns and guide effective prevention and treatment strategies. This study aims to provide a comprehensive analysis of the epidemiology of breast cancer over a five-year period in a tertiary care center. Methods: A 3 year prospective and 2 year retrospective study was conducted, involving a thorough examination of medical records from a tertiary care centre spanning five years (2014-2019). Demographic information, clinical characteristics, and histopathological details of breast cancer patients were collected and analyzed. Descriptive statistics, including frequencies and percentages, were used to summarize the data. Results: The research encompassed a cohort of 277 individuals diagnosed with breast carcinoma. Surgical interventions revealed that 47.4% underwent modified radical mastectomy, 16.7% lumpectomy. Predominantly in females were affected (99.2%). The highest incidence of cases (29.6%) occurred in the 6th decade, postmenopausal status was noted in 58.8% of females, and the most prevalent clinical manifestation was an enlarging breast lump/mass (83.8%). Left breast involvement prevailed (58.8%), with 53.1% affecting the upper outer quadrant. Infiltrating ductal carcinoma


Introduction:
Breast cancer is one of the major causes of morbidity and mortality in females worldwide.Globally breast cancer mortality rates are very high, standing at approximately 15% (Globocan 2018).The clinical outcome in breast cancer patients is influenced by tumour stage, grade and expression of hormonal receptors (Estrogen receptor/ER, progesterone receptor/PR, and Her2-neu receptors) (Anand and Kumar, 2014).Despite advancements in diagnostic and therapeutic modalities, understanding the nuances of its epidemiology within specific healthcare settings remains paramount.Breast cancer is a pervasive health challenge worldwide, necessitating continuous epidemiological investigations to delineate its patterns and guide effective public health interventions.This paper presents a detailed analysis of the epidemiology of breast cancer over a five-year period within a tertiary care centre.The study aims to provide a comprehensive understanding of the demographic, clinical, and histopathological characteristics of breast cancer patients, emphasizing the importance of this information in shaping targeted prevention and treatment strategies.

Methods:
The present study comprised 432 patients diagnosed with malignant breast tumors over a period of 5 years (3 years retrospective and 2 years prospective) from 2014 to 2019, attending the out patient and in patient services of the Department of General Surgery, Jawaharlal Nehru Medical College Hospital, AMU, Aligarh.
For the purpose of this study those cases in which only core biopsies were received, were excluded and only specimens of modified radical mastectomies and lumpectomies were included, in order to ensure optimal tissue adequacy for further analysis.This resulted in a final study population of 277 patients.A detailed clinical history and examination, along with available records of investigations were obtained in each case.The histopathological specimens from these patients were received in the histopathology section of the Department of Pathology, J. N. Medical College, AMU.After a detailed gross examination, careful sampling was done and sections from the relevant areas were submitted for further processing as per routine lab protocol.The archival slides were also retrieved from the histopathological records of the Department of Pathology.These slides were also reviewed.A retrospective cohort study was conducted, involving the thorough examination of medical records from the tertiary care centre spanning from 20XX to 20XX.Demographic data, clinical characteristics, and histopathological details of breast cancer patients were systematically collected and subjected to rigorous analysis.Descriptive statistics, including frequencies and percentages, were utilized to summarize the findings.

Results:
The study encompassed a total of 432 breast cancer cases diagnosed and treated at the tertiary care centre during the stipulated five-year period.Surgical interventions revealed that 47.4% underwent modified radical mastectomy, 16.7% lumpectomy, and 35.9% core biopsies, however core biopsies were excluded.Subsequent analysis focused on 277 cases (MRM and Lumpectomy).The mean age at diagnosis was years (29.6%),.The highest incidence of cases (29.6%) occurred in the 6th decade, with 23.5% above years and 21.3% in the 41-50 age group.Breast cancer is predominantly affecting females (99.2%) with only two cases of carcinoma breast in males (0.8%).Among females patients 58.8% of females have attained menopause, and the most prevalent clinical manifestation was an enlarging breast lump/mass (83.8%) followed by lymphadenopathy (120 cases, 43.3%).The other associated clinical findings were ulceration/ fungating mass (30 cases, 10.8%), nipple retraction (29 cases, 10.5%), mastalgia ( 28 cases, 10.1%), and nipple discharge (20 cases, 7.2%).Left breast involvement prevailed (58.8%), with 53.1% affecting the upper outer quadrant of the breast.Infiltrating ductal carcinoma (No special type) comprised the largest histopathological subgroup in the present study, with 260 cases (93.9%).Invasive lobular carcinoma was diagnosed in 10 cases (2.2%).cases each of medullary carcinoma , metaplastic carcinoma and papillary carcinoma were also observed, along with a single case of mucinous carcinoma during the course of this study.Histopathological grades were assigned to all 260 cases of infiltrating ductal carcinoma (NST) using the Modified Scarff Bloom Richardson system.Grade II tumors comprised the largest subgroup, with cases (58.8%), followed by grade III (30.8%) and grade I carcinomas (10.4%).All the cases of breast carcinoma in this study were categorized according to the TNM staging system.Most patients presented in stage 3 (163 cases, 58.8%), followed by stage 2 (94 cases, 34%).20 cases had an early presentation in stage 1.Immunohistochemical staining for ER, PR and Her2/neu was available in 228 cases of infiltrating ductal carcinoma (NST).Maximum cases were triple negative for all the 3 markers (ER, PR, Her2/neu), (98 cases, 42.9%), followed by ER positive luminal A breast cancer in 67 cases (29.4%), and Her2 enriched breast cancer(43 cases, 18.9%).Only 20 cases were positive for all markers (ER, PR, Her2/neu) (Luminal B type).These findings shed light on the demographic distribution, clinical characteristics, and histopathological subtypes and hormone profile of breast carcinoma in the studied population, offering valuable insights for clinical understanding and management.

Conclusions:
The present study evaluated the histopathological spectrum of breast carcinoma diagnosed in the Department of Pathology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, over a period of 5 years (3 years retrospective and 2 years prospective), from 2014 to 2019.This study analysis provides a comprehensive insight into the epidemiological landscape of breast cancer within the confines of a tertiary care centre.The findings illuminate key demographic and clinical characteristics of the patient population, emphasizing the imperative for targeted interventions.Early detection initiatives, screening programs, and personalized treatment strategies must be prioritized to mitigate the impact of breast cancer.The data generated from this study contribute to the broader understanding of breast cancer epidemiology and hold implications for healthcare policies aimed at improving outcomes for affected individuals.

Future Directions:
Further research is warranted to explore evolving trends in breast cancer incidence, survival rates, and the impact of interventions within the population served by the tertiary care centre.Prospective studies could provide a dynamic perspective on changing epidemiological patterns and offer insights into the efficacy of implemented preventive and therapeutic measures.

Tables:
Table I

Figure 2b :
Figure 2b: Tissue section showing small to moderate size tumor cells with mild atypia, infiltrating the fibrous stroma in a discohesive manner (H&E,40) Figure 3a: Tissue section showing sheets of pleomorphic undifferentiated cells, infiltrating the fibrous stroma (H and E, 10x) Figure 3b: Tissue section showing atypical cells with indistinct cytoplasm, irregular round to oval vesicular nuclei, coarse chromatin and prominent nucleoli (H and E, 40x) Figure 4a: Tissue section showing extensive papillary arrangement of ductal epithelial cells with adjacent fibrotic stroma within which foci of invasion are seen (H and E,10x) Figure 4b : Tissue section showing extensive papillary arrangement of ductal epithelial cells with delicate fibrovascular core (H and E, 40x) Figure 5a : Tissue section showing nests of malignant tumor cells surrounded by pools of extracellular mucin (H and E, 10x) Figure 5b : Tissue section showing small islands of mildly pleomorphic malignant epithelial cells within extensive extracellular mucin (H and E, 40x) Figure 6a: Tissue section showing Grade I IDC (NST) with >75% tubule formation, lined by small hyperchromatic malignant ductal cells within abundant fibro collagenous stroma (H and E, 10x) Figure 6b: Tissue section showing small irregular tubules lined by malignant ductal epithelial cells and absence of myoepithelial cell layer (H and E, 40x) Figure 7a: Tissue section showing grade II IDC (NST) with tubular arrangement as well as small sheets of malignant cells with moderate nuclear pleomorphism and few mitotic figures.(H and E,10x) Figure 7b : Tissue section showing atypical ductal epithelial cells with moderate nuclear pleomorphism and desmoplastic reaction in surrounding stroma (H and E,40x) Figure 8a : Tissue section showing sheets of malignant ductal epithelial cells in an inflamed stroma, tubule formation is minimal (H and E, 10x) Figure 8b : Tissue section showing irregular islands of pleomorphic cells intermixed with inflammation with mitotic figures (H and E, 40x) Figure 9a, b and c : IHC for Estrogen receptors (ER) (a) and Progesterone receptors (PR) (b) showing positive expression (c) negative expression of Her2neu receptors in Luminal A type of IDC (NST) Figure 10 a, b and c : IHC for Estrogen receptors (ER) (a) showing positive expression and Progesterone receptors (PR) (b) showing negative expression (c) Her2neu receptor is showing strong expression in Luminal B type of IDC (NST) Figure 11 a, b and c : IHC for Estrogen receptors (ER) (a) and Progesterone receptors (PR) (b) showing negative expression, (c) strong expression of Her2neu receptor in HER2 enriched type of IDC (NST) Fig 10bFig10c