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Table of Contents
Year : 2022  |  Volume : 8  |  Issue : 2  |  Page : 108-110

Triple-negative breast cancer in young aged Indian women - An overview

1 Deputy Dean Research, Central Research Facility, Santosh Deemed to be University, Ghaziabad, Uttar Pradesh, India
2 Professor of General Surgery, Vice-Chancellor, Santosh Deemed to be University, Ghaziabad, Uttar Pradesh, India

Date of Submission03-Nov-2022
Date of Acceptance24-Nov-2022
Date of Web Publication11-Jan-2023

Correspondence Address:
Sivanesan Dhandayuthapani
Central Research Facility (Biochemistry), Ghaziabad - 201 009, Uttar Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/sujhs.sujhs_32_22

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The incidence of breast cancer has overtaken cervical cancer over the past decade and becoming the most common type of cancer among Indian women. Morbidity and mortality associated with the type of cancer are disproportionately higher in Indian women. Despite efforts being made to increase awareness about the causes, a large population of Indian women are already present with advanced stages of the disease. Reproductive factors are among the most well-established risk factors for breast cancer. However, their associations with different breast cancer subtypes defined by joint estrogen receptor/progesterone receptor/human epidermal growth factor status remain unclear. Triple-negative breast cancers (TNBCs) are known for early age at presentation, large tumor sizes, and overall poor prognosis. However, Indian studies are scarce with limited follow-up data. Hence, the present study is aimed at characterizing nonmetastatic TNBC patients in our population and comparing their outcomes with the non-TNBC subset. TNBCs are a subset of tumors with poorly understood tumor biology and behavior. Despite being labeled as having aggressive tumor biology and behavior, not many differences are seen in their clinical outcomes when they present as locally advanced cases.

Keywords: Estrogen receptor/progesterone receptor/HER2, Indian women, triple-negative breast cancer, triple-negative breast cancer

How to cite this article:
Dhandayuthapani S, Bhagat TS. Triple-negative breast cancer in young aged Indian women - An overview. Santosh Univ J Health Sci 2022;8:108-10

How to cite this URL:
Dhandayuthapani S, Bhagat TS. Triple-negative breast cancer in young aged Indian women - An overview. Santosh Univ J Health Sci [serial online] 2022 [cited 2023 May 30];8:108-10. Available from: http://www.sujhs.org/text.asp?2022/8/2/108/367567

  Introduction Top

Noncommunicable diseases (NCDs) accounted for 71% of total deaths globally. According to the World Health Organization 2018 report, it was estimated that NCDs account for 63% of all deaths, where cancer was one of the leading causes (9%) in India (World Health Organization [WHO], 2018).[1] Reports from developed and developing countries provide updated information on cancer occurrence, trends, and projections.[2],[3] GLOBOCAN 2012, a statistical report developed by the WHO, showed that cancer troubled more Indian women than men with breast cancer in women ranks four in India compared to other countries (GLOBOCAN, 2012).[4] It was also reported that there was a significant increase from 0.45 million in 2005 to 0.7 million in 2015, showing an increased rate of 55%. Even though a significant rise in the incidence of all sites of cancer was observed in the majority of the PBCRs, breast cancer among women was shown to be drastically raised from 75, 600 in 2005 to 134,200 in 2015 with an increased rate of about 78%. It is estimated that, in India, the total number of incidence cases in males to be 679,421 in 2020 and 763,575 in 2025; and in females, where the total number of incidence cases is estimated as 712,758 in 2020 and 806,218 in 2025. Breast (238,908) is expected to be the most common site of cancer in 2025 with 14.8% of the total cases, followed by cancer lung (111,328) and mouth (90,060) (NCDRI, 2020).[5]

Systematic collection of data on cancer in India has been performed since 1982 by the population-based cancer registries (PBCRs) and hospital-based cancer registries under the National Cancer Registry Programme (NCRP) of the National Centre for Disease Informatics and Research (NCDIR) of the Indian Council of Medical Research (ICMR; ICMR-NCDIR-NCRP), Bengaluru. Several NCRP reports on cancer from different registries across India have been published (NCDIR, 2013, 2014, 2020).[6] Even though it was reported that cancer of breast followed by cervix uteri as the leading site of cancer in Delhi and Mumbai over the years, it was also predicted that 1 in 9 Indians will develop cancer in their lifetime, whereas 1 in 29 females will develop breast cancer (NCDIR, 2020).[7] Furthermore, recent literatures have reported that the incidence rate of breast cancer increased significantly by 3% annually while there was a significant decrease in cervical cancer by-1.2% annually over the time period from 1988 to 2016 (NCDRI, 2020).[5] Hence, it is reported that breast cancers have overtaken the cervix uteri.

  Risk Factors for Breast Cancer in India Top

Breast cancer is the major cause of morbidity and mortality among females ranking number one in Indian metropolitan cities such as Delhi, Kolkata, Pune and Thiruvananthapuram, Bangalore, and Mumbai, and in the northeast, whereas in rural areas such as Barshi hold the second position. Epidemiological study of breast cancer across different PBCRs in India shows increasing trends based on the incidence and mortality mainly due to rapid urbanization, industrialization, population growth, and aging affecting almost all parts of India. In general, the major risk factors in India leading to increasing incidence of cancer are considered age, marital status, location (urban/rural), low parity, breastfeeding, hormone replacement therapy intake (perimenopause), family history (maternal/paternal) body mass index, waist-to-hip ratio, obesity, alcohol consumption, tobacco chewing, smoking, lack of exercise, diet, and environmental factors. However, the alarming burden of increased incidence of breast cancer in younger women is not distinctly known.

  Different Types of Breast Cancer Top

Traditionally, breast cancer has been classified into four main molecular subtypes, namely luminal A, luminal B, human epidermal growth factor (HER2) positive, and triple-negative/basal-like [Figure 1]. Out of the different types, triple-negative breast cancer (TNBC), which is defined by a lack of estrogen receptor, progesterone receptor, and HER2, is one of the biologically more aggressive types with higher rates of local recurrence, early metastasis with very poor overall survival (OS) rate.[8],[9] However, earlier studies have also emphasized that 14%94% of TNBC eventually metastasize to various organs of the body including the liver, brain, lungs and pleura, and bone with extremely low OS rates after metastasis.[10],[11]
Figure 1: An overview of different types of breast cancer

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Until recently, the longer duration of breastfeeding was a natural continuation of childbearing in the Middle East, Africa, and Southeast Asia, where >90% of women used to breastfeed their infants for >12 months. This trend was positively correlated with significant protection against pregnancy-associated TNBCs in these regions. This trend was positively correlated with significant protection against pregnancy-associated TNBCs in these regions. For example, two recent casecontrol studies, one conducted in Tunisia between 2006 and 2009 on 400 cases and 400 controls,[12] and another conducted in South India between 2002 and 2005 on 1866 cases and 1873 controls,[13] showed that longer lifetime duration of breastfeeding was inversely associated with breast cancer risk among premenopausal women.[14],[15],[16]

Parity along with age- and lactation-associated breast cancer often diagnosed within the 25 years after a full-term pregnancy. Most particularly, parity-associated breast cancer is usually present with more advanced, poorly differentiated, high-grade cancers that show shorter time to progression, and often of the TNBC subtype. Study reports for all over the world show that pregnancy-associated TNBC is independently associated with poor survival, underscoring the impact of the pregnant breast microenvironment on the biology, and consequently, the prognosis of these tumors. Although it is not yet clear, a link between pregnancy-associated TNBCs and lack or shorter duration of breastfeeding, and/or age particularly in Indian women can be developed.

  Triple-Negative Breast Cancer and Young Indian Women Top

Younger aged patients tend to be triple negative that inclines to be a significant poor prognostic factor.[17] Several meta-analysis studies have also suggested that the prevalence of TNBC in India is considerably higher compared with that seen in Western populations.[18],[19] To the best of our knowledge, studies exploring the epidemiological evidence to directly correlate the prevalence of TNBC to age, lactation, and parity in Indian women of the reproductive age group. As TNBCs are one of the biologically more aggressive types with higher rates of local recurrence and early metastasis with very poor OS rate, it would be worthwhile to identify the direct correlation of age, lactation, and parity to the prevalence of TNBC in Indian women.

Considering the general health and an innermost feature of human development, reproductive health plays a very important role. Although most of the complications related to health arise in old age, reflection on the general health status could be observed earlier during the reproductive life events and is a worldwide concern for women during this reproductive age (1549 years) group. Hence, reproductive health is a precondition for social, economic, and human development. Considering the importance of reproductive health, epidemiological profiling of age-, parity-, and lactation-based TNBC would provide insight into the protective measures by not only eliminating any potential TNBC precursors from the breast, but also will provide a way for the national implication on prevention and spread of advanced stage of cancer, and reducing the mortality rate of the young age women because of TNBC.

  Conclusion Top

Therefore, it could be concluded that to the best of our knowledge, focus on the determination of the epidemiological correlation of age, parity, lactation, and positive family history toward the incidence of TNBC could be much meaningful in the identification of the major route cause for the increase in the incidence rate of TNBC. Furthermore, it could also pave the way to determine insight into any preventive measures that can be recognized to protect and/or treat the TNBC incidence due to age, parity, lactation, and + ve family history. Hence, there is an urgent need to elaborate the study to identify the specific genes involved in the cause of TNBC in young aged women and thereby lay an outline for preventive measures and/or effective treatment options.

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Conflicts of interest

There are no conflicts of interest.

  References Top

World Health Organization. World Health Statistics 2019: Monitoring Health for the SDGs. Geneva, Switzerland: World Health Organization; 2018.  Back to cited text no. 1
Jemal A, Ward EM, Johnson CJ, Cronin KA, Ma J, Ryerson B, et al. Annual report to the nation on the status of cancer, 1975-2014, featuring survival. J Natl Cancer Inst 2017;109:djx030. [Doi: 10.1093/jnci/djx030].  Back to cited text no. 2
Pongnikorn D, Daoprasert K, Waisri N, Laversanne M, Bray F. Cancer incidence in northern Thailand: Results from six population-based cancer registries 1993-2012. Int J Cancer 2018;142:1767-75.  Back to cited text no. 3
Globocan 2012 – Home. 2018. Available from: http://globocan.iarc.fr/. [Last accessed on 2018 Mar 28].  Back to cited text no. 4
National Centre for Disease Informatics and Research: Consolidated Report of Hospital Based Cancer Registries, 2004-2006, 2007-2011, 2012-2014. Bengaluru, India: National Cancer Registry Programme (NCRP-ICMR); Available from: https://ncdirindia.org/Reports.aspx. [Last accessed on 2022 Oct 17].  Back to cited text no. 5
National Centre for Disease Informatics and Research: Time Trends in Cancer Incidence Rates, 1982-2010. Bangalore: National Cancer Registry Programme (NCRP-ICMR); 2013. Available from: https://www.ncdirindia.org/All_Reports/TREND_REPORT_1982_2010/. [Last accessed on 2022 Oct 17].  Back to cited text no. 6
National Centre for Disease Informatics and Research: Report of National Cancer Registry Programme. India: National Cancer Registry Programme (NCDIR-ICMR); 2020. Available from: https://www.ncdirindia.org/All_Reports/Report_2020/resources/NCRP_2020_2012_16.pdf. [Last accessed on 2022 Oct 17].  Back to cited text no. 7
Abramson VG, Lehmann BD, Ballinger TJ, Pietenpol JA. Subtyping of triple-negative breast cancer: Implications for therapy. Cancer 2015;121:8-16.  Back to cited text no. 8
Haffty BG, Yang Q, Reiss M, Kearney T, Higgins SA, Weidhaas J, et al. Locoregional relapse and distant metastasis in conservatively managed triple negative early-stage breast cancer. J Clin Oncol 2006;24:5652-7.  Back to cited text no. 9
Tseng LM, Hsu NC, Chen SC, Lu YS, Lin CH, Chang DY, et al. Distant metastasis in triple-negative breast cancer. Neoplasma 2013;60:290-4.  Back to cited text no. 10
Kassam F, Enright K, Dent R, Dranitsaris G, Myers J, Flynn C, et al. Survival outcomes for patients with metastatic triple-negative breast cancer: Implications for clinical practice and trial design. Clin Breast Cancer 2009;9:29-33.  Back to cited text no. 11
Awatef M, Olfa G, Imed H, Kacem M, Imen C, Rim C, et al. Breastfeeding reduces breast cancer risk: A case-control study in Tunisia. Cancer Causes Control 2010;21:393-7.  Back to cited text no. 12
Gajalakshmi V, Mathew A, Brennan P, Rajan B, Kanimozhi VC, Mathews A, et al. Breastfeeding and breast cancer risk in India: A multicenter case-control study. Int J Cancer 2009;125:662-5.  Back to cited text no. 13
Guinee VF, Olsson H, Möller T, Hess KR, Taylor SH, Fahey T, et al. Effect of pregnancy on prognosis for young women with breast cancer. Lancet 1994;343:1587-9.  Back to cited text no. 14
Middleton LP, Amin M, Gwyn K, Theriault R, Sahin A. Breast carcinoma in pregnant women: Assessment of clinicopathologic and immunohistochemical features. Cancer 2003;98:1055-60.  Back to cited text no. 15
Reed W, Hannisdal E, Skovlund E, Thoresen S, Lilleng P, Nesland JM. Pregnancy and breast cancer: A population-based study. Virchows Arch 2003;443:44-50.  Back to cited text no. 16
Gogia A, Raina V, Deo SV, Shukla NK, Mohanti BK. Triple-negative breast cancer: An institutional analysis. Indian J Cancer 2014;51:163-6.  Back to cited text no. 17
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Sandhu GS, Erqou S, Patterson H, Mathew A. Prevalence of triple-negative breast cancer in India: Systematic review and meta-analysis. J Glob Oncol 2016;2:412-21.  Back to cited text no. 18
Ghosh J, Gupta S, Desai S, Shet T, Radhakrishnan S, Suryavanshi P, et al. Estrogen, progesterone and HER2 receptor expression in breast tumors of patients, and their usage of HER2-targeted therapy, in a tertiary care centre in India. Indian J Cancer 2011;48:391-6.  Back to cited text no. 19
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