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Cancer Surveillance data of Rare Epithelial Breast cancers in females-A Report from Population Based Cancer Registries in India. Dr Shakuntala TS, Dr Meesha Chaturvedi, Sathish Kumar K, Priyanka Das, Sudarshan KL, Teena Sajan, Vinodh Nallasamy, Anish John and Dr Prashant Mathur
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Background Rare Breast cancer is a divergent group of diseases which presents with varied clinical presentations, morphological characteristics and clinical management. This study aims to identify the various rare breast tumors based on morphological characteristics through the Population Based Registries and Hospital Based Registries for the period of in India. This will help in classifying them according to their relevant features regarding rare cancers.
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Methods The data from five Population Based Cancer Registries (PBCRs) and Hospital Based Registries(HBCRs) under National Cancer Registry Programme (NCRP) in India was used to identify the rare epithelial tumors based on the morphological subtypes. The analysis was done for a collective period of from the following PBCRs- Bangalore ( ), Bhopal ( ), Chennai ( ), Mumbai ( ) and Delhi ( ) and the various HBCRs, data was stratified based on morphologies, using the codes from International Classification of Diseases for Oncology, 3rd Edition (ICD-O-3). The Crude Rate and Age Adjusted Incidence Rates (AAR per 1, 00, 000 population) was calculated using in-house developed PBCRDM 2.1 software. The HBCR Data was analyzed to determine the correlation between the Clinical Extent of the Disease and the Treatment Patterns that are Followed respectively.
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Data from 5 PBCRs registered under NCRP-NCDIR was analyzed for the period of 1982-2014
Incidence of <6 per year per lakh population was identified and the selected PHMs for the 4 Major types of Breast tumors was used for further analysis CR & AAR was Calculated for the 4 Major types of Breast tumors and for the respective registries Bangalore ( ) Bhopal ( ) Chennai ( ) Mumbai ( ) Delhi ( ) Rare tumors of Breast: Mammary Pagets Special types of Adenocarcinoma Metaplastic Carcinoma Salivary Gland Type Tumors of Breast
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Data from various HBCRs registered under NCRP-NCDIR was analyzed for the period of 1982-2014
Incidence of <6 per year per lakh population was identified and the selected PHMs for the 4 Major types of Breast tumors was used for further analysis Proportion for Clinical Extent of the disease and Treatment Patterns Followed were compared Rare tumors of Breast: Mammary Pagets Special types of Adenocarcinoma Metaplastic Carcinoma Salivary Gland Type Tumors of Breast
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1. Mammary Paget’s disease of breast
Results 1. Mammary Paget’s disease of breast Morphology Code Description 8540 Paget disease, mammary Paget disease of breast 8541 Paget disease and infiltrating duct carcinoma of breast 8543 Paget disease and intraductal carcinoma of breast
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1. Mammary Paget’s disease of breast
Age Group Numbers Population ASPR 0-4 0.0000 5-9 10-14 15-19 20-24 1 0.0028 25-29 6 0.0171 30-34 9 0.0325 35-39 15 0.0582 40-44 0.0777 45-49 31 0.1844 50-54 0.2400 55-59 33 0.3397 60-64 0.3548 65-69 32 0.5447 70-74 10 0.2413 75+ 17 0.3431 Unk. Total 231 0.0697 AAR
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2. Special types of adenocarcinoma of breast
Morphology Code Description 8050 Papillary carcinoma, NOS 8201 Ductal carcinoma, cribriform type 8211 Tubular adenocarcinoma 8260 Papillary adenocarcinoma, NOS 8290 Oxyphilic adenocarcinoma 8314 Lipid-rich carcinoma 8315 Glycogen-rich carcinoma 8401 Apocrine adenocarcinoma 8480 Mucinous adenocarcinoma 8481 Mucin-producing adenocarcinoma 8502 Secretory carcinoma of breast Juvenile carcinoma of breast 8510 Medullary carcinoma, NOS
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2. Special types of Adenocarcinomas
Age Group Numbers Population ASPR 0-4 0.0000 5-9 1 0.0032 10-14 15-19 2 0.0063 20-24 19 0.0535 25-29 67 0.1907 30-34 134 0.4837 35-39 234 0.9084 40-44 273 1.4140 45-49 344 2.0461 50-54 294 2.2761 55-59 296 3.0472 60-64 330 3.7764 65-69 267 4.5451 70-74 225 5.4300 75+ 254 5.1263 Unk. Total 2740 0.8268 AAR
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3. Metaplastic carcinoma of breast
Morphology Code Description 8070 Squamous cell carcinoma, NOS 8560 Adenosquamous carcinoma Mixed adenocarcinoma and squamous cell carcinoma Mixed adenocarcinoma and epidermoid carcinoma 8571 Adenocarcinoma with cartilaginous and osseous metaplasia 8572 Adenocarcinoma with spindle cell metaplasia 8575 Metaplastic carcinoma, NOS
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3. Metaplastic carcinoma of breast
Age Group Numbers Population ASPR 0-4 0.0000 5-9 10-14 15-19 20-24 2 0.0056 25-29 11 0.0313 30-34 18 0.0650 35-39 26 0.1009 40-44 36 0.1865 45-49 39 0.2320 50-54 44 0.3406 55-59 27 0.2780 60-64 30 0.3433 65-69 28 0.4766 70-74 12 0.2896 75+ 19 0.3835 Unk. Total 292 0.0881 AAR
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4. Salivary gland type tumours of breast
Morphology Code Description 8200 Adenoid cystic carcinoma 8430 Mucoepidermoid carcinoma 8550 Acinar cell adenocarcinoma 8982 Myoepithelial carcinoma
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4. Salivary gland type tumours of breast
Age Group Numbers Population ASPR 0-4 0.0000 5-9 10-14 15-19 20-24 25-29 1 0.0028 30-34 0.0036 35-39 4 0.0155 40-44 7 0.0363 45-49 2 0.0119 50-54 0.0310 55-59 0.0412 60-64 10 0.1144 65-69 0.1702 70-74 0.0483 75+ 0.0202 Unk. Total 46 0.0139 AAR
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CR and AARs Sub - Types CR AAR Obs Paget’s 0.7 0.091 231
Adenocarcinoma 0.83 1.05 2740 Carcinoma 0.09 0.11 292 Salivary 0.14 0.02 46 CR & AAR Proportion & Observed Numbers
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PBCR Registry Data 1. Bangalore PBCR Age Group Numbers Population ASPR
0-4 0.0000 5-9 10-14 15-19 20-24 6 0.0664 25-29 24 0.2604 30-34 40 0.5942 35-39 70 1.1305 40-44 81 1.8900 45-49 110 2.9087 50-54 105 3.6132 55-59 90 4.2916 60-64 102 5.1447 65-69 76 5.9939 70-74 55 895195 6.1439 75+ 57 5.1191 Unk. Total 816 1.0287 AAR 1.38
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2. Mumbai PBCR Age Group Numbers Population ASPR 0-4 13505660 0.0000
0.0000 5-9 1 0.0068 10-14 15-19 0.0071 20-24 8 0.0507 25-29 25 0.1604 30-34 61 0.4758 35-39 112 0.9415 40-44 129 1.4048 45-49 162 2.0365 50-54 149 2.4462 55-59 156 3.4089 60-64 166 4.2093 65-69 5.9251 70-74 111 5.9015 75+ 169 7.4727 Unk. Total 1412 0.9286 AAR
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3. Chennai PBCR Age Group Numbers Population ASPR 0-4 5042722 0.0000
0.0000 5-9 10-14 15-19 1 0.0163 20-24 5 0.0723 25-29 24 0.3522 30-34 35 0.6567 35-39 54 1.0566 40-44 55 1.4056 45-49 65 1.8719 50-54 57 2.0566 55-59 2.4994 60-64 2.7470 65-69 41 3.1096 70-74 33 965195 3.4190 75+ 34 3.0334 Unk. Total 512 0.7941 AAR
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4. Bhopal PBCR Age Group Numbers Population ASPR 0-4 1813691 0.0000
0.0000 5-9 10-14 15-19 20-24 25-29 30-34 5 0.3444 35-39 8 0.6069 40-44 7 994565 0.7038 45-49 13 828472 1.5692 50-54 6 593305 1.0113 55-59 454409 1.7605 60-64 10 437418 2.2861 65-69 9 286495 3.1414 70-74 4 208046 1.9227 75+ 238035 2.5206 Unk. Total 76 0.4161 AAR
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5. Delhi PBCR Age Group Numbers Population ASPR 0-4 1734261 0.0000 5-9
0.0000 5-9 10-14 15-19 20-24 4 0.2161 25-29 12 0.7011 30-34 21 1.5326 35-39 34 2.7350 40-44 58 930627 6.2324 45-49 61 775379 7.8671 50-54 56 554801 55-59 51 425434 60-64 65 409068 65-69 47 267428 70-74 41 194312 75+ 25 220903 Unk. Total 475 2.7479 AAR
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HBCRs Data- Comparison between Clinical Extent of Disease & Treatment
1. Mammary Paget’s
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2. Special Types of Adenocarcinoma
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3. Special Types of Adenocarcinoma
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4. Salivary Gland Type Tumors of the Breast
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Summary The PBCR registries data was analyzed for 4 Broad Categories which includes 20 Subtypes and was classified as Rare Epithelial tumors of the Breast. A total of 3,309 cases have been reported from the various registries between The number of observed cases and AARs were for Mammary Paget’s disease of Breast (231 & 0.09), for Special types of Adenocarcinoma of Breast (2740 & 1.05), for Metaplastic Carcinoma of Breast (292 & 0.11) and for Salivary gland type tumors of the breast (46 & 0.02) respectively. Based on the 5 registries the Observed Numbers and AAR were Bangalore PBCR (816 & 1.34), Mumbai PBCR (1412 & 1.18), Chennai PBCR (512 & 0.86), Bhopal PBCR (76 & 0.59), Delhi PBCR (4575 & 3.97)
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Conclusion The present study gives an insight on the indication of type and treatment of rare breast cancer in India, the data was done in Comparison with Rarecare Net for the European population and had similar epidemiological information. We are proposing on creating a repository for such cases where the data from India will be pooled in as rare tumors. This exercise will give the necessary information to further understand the sub classification, behaviors and rarity of the tumors in Indian scenario. The same approach for classification of rare tumors could be utilized for various other sites and a National Repository can be established.
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Thank you
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IARC data Number of New Cases and Deaths per 100,000: The number of new cases of female breast cancer was per 100,000 women per year. The number of deaths was 20.6 per 100,000 women per year. These rates are age-adjusted and based on cases and deaths. Lifetime Risk of Developing Cancer: Approximately 12.8 percent of women will be diagnosed with female breast cancer at some point during their lifetime, based on data. Prevalence of This Cancer: In 2016, there were an estimated 3,477,866 women living with female breast cancer in the United States.
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IARC data Percent Surviving 5 Years ( ) 89.9%
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Estimated New Cases in 2019 : 268,600
% of All New Cancer Cases :15.2% Estimated Deaths in 2019 :41,760 % of All Cancer Deaths: 6.9%
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New Cases, Deaths and 5-Year Relative Survival
New cases come from SEER 9 Incidence. Deaths come from U.S. Mortality , All Races, Females. Rates are Age-Adjusted. Modeled trend lines were calculated from the underlying rates using the Joinpoint Trend Analysis Software. Year Perc ent Surviving0100 SEER 9 5-Year Relative Survival Percent from , All Races, Females. Modeled trend lines were calculated from the underlying rates using the Joinpoint Survival Model Software.
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Changes Over Time Keeping track of the number of new cases, deaths, and survival over time (trends) can help scientists understand whether progress is being made and where additional research is needed to address challenges, such as improving screening or finding better treatments. Using statistical models for analysis, rates for new female breast cancer cases have been rising on average 0.3% each year over the last 10 years. Death rates have been falling on average 1.8% each year over year survival trends are shown below.
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There are four main female breast cancer subtypes, including the following in order of prevalence:
HR+/HER2- ("Luminal A") HR-/HER2- ("Triple Negative") HR+/HER2+ ("Luminal B") HR-/HER2+ ("HER2-enriched") HR stands for hormone receptor. HR+ means that tumor cells have receptors for the hormones estrogen or progesterone, which can promote the growth of HR+ tumors. HER2 stands for human epidermal growth factor receptor. HER2+ means that tumor cells make high levels of a protein called HER2/neu, which has been shown to be associated with certain aggressive types of breast cancer.
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At a Glance When all subtypes are combined, female breast cancer is fairly common. In 2019, it is estimated that there were 268,600 new cases of female breast cancer. The breast cancer subtype HR+/HER2- is the most common subtype with an age-adjusted rate of 85.8 new cases per 100,000 women, based on cases. This is a rate more than six times higher than the triple-negative breast cancer rate of 13.0 and the HR+/HER2+ breast cancer rate of 12.9, and over 15 times higher than HR-/HER2+ breast cancer rate of 5.4.
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Rate of New Breast Cases per 100,000 Women, SEER 21 2012-2016
Subtype New Cases HR+/HER2- 85.8 HR-/HER2- 13.0 HR+/HER2+ 12.9 HR-/HER2+ 5.4 Unknown 10.4 Total 127.5
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Percent of Female Breast Cases by Cancer Subtype
Percent of Cases HR+/HER2- % HR-/HER2- % HR+/HER2+ % HR-/HER2+ % Unknown %
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Who Gets This Cancer? Female breast cancer overall is most common in middle-aged and older women. Although rare, men can develop breast cancer as well. The number of new cases of female breast cancer, with all subtypes combined, was per 100,000 women per year based on cases. The distribution of breast cancer subtypes among the female population varies by age, race, ethnicity, stage, and more. Compared with women with HR+/HER2− subtype (the most common subtype), those diagnosed with the other three subtypes were somewhat more likely to be younger, belong to minority groups, and be diagnosed with cancer at a later stage. (Howlader 2018)
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Rate of New Female Breast Cancer Subtypes per 100,000 by Race
Race / Ethnicity HR+/HER2- Rate HR-/HER2- Rate HR+/HER2+ Rate HR-/HER2+ Rate Unknown Rate White 90.2 12.1 13.0 5.1 10.1 Black 70.2 22.3 6.6 11.9 American Indian / Alaska Native 51.7 7.5 8.3 4.8 7.2 Asian or Pacific Islander 66.3 8.4 11.6 5.9 7.9 Hispanic 62.2 10.4 10.6 9.2 Rate of New Female Breast Cancer Subtypes per 100,000 by Race WhiteBlackAI/ANªAPIᵇHispanicRace Rate of New Cases0100 HR+/HER2- Rate HR-/HER2- Rate HR+/HER2+ Rate HR-/HER2+ Rate Unknown Rate SEER , a American Indian / Alaska Native, b Asian or Pacific Islander White women have the highest rate of new cases of HR+/HER2− breast cancer. Black women have the highest rate of new cases of HR−/HER2− breast cancer, also known as the triple-negative subtype.
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For example, among those with
While breast cancer subtype affects survival, stage at diagnosis may be the most powerful factor in determining survival outcome. For example, among those with localized disease, the survival rate after 5 years was greater than 91 percent regardless of subtype. Additionally, survival for localized triple-negative female breast cancer was 91.0 percent, but it dropped to 11.2 percent for distant disease.
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HBCR Data Mammary Paget’s
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Special Types of Adenocarcinoma
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Special Types of Carcinoma
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Salivary Gland Type Tumors of the Breast
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