|
Year : 2009 | Volume
: 52
| Issue : 2 | Page : 171-174 |
|
Hormone receptors over the last 8 years in a cancer referral center in India: What was and what is? |
|
Tanuja Shet1, Atin Agrawal1, Mandar Nadkarni2, Mahendra Palkar1, Rohini Havaldar3, Vani Parmar2, Rajendra Badwe2, RF Chinoy1
1 Department of Pathology, Tata Memorial Hospital, Parel, Mumbai - 400 012, Maharashtra, India 2 Department of Surgical Oncology, Tata Memorial Hospital, Parel, Mumbai - 400 012, Maharashtra, India 3 Department of Central Research Secretariat, Tata Memorial Hospital, Parel, Mumbai - 400 012, Maharashtra, India
Click here for correspondence address and email
|
|
 |
|
Abstract | | |
This study was carried out to observe the trend in hormone receptors over the last 8 years in a tertiary cancer center in India. A total of 11,780 tumors analyzed for hormone receptors over the last 7 years were compared with the results of hormone receptor expression in a prior published study on 798 cases of breast cancer from the same institute. The patient's ages ranged from 18 to 102 years, Sixty percent of the patients were in the age group of 31-50 years. Seventy percent of the tumors were grade III tumors. The percentage of hormone receptor expression in breast cancer in the last 8 years varied from 52 to 57%. The overall receptor expression in the last 8 years shifted within a 5% range, confirming that the hormone receptor expression in Indian patients with breast cancer is low. However, there was redistribution within the pattern of estrogen receptor (ER) and progesterone receptor (PR) expression among tumors showing hormone receptor expression. Breast cancers showing only PR expression reduced dramatically from 21% in the year 1999 to in the year 2006, with a parallel increase in breast cancers showing combined ER and PR positivity (from 25 to 41.8%) and only ER expression (from 7.4 to 10.6%). The hormone receptor expression in breast cancers in India is and continues to be low but the high incidence of only PR-positive tumors in our population reported earlier was misrepresented. Keywords: Breast cancer, estrogen receptors, immunohistochemical method, progesterone receptors
How to cite this article: Shet T, Agrawal A, Nadkarni M, Palkar M, Havaldar R, Parmar V, Badwe R, Chinoy R F. Hormone receptors over the last 8 years in a cancer referral center in India: What was and what is?. Indian J Pathol Microbiol 2009;52:171-4 |
How to cite this URL: Shet T, Agrawal A, Nadkarni M, Palkar M, Havaldar R, Parmar V, Badwe R, Chinoy R F. Hormone receptors over the last 8 years in a cancer referral center in India: What was and what is?. Indian J Pathol Microbiol [serial online] 2009 [cited 2023 Jun 10];52:171-4. Available from: https://www.ijpmonline.org/text.asp?2009/52/2/171/48909 |
Introduction | |  |
Hormone receptor estimation in breast cancer has shifted from the biochemistry laboratory to the immunohistochemistry (IHC) laboratory and from there on to a surgical pathologist preview in the last decade. Immunohistochemical demonstration of the hormone receptors in breast cancer is here to stay given its convenience, cost effectiveness, applicability to paraffin-processed material and the fact that hormone receptors by this method are specifically assessed within the actual tumor. [1] It was observed that in patients receiving endocrine treatment, estrogen receptor (ER) positivity by IHC was associated with an improved disease-free survival (DFS) and overall survival, while no such significance was seen with the ligand binding assay/dextran-coated charcoal assay results. [2]
The main concern in the demonstration of hormone receptors by IHC is the high degree of interlaboratory variance. [3],[4],[5] In a quality assurance program by the United Kingdom National External Quality Assurance Scheme (UKNEQAS), where 200 labs from 26 countries participated, only one-third of the laboratories scored the low-expressing tumors correctly while one-third of the tumors were labeled as false negative. [3]
In a publication from our institute 5 years ago we documented a total hormone receptor expression of only 53.5% breast cancers in Indian patients as opposed to 75-80% reported in the western literature. [1],[6] The percentage of tumors expressing only progesterone receptor (PR) was also high (21%) in our previous study. [6]
Was this low hormone receptor positivity and high percentage of only PR expression in breast tumors due to the lack of quality control or did it represent an unusual biology of tumors in this part of the continent?
Subsequent to our initial published work, we have implemented several changes in the processing of the tissues of breast cancer and in the IHC technique. We undertook this analysis of tumors at our hospital to observe whether the trend in receptors has changed following these measures over the last 7 years.
Materials and Methods | |  |
All the cases of breast cancer accessioned at our institute from the year 2000 to the year 2006 were retrieved to document the hormone receptor status. The previous data published in year 1999 was used for comparative purposes, making this an 8-year study. [6] A total of 11,780 cases were studied for hormone receptors during the 7-year study period while 798 additional cases had been evaluated in the previous study. [6] In the latter 7 years, we included only in-house cases where the processing was performed at our institute. All referral material was excluded from this analysis. Fixation of tissues till January 2001 was in 10% formalin and after that time it was in 10% neutral buffered formalin (NBF), with the pH monitored to 7.2.
IHC for the hormone receptors was performed using the Avidin Biotin complex method and the Vecta stain ABC kit, Vector laboratories, UK. Primary antibody used for the demonstration of the ER was monoclonal mouse antibody anti-human ER clone 1D5 and for the PR was monoclonal mouse antibody anti-human PR clone PGR636. Both the antibodies were from the Immunotech Company, Marseille, France till December 2000 and subsequently antibodies from the DAKO Company, Glostrup, Denmark were used. Antigen retrieval was performed by immersing the sections into preheated sodium citrate, pH 6, and either microwaving for 30min or pressure cooking for 5-10min (till 1 whistle blows). Samples before May 2001 underwent microwave-based antigen retrieval after which we shifted to the pressure cooking method for antigen retrieval. The rest of the steps were similar to the usual IHC method. Any tumor with >5% of cells showing nuclear staining was considered as positive.
Results | |  |
Hormone receptors were positive in 6349/11,780 (53.9%) breast cancers tested for the hormone receptors over the last 8 years. All patients were females except 1.6%, who were males. Patients age ranged from 18 to 102 years; however, 60% of the patients were in the age group of 31-50 years of age. The tumor grade as per the modified Scarff-Richardson Bloom scoring system was Grade I = 2%, Grade II = 28% and Grade III = 70%.
The ER and PR expression of tumors over the last 8 years is given in [Table 1]. As seen from the Table, the percentage of hormone receptor expression in the last 8 years varied from 52 to 57%. An interesting drift in the pattern of ER and PR expression was observed. Comparing the pattern of hormone receptor expression in 1999 and 2006, the percentage of tumors showing only PR expression reduced remarkably from 21 to 3.4%, with a parallel increase in the number of tumors expressing both ER and PR (25-41.8%) and only the ER antigen (7.4-10.6%).
The hormone receptor status was significantly associated with the age of patients, as depicted in [Table 2]. The hormone receptor expression significantly correlated with tumor grade ( P -value < 0.001). The entire Grade I tumors, 93% of the Grade II tumors and 39.5% of the Grade III tumors expressed hormone receptors. The association of hormone receptors with histological subtype of breast carcinoma in the year 2005 was evaluated. The hormone receptor expression correlated significantly with the histological subtype of breast cancer ( P -value = 0.004), wherein infiltrating lobular carcinoma, mucinous carcinoma and variants of papillary carcinoma expressed hormone receptors at a significantly higher level than infiltrating duct carcinoma (IDC), not otherwise specified. When the results of ER positivity in specific histological types in the year 2005 were compared with our previous study in 1999, there were a few differences.
The percent ER positivity in IDC improved from 29 to 39% while it reduced from 63 to 49% in invasive lobular carcinoma (ILC). The PR expression on the other hand reduced from 44.8 to 34% invasive duct carcinoma and from 69.7 to 48% in ILC. The ER expression in mucinous cancers remained the same in both these years whereas the PR was reduced by half. This proves the redistribution within the ER and PR groups even in the special histological types of breast cancer. Hormone receptor estimation during the study period was performed only in patients with intraduct carcinoma showing foci of microinvasion. Of these, 5% showed ER and PR expression. One-third of the patients (39%) presented with tumors >5cm or locally advanced breast cancers. These patients however did not show any different hormone receptor expression than the operable breast cancers.
Discussion | |  |
The Early Breast Cancer Trialists Collaborative Group has confirmed that the amount of benefit from adjuvant endocrine therapy in breast cancer is proportional to the amount of ER present in the primary tumor. [7] The option of hormonal therapy is now offered to every patient of breast cancer irrespective of age based on the tumor receptor status. [8] Hence, ER/PR estimation needs to be carried out in every patient diagnosed with breast cancer. The tremendous clinical importance of this test has improved its commercial value and coerced many laboratories to offer ER and PR testing in breast cancer. Consequently, there is a need for strict quality assurance in the immunohistochemical demonstration of hormone receptors in breast cancer. [4] With this in mind, many quality assurance programs across various countries have been started. [3],[9] These have confirmed that there is a great degree of variability in the methodology of IHC demonstration of hormone receptors.
Recommendations for improving hormone receptor estimation include participation in an external quality assurance scheme for immunocytochemistry, including an audit of the percentage-positive tumors in a laboratory against the accepted norms annually. [10] For the last issue, it is important to record the standard hormone receptor expression in a given population. It is clear that there are some racial differences in hormone receptor expression in breast cancer. [11] This study was an attempt to audit the hormone receptor status of tumors at our institute in the last 8 years with a view to observe the trend and to analyze the actual status of hormone receptor expression in breast cancer at our institute.
The hormone receptor expression in breast cancers in India is low. [6],[12] A study from the same city as ours attributed the incidence of ER negativity and PR positivity (ER-/PR+) to the use of suboptimal manual assays rather than true genetic differences. [13] The authors repeated 37 ER-/PR+ cases using automated IHC and a different set of ER antibodies. On repeat IHC, only 24.3% of the tumors remained ER negative while 28 (75.6%) tumors retested as ER positive. [13] We agree that high PR+ tumors reported in our earlier paper [6] were overrepresented due to underreporting of ER.
Nevertheless, the current study enforces a fact documented in a previous study from our institute [6] that the overall hormone positivity in India is low. The patient demographic features in this study are nearly similar to previous studies [6],[12] from India indicating that the cause for the low receptor expression in Indian patients may be due to younger age and higher grade of breast cancers. The ER expression in our patient population in the best possible situation was 50.5% and the PR expression was 42% as opposed to the 75% ER and 58% PR positivity reported in the literature. [14]
The chief cause for false negativity in hormone receptor demonstration by IHC is inefficient antigen retrieval. [15] Different combinations of heating devices and antigen retrieval solutions are available. Ethylene Diammine Tetraacetic acid (EDTA) is thought to be a superior antigen retrieval solution irrespective of the heating method used. [16] Pressure cooking is found to be the most convenient heating method on practical grounds as it allows for the simultaneous handling of a large number of slides and saves time. [16] In this study, a stark jump in the percentage of positivity was observed in the year 2001 after implementing use of NBF for fixation, changing the antibody and using pressure cooking for antigen retrieval. We have introduced the pressure method for antigen retrieval in 2001 and this was associated with an increased detection of ER-positive tumors with a reduction in PR only expressing tumors. Hence, we agree that pressure cooking is a more accessible and effective method for antigen retrieval in hormone receptor estimation than the microwave-based methods in developing nations, although we continue to use sodium citrate rather than EDTA as the antigen retrieval solution for economical reasons.
The UKNEQAS documented that the hormone receptor estimation results are not compromised when histological material from different sources is processed by a common protocol of antigen retrieval and analyzed with automated IHC systems. [17] Most laboratories in Europe use alcoholic formalin for fixation of tissues from breast cancer for better demonstration of ER and PR. [1] In our experience, many laboratories in our country do not follow strict fixation policies and may not even use buffered formalin for fixation, resulting in suboptimal processing and some degree of irreversible damage.
Lowering the cut-off points for reporting hormone receptors will help in reducing the false negatives for hormone receptors in breast cancers. A consensus development panel of the US National Institutes of Health recommended in 2001 that any ER staining in breast cancers should be sufficient to consider a tumor ER positive and the patient a suitable candidate for endocrine therapy. [18] In a recent paper, the all or none method of scoring hormone receptors for scoring ER appeared valid as a prognostic indicator of survival in patients with positive lymph nodes. [19] We stuck to 5% positivity to ensure uniformity for this analysis although our practice is to report any degree of hormone receptors in our routine histology report.
There has been controversy about the importance of PR receptor estimation in breast cancer, with a strong opinion that PR estimation should be stopped. [20] But, several studies have shown that patients with PR+ tumors benefit with endocrine therapy although PR is a weaker predictor of response to endocrine therapy than ER. [21],[22],[23] Preliminary data suggest that there is no difference in DFS between tamoxifen and anastrozole in the subgroup of patients with ER- and PR+ tumors, while anastrozole was found to be significantly superior to tamoxifen in the subgroup of ER+ and PR− patients. [24]
The results of our study indicate that a high degree of only PR+ tumors in a laboratory calls for a need for quality check on the ER antigen retrieval methods. In this study, patients with only PR+ tumors received endocrine therapy, which would have not been the case if the PR testing had not been performed. In our opinion, PR serves as a check of the ever so frail ER testing and helps in quality control of the ER antigen.
To conclude, the high incidence of only PR+ tumors in our population is what was but hormone receptor expression in breast cancers in India is and continues to be low. This can be attributed to the younger age of patients and the increased incidence of Grade III cancers. The hormone receptor results appear to have now stabilized at our institute but there is scope for additional quality checks from laboratories abroad. We have started using the polymer technology for demonstration of hormone receptors in breast cancer recently and it will be some time before these results emerge. Lessons from this exercise were useful to other states in our country and may help others facing similar problems.
References | |  |
1. | Zafrani B, Aubriot MH, Mouret E, De Cremoux P, De Rycke Y, Nicolas A, et al . High sensitivity and specificity of immunohistochemistry for the detection of hormone receptors in breast carcinoma: Comparison with biochemical determination in a prospective study of 793 cases. Histopathology 2000;37:536-45. |
2. | Harvey JM, Clark GM, Osborne CK, Allred DC. Estrogen receptor status by immunohistochemistry is superior to the ligand-binding assay for predicting response to adjuvant endocrine therapy in breast cancer. J Clin Oncol 1999;17:1474-81. [PUBMED] [FULLTEXT] |
3. | Rhodes A, Jasani B, Barnes DM, Bobrow LG, Miller KD. Reliability of immunohistochemical demonstration of oestrogen receptors in routine practice: Interlaboratory variance in the sensitivity of detection and evaluation of scoring systems. J Clin Pathol 2000;53:125-30. [PUBMED] [FULLTEXT] |
4. | Barnes DM, Millis RR, Beex LV, Thorpe SM, Leake RE. Increased use of immunohistochemistry for oestrogen receptor measurement in mammary carcinoma: The need for quality assurance. Eur J Cancer 1998;34:1677-82. [PUBMED] [FULLTEXT] |
5. | Layfield LJ, Gupta D, Mooney EE. Assessment of tissue estrogen and progesterone receptor levels: A survey of current practice, techniques, and quantitation methods. Breast J 2000;6:189-96. [PUBMED] [FULLTEXT] |
6. | Desai SB, Moonim MT, Gill AK, Punia RS, Naresh KN, Chinoy RF. Hormone receptor status of breast cancer in India: A study of 798 tumors. Breast 2000;9:267-70. [PUBMED] [FULLTEXT] |
7. | EBCTCG; Early Breast Cancer Trialists Collaborative Group. Tamoxifen for early breast cancer: An overview of randomized trials. Lancet 1998;351:1451-67. |
8. | Elledge RM, Osborne CK. Estrogen receptors and breast cancer: It is time for individual treatment based on estrogen receptor status. BMJ 1997;314:1843-44. [PUBMED] [FULLTEXT] |
9. | Regitnig P, Reiner A, Dinges HP, Hofler G, Muller-Holzner E, Lax SF, et al . Quality assurance for detection of estrogen and progesterone receptors by immunohistochemistry in Austrian pathology laboratories. Virchows Arch 2002;441:328-34. |
10. | Wells CA, Sloane JP, Coleman D, Munt C, Amendoeira I, Apostolikas N, et al . Consistency of staining and reporting of oestrogen receptor immunocytochemistry within the European Union: An inter-laboratory study. Virchows Arch 2004;445:119-28. [PUBMED] [FULLTEXT] |
11. | Li CI, Malone KE, Daling JR. Differences in breast cancer hormone receptor status and histology by race and ethnicity among women 50 years of age and older. Cancer Epidemiol Biomarkers Prev 2002;11:601-7. [PUBMED] [FULLTEXT] |
12. | Redkar AA, Kabre SS, Mittra I. Estrogen and progesterone receptors measurement in breast cancer with enzyme-immunoassay and correlation with other prognostic factors. Indian J Med Res 1992;96:1-8. [PUBMED] |
13. | Navani S, Bhaduri AS. High incidence of oestrogen receptor negative progesterone receptor positive phenotype in Indian breast cancer: Fact or fiction? Indian J Pathol Microbiol 2005;48:199-201. |
14. | Rhodes A, Jasani B, Balaton AJ, Barnes DM, Miller KD. Frequency of oestrogen and progesterone receptor positivity by immunohistochemical analysis in 7016 breast carcinomas: Correlation with patient age, assay sensitivity, threshold value, and mammographic screening. J Clin Pathol 2000;53:688-96. [PUBMED] [FULLTEXT] |
15. | Rhodes A, Jasani B, Balaton AJ, Barnes DM, Anderson E, Bobrow LG, et al . Study of interlaboratory reliability and reproducibility of estrogen and progesterone receptor assays in Europe. Documentation of poor reliability and identification of insufficient microwave antigen retrieval time as a major contributory element of unreliable assays. Am J Clin Pathol 2001;115:44-58. |
16. | Pileri SA, Roncador G, Ceccarelli C, Piccioli M, Briskomatis A, Sabattini E, et al . Antigen retrieval techniques in immunohistochemistry: Comparison of different methods. J Pathol 1997;183:116-23. [PUBMED] [FULLTEXT] |
17. | Rhodes A, Jasani B, Balaton AJ, Miller KD. Immunohistochemical demonstration of oestrogen and progesterone receptors: Correlation of standards achieved on in house tumors with that achieved on external quality assessment material in over 150 laboratories from 26 countries. J Clin Pathol 2000;53:292-301. [PUBMED] [FULLTEXT] |
18. | Eifel P, Axelson JA, Costa J, Crowley J, Curran WJ Jr, Deshler A, et al . National Institutes of Health Consensus Development Conference Statement: Adjuvant therapy for breast cancer, November 2000. J Natl Cancer Inst 2001;93:979-89. [PUBMED] [FULLTEXT] |
19. | Fisher ER, Anderson S, Dean S, Dabbs D, Fisher B, Siderits R, et al . Solving the dilemma of the immunohistochemical and other methods used for scoring estrogen receptor and progesterone receptor in patients with invasive breast carcinoma. Cancer 2005;103:164-73. [PUBMED] [FULLTEXT] |
20. | Olivotto IA, Truong PT, Speers CH, Bernstein V, Allan SJ, Kelly SJ, et al . Time to stop progesterone receptor testing in breast cancer management. J Clin Oncol 2004; 22:1769-70. [PUBMED] [FULLTEXT] |
21. | Colomer R, Beltran M, Dorcas J, Cortes-Funes H, Hornedo J, Valentin V, et al . It is not time to stop progesterone receptor testing in breast cancer. J Clin Oncol 2005;23:3868-9. [PUBMED] [FULLTEXT] |
22. | Colozza M, Larsimont D, Piccart MJ. Progesterone receptor testing: Not the right time to be buried. J Clin Oncol 2005;23:3867-8. [PUBMED] [FULLTEXT] |
23. | Bardou VJ, Arpino G, Elledge RM, Osborne CK, Clark GM. Progesterone receptor status significantly improves outcome prediction over estrogen receptor status alone for adjuvant endocrine therapy in two large breast cancer databases. J Clin Oncol 2003;21:1973-9. [PUBMED] [FULLTEXT] |
24. | Bernoux A, de Cremoux P, Laine-Bidron C, Martin EC, Asselain B, Magdelenat H. Estrogen receptor negative and progesterone receptor positive primary breast cancer: Pathological characteristics and clinical outcome. Breast Cancer Res Treat 1998;49:219-25. |

Correspondence Address: Tanuja Shet Department of Pathology, Tata Memorial Hospital, Parel, Mumbai - 400 012 India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0377-4929.48909

[Table 1], [Table 2] |
|
This article has been cited by | 1 |
A Clinicopathological Analysis of Molecular Subtypes of Breast Cancer using Immunohistochemical Surrogates: A 6-Year Institutional Experience from a Tertiary Cancer Center in North India |
|
| Puneet Kaur Somal, Sankalp Sancheti, Aishwarya Sharma, Akash Pramod Sali, Debashish Chaudhary, Alok Goel, Tapas Kumar Dora, Rahat Brar, Ashish Gulia, Jigeeshu Divatia | | South Asian Journal of Cancer. 2023; | | [Pubmed] | [DOI] | | 2 |
Relationship of vitamin D deficiency with mammographic breast density and triple-negative breast cancer: A cross-sectional study |
|
| CHANDRA KUNWARI SINGH, SHAJI THOMAS, BINITA GOSWAMI, SHAILI TOMER, OM PRAKASH PATHANIA | | The National Medical Journal of India. 2022; 34: 271 | | [Pubmed] | [DOI] | | 3 |
Molecular Profile and Clinico-pathological Characteristics of Breast Cancer in Central India: First Investigative Report |
|
| Aaryan Anand, Arpan Mishra, Harikrishna Damde, Arjun Saxena, Sanjay Kumar Yadav, Dhananjaya Sharma | | Indian Journal of Surgical Oncology. 2022; | | [Pubmed] | [DOI] | | 4 |
Comparison of various scoring systems by immunohistochemistry for evaluating hormone receptors (Estrogen receptor and progesterone receptor) in carcinoma of breast |
|
| PrachiDileep Rai, Sunita Vagha, Samarth Shukla, Arvind Bhake | | Journal of Datta Meghe Institute of Medical Sciences University. 2020; 15(2): 202 | | [Pubmed] | [DOI] | | 5 |
Intrinsic subtyping of breast cancer and its relevance with clinico-pathological features and outcomes in patients from North India: a single center experience |
|
| S Harish, S Anand, Manoj Prashar, Nishant Lohia, Sankalp Singh, S Viswanath | | Journal of Dr. NTR University of Health Sciences. 2020; 9(3): 164 | | [Pubmed] | [DOI] | | 6 |
Meta-Analysis of Prevalence of Triple-Negative Breast Cancer and Its Clinical Features at Incidence in Indian Patients With Breast Cancer |
|
| Apurv Kulkarni, Devaki A. Kelkar, Nidhi Parikh, Lingadahalli S. Shashidhara, Chaitanyanand B. Koppiker, Madhura Kulkarni | | JCO Global Oncology. 2020; (6): 1052 | | [Pubmed] | [DOI] | | 7 |
Breast carcinoma histopathological correlation with molecular classification: A comparative study |
|
| Savita Soni, Neha Sethi, Aradhana Gupta, Ankita Singh Srivastava | | Indian Journal of Pathology and Oncology. 2020; 7(4): 613 | | [Pubmed] | [DOI] | | 8 |
Breast Cancer Demographics, Types and Management Pathways: Can Western Algorithms be Optimally used in Eastern Countries? |
|
| S. Chakraborty,T. Wadasadawala,R. Ahmed,C. Coles,S. Chatterjee | | Clinical Oncology. 2019; 31(8): 502 | | [Pubmed] | [DOI] | | 9 |
To Evaluate the Incidence of ER, PR and Her2/Neu Status in Newly Diagnosed Breast Cancer Patients at a Tertiary Care Centre |
|
| Dinesh Kumar Sinha,Anita Kumari,Sangeeta Pankaj,Simi Kumari,Vijayanand Choudhary,Anjili Kumari,Jaya Kumari,Syed Nazneen,Shishir Kumar | | Indian Journal of Gynecologic Oncology. 2018; 16(3) | | [Pubmed] | [DOI] | | 10 |
Patterns of Care of Breast Cancer Patients in a Rural Cancer Center in Western India |
|
| Bhagwan M. Nene,Farida Selmouni,Manoj Lokhande,Sanjay J. Hingmire,Richard Muwonge,Kasturi Jayant,Rengaswamy Sankaranarayanan | | Indian Journal of Surgical Oncology. 2018; 9(3): 374 | | [Pubmed] | [DOI] | | 11 |
Is Breast Cancer Problem in India Worse Than That of the West? Reflection of Analysis of Breast Cancer Molecular Subtyping from Tertiary Cancer Care Center in Northern India |
|
| Jeetendar Paryani,Sameer Gupta | | Indian Journal of Surgery. 2018; | | [Pubmed] | [DOI] | | 12 |
Outcomes of Triple-Negative Breast Cancers (TNBC) Compared with Non-TNBC: Does the Survival Vary for All Stages? |
|
| Gaurav Agarwal,Gitika Nanda,Punita Lal,Anjali Mishra,Amit Agarwal,Vinita Agrawal,Narendra Krishnani | | World Journal of Surgery. 2016; 40(6): 1362 | | [Pubmed] | [DOI] | | 13 |
Hormone-receptor expression and survival patterns in operated cases of female invasive ductal breast carcinoma in Kerala: a retrospective cohort study |
|
| Ajith Vettuparambil,Ravindran Chirukandath,Terence B Culas,Sajna Mathumkunnath Vijayan,Gautham Rajan,Sathidevi Vadakkepura Kuttappan | | World Journal of Surgical Oncology. 2015; 13(1) | | [Pubmed] | [DOI] | | 14 |
ASSESSMENT OF PROGESTERONE RECEPTOR EXPRESSION IN CARCINOMA BREAST CASES PRESENTING TO A TERTIARY CARE HOSPITAL IN ANDHRA PRADESH |
|
| Srikanth Reddy Challapalli, Archana Chilakala, Sri Hari Rao Bathalapalli, Sujana Thalamati | | Journal of Evolution of Medical and Dental Sciences. 2015; 4(84): 14726 | | [Pubmed] | [DOI] | | 15 |
Correlation of Hormonal Receptors Estrogen Receptor, Progesterone Receptor and Her-2/Neu with Tumor Characteristics in Breast Carcinoma: Study of 100 Consecutive Cases |
|
| Priyadarshini Biswal,Susmita Behera,Asaranti Kar,Dilleswari Pradhan,Pradeep Kumar Behera,Subrat Burma,Chandraprava Mishra | | International Journal of Clinical Medicine. 2015; 06(12): 961 | | [Pubmed] | [DOI] | | 16 |
Immunohistochemical Profile of Breast Cancer Patients at a Tertiary Care Hospital in New Delhi, India |
|
| Dinesh Chandra Doval,Anila Sharma,Rupal Sinha,Kapil Kumar,Ajay Kumar Dewan,Harit Chaturvedi,Ullas Batra,Vineet Talwar,Sunil Kumar Gupta,Shailendra Singh,Vidula Bhole,Anurag Mehta | | Asian Pacific Journal of Cancer Prevention. 2015; 16(12): 4959 | | [Pubmed] | [DOI] | | 17 |
Clinico-Morphological Profile and Receptor Status in Breast Cancer Patients in a South Indian Institution |
|
| Saptarshi Ghosh,Shreyasee Sarkar,Samara Simhareddy,Sivasankar Kotne,Pammidimukkala Bramh Ananda Rao,Satya Prakash Venkatachalam Turlapati | | Asian Pacific Journal of Cancer Prevention. 2014; 15(18): 7839 | | [Pubmed] | [DOI] | | 18 |
Association of promoter methylation of ERa and ERß with sporadic breast cancer—a study from North India |
|
| Shilpi Chattopadhyay,S. V. S. Deo,N. K. Shukla,Syed Akhtar Husain | | Tumor Biology. 2014; | | [Pubmed] | [DOI] | | 19 |
Estrogen and progesterone receptor status in breast cancer: a cross-sectional study of 450 women in Kerala, South India |
|
| Gautham Rajan,Terence B Culas,PS Jayalakshmy | | World Journal of Surgical Oncology. 2014; 12(1): 120 | | [Pubmed] | [DOI] | | 20 |
Study of Hormone Receptors and Epidermal Growth Factor Expression in Invasive Breast Cancers in a Cohort of Western India |
|
| Hardik Dodiya,Amit Patel,Dipal Patel,Ashish Kaushal,D. G. Vijay | | Indian Journal of Clinical Biochemistry. 2013; 28(4): 403 | | [Pubmed] | [DOI] | | 21 |
The epigenetic silencing of the estrogen receptor (ER) by hypermethylation of the ESR1 promoter is seen predominantly in triple-negative breast cancers in Indian women |
|
| Jyothi S. Prabhu, Kanu Wahi, Aruna Korlimarla, Marjorrie Correa, Suraj Manjunath, N. Raman, B. S. Srinath, T. S. Sridhar | | Tumor Biology. 2012; | | [VIEW] | [DOI] | | 22 |
Estrogen Receptor and Progesterone Receptor Status in Breast Cancer in Relation to Age, Histological Grade, Size of Lesion and Lymph Node Involvement |
|
| Gulam Nabi Sofi,Junaid Nabi Sofi,Raja Nadeem,Rayees Yousuf Shiekh,Faroze Ahmad Khan,Abid Ahmad Sofi,Hillal Ahmad Bhat,Rayees Ahmad Bhat | | Asian Pacific Journal of Cancer Prevention. 2012; 13(10): 5047 | | [Pubmed] | [DOI] | | 23 |
Challenges and opportunities in the design and implementation of breast cancer clinical trials in developing countries |
|
| Sudeep Gupta,Shona Nag,Shaheenah Dawood | | Clinical Investigation. 2012; 2(6): 579 | | [Pubmed] | [DOI] | | 24 |
Immunochemistry for oestrogen receptor, progesterone receptor and HER2 on cell blocks in primary breast carcinoma : ER, PR and HER2 on cell blocks in breast cancer |
|
| K. Kumar S, N. Gupta, A. Rajwanshi, K. Joshi, G. Singh | | Cytopathology. 2011; : no | | [VIEW] | [DOI] | | 25 |
Estrogen Receptor Negative Breast Cancer in India: Do We Really Have Higher Burden of this Subtype? |
|
| Suraj Manjunath,Jyothi S. Prabhu,Rohini Kaluve,Marjorie Correa,T. S. Sridhar | | Indian Journal of Surgical Oncology. 2011; 2(2): 122 | | [Pubmed] | [DOI] | | 26 |
Breast cancer management in low resource countries (LRCs): Consensus statement from the Breast Health Global Initiative |
|
| | | The Breast. 2011; 20: S3 | | [VIEW] | [DOI] | | 27 |
Trends in breast, ovarian and cervical cancer incidence in Mumbai, India over a 30-year period, 1976–2005: an age–period–cohort analysis |
|
| P K Dhillon, B B Yeole, R Dikshit, A P Kurkure, F Bray | | British Journal of Cancer. 2011; | | [VIEW] | [DOI] | | 28 |
Breast cancers in U.S. residing Indian-Pakistani versus non-Hispanic White women: comparative analysis of clinical-pathologic features, treatment, and survival |
|
| Meena S. Moran, Lou Gonsalves, Donna M. Goss, Shuangge Ma | | Breast Cancer Research and Treatment. 2011; | | [VIEW] | [DOI] | | 29 |
Comparison of heat induced antigen retrieval techniques for immune-histochemical estrogen receptor expression in ductal carcinoma of breast in females |
|
| Qadir, A., Mushtaq, S., Sharif, M.A., Mamoon, N., Khadim, M.T. | | Journal of the College of Physicians and Surgeons Pakistan. 2010; 20(8): 519-523 | | [Pubmed] | | 30 |
Breast cancer histology and receptor status characterization in Asian Indian and Pakistani women in the U.S. - a SEER analysis |
|
| Kakarala, M., Rozek, L., Cote, M., Liyanage, S., Brenner, D.E. | | BMC Cancer. 2010; 10(art191) | | [Pubmed] | | 31 |
Estrogen and progesterone hormone receptor status in breast carcinoma: Comparison of immunocytochemistry and immunohistochemistry |
|
| Radhika, K., Prayaga, A. | | Indian Journal of Cancer. 2010; 47(2): 148-150 | | [Pubmed] | | 32 |
Breast cancer: Search for new targets and improvement of existing techniques |
|
| Bharath, R., Parikh, P.M. | | Indian Journal of Cancer. 2010; 47(2): 95-97 | | [Pubmed] | | 33 |
Breast cancer histology and receptor status characterization in Asian Indian and Pakistani women in the U.S. - a SEER analysis |
|
| Madhuri Kakarala,Laura Rozek,Michele Cote,Samadhi Liyanage,Dean E Brenner | | BMC Cancer. 2010; 10(1) | | [Pubmed] | [DOI] | | 34 |
Hormones and gallbladder cancer in women |
|
| Savio G. Barreto, Hirofumi Haga, Parul J. Shukla | | Indian Journal of Gastroenterology. 2009; 28(4): 126 | | [VIEW] | [DOI] | |
|
|
 |
 |
|
|
|
|
|
|
Article Access Statistics | | Viewed | 7839 | | Printed | 278 | | Emailed | 7 | | PDF Downloaded | 652 | | Comments | [Add] | | Cited by others | 34 | |
|

|