# Interplay of Receptor Status, Age, and Stage in Breast Cancer: A Prospective Analysis

## TL;DR

This study explores how age, hormone receptor status, and cancer stage are related in breast cancer patients in Pakistan, finding that younger patients tend to have more aggressive tumors.

## Contribution

The study provides new insights into the interplay of receptor status, age, and stage in breast cancer among Pakistani women.

## Key findings

- Younger patients are more likely to have triple-negative breast cancer and higher-grade tumors.
- Older patients predominantly have ER/PR-positive, HER2/NEU-negative cancers.
- Age-related differences in tumor grade and receptor status suggest the need for age-specific treatment strategies.

## Abstract

Background

Breast cancer is the most prevalent cancer among women globally, with significant variations in incidence and characteristics across different age groups and regions. Understanding the relationship between age, hormone receptor status, and breast cancer stage is crucial for developing effective treatment strategies.

Objectives

This study aimed to: (1) categorize the relationship between receptor status and the stage of breast cancer, (2) determine the frequency of different receptor statuses according to patient age, and (3) correlate the relationship between age and the stage of breast cancer among Pakistani women.

Materials and methods

A prospective analysis was conducted on 1003 breast cancer patients from a semi-government-run hospital in Lahore, Pakistan, between October 2021 to October 2023 using systematic sampling to recruit every fourth patient of breast cancer. Data on age, tumor grade, histopathological subtype, and hormone receptor status (estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2/NEU (HER2/NEU), Ki-67) were collected and analyzed using SPSS v26 (IBM Corp., Armonk, USA). Chi-squared test was employed to explore associations between age groups and receptor status.

Results

The mean age of patients was 50.5 years, with a concentration of cases between 41 and 60 years. Invasive ductal carcinoma (IDC) was the most common subtype (91%). Grade II tumors were most prevalent (50.6%), followed by Grade III (45.5%). The majority of patients were ER-positive (62.4%), followed by PR-positive (52.3%), while HER2/NEU positivity was 44%. The most common receptor status was HER2/NEU negative and ER/PR positive (28.9%). Receptor status distribution varied significantly among age groups (p < 0.000), with younger patients more likely to have triple-negative breast cancers and older patients more likely to have ER/PR-positive, HER2/NEU-negative cancers. Ki-67 levels were assessed in 41.5% of patients, with higher levels observed in younger patients. Younger patients (20-30 years) had a higher prevalence of Grade III tumors, whereas older patients (over 60 years) more frequently had Grade II tumors. There were no significant differences in hormone receptor status distribution across cancer stages (p = 0.76). The stage of carcinoma did not significantly differ across age groups (p = 0.05).

Conclusion

The study highlights significant age-related differences in breast cancer pathology, particularly in tumor grade and receptor status, underscoring the need for age-specific treatment strategies. Younger patients tend to present with more aggressive tumors, necessitating tailored therapeutic approaches to improve outcomes.