Triple negative breast cancer (TNBC), the surgeons and physicians dilemmain Pakistan

Purpose: Breast cancer is one of the most common feminine cancers globally. It accounts for about 15-20% and among these TNBC accounts for 15% of all breast cancer patients. This is the most aggressive form of breast cancer. Breast cancer is a diversified group of biological cancers. Its subtypes have its own history, histopathology, hormone receptors and hormone epidermal growth factor receptor 2 (Her 2). The incidence rates of breast cancer and oral cancer in Karachi are highest in Asia. This study aims to provide data about molecular subtypes of breast cancer in Pakistan. Methods: A cross sectional multi Centre study conducted in surgical departments of CHK, ASH, JPMC, LNH, Institute of Surgery and Medicine (ISM) and other hospitals, after the approval of ethical review committee. A total of 160 patients were recruited from 2010- 2013. Descriptive analysis contains age, ethnicity, BMI, marital status and religion of the cohort. Reproductive risk factors were also taken under consideration like first menstrual age, pregnancies, no. of children, breast feeding and duration, first delivery age, last delivery age, menopause status and hormonal or birth control medications, other life style risk factors like medical allegories, smoking, alcohol consumptions, soft drink intake were also assessed. Diagnosis was done by physical examination, mammography, immunohistochemistry, Fine needle aspiration cytology and FISH analysis. Molecular classification was done according to ASCO/CAP, 2013 guidelines. Statistical data analysis was done by SPSS 17.0. Results: The total frequency for TNBC is 34.3%. The mean age is 45.69±13.9 and BMI is 24.52 ± 4.95. Urdu speaking and Punjabis are most effected ethnic groups. The type of each patient is categories as ILC 6.55%, Mucinous 2.45%, Invasive adenocarcinoma 0.81%, metaplastic 4.09%, and IDC 86%. Position of tumor left (48%) and right (52%). Consistency is hard and firm mostly margins are well defined. Tumor size ranges 2-5cm (65.5%) and ? 5cm (34.5%). The largest size of tumor was 15cm X 10cm.Tumor site were centrally placed (7.3%), lower inner quadrant (5.5%), lower outer quadrant (25.5%), lower outer inner quadrant (1.8%) upper inner quadrant (5.5%), upper outer quadrant (32.7%) and upper outer inner quadrant (9.1%). upper outer lower quadrant (10.9%). Conclusions: Triple negative breast cancer is 15-20% reported globally, however current study found 34.3%. Ladies from Punjabi origin are more prone to TNBC. Current research had found that adding the chemotherapy drug carboplatin or the angiogenesis inhibitor Avastin to standard chemotherapy drugs could produce a rapid decline in TNBC, would help clinicians to treat breast cancer patients on the basis of their molecular profile.