Prognostic and predictive parameters of breast cancer: The role of pathologist in the Sr-i Lankan perspective.

Abstract

Breast cancer has been and continues to be a maj,)r health problem. The incidence of breast cancer has increased globally over the la:;t several decades and the greatest increase hac; been seen in Asian countries. It has hecome the commonest cancer in Sri Lanka irrespective <1f the gender. Although breast cancer is a cancer with a good prognosis if detected and treated early, most of 01.1r patients seek medical attention at an advanced stage of the disease. Most of them have high grade tumours. Breast cancer compris('S an extraordinarily diver,e group of diseases in terms of presentation, morphobgy, biological characte istics and clinical behaviour. Tumours of apparently homogenous morphology still vary in response to therapy and have distinct outcomes. Therefore, managemc nt of breast cancer has become a challenging task. The role of the pathologist has evolved parallel to the improvements in the management. The traditic,nal role of pathologist was to diagnose breast cancer. but the emerging challerige is to provide the maximum prognostic and predicth e information so that the b,::st tailored therapy is given to the patient.

Prognostic factors are important for forecasting outcomes in individual patients and can be used to refine treatment choices. Predictive factors are measurements associated with the degree of response to a spec fie therapy. At present hormone receptor status is the well defined predictive factor of breast cancer in predicting the responsiveness to hormonal therapy. The recommended prognostic and predictive factors of breast canct:r include age, tumour sire, axillary lymph node status, histological tumour type, pathological grade, horm,Jne receptor status and the Her 2 expression of the tumo'.:. There are many more pathological parameters which are yet to be included in the recommended list.

Except for the age of the patient all the othe1· recommended prognostic and predictive factors mentioned are assessed by •:he pathologist. Therefore, the histopathology report is considered the gold stand,trd to decide on the treatment of breast cancer. Hormone receptor status of breast cancer is an essential componhormonal therapy. Patients with hormone receptor positive breast cancers have ., favourable response to endocrine therapy and improved survival. Hormone receptc,r expression of breast cancers in Sri Lanka is low and deviates from the glob:, I pattern. Only 32 to 53% of breast cancer patients in Sri Lanka benefits from hormonal therapy. Measures at national level should b.- taken to increase the early detection of breast cancer to improve the outcome as most of our patients ha, aggressive tumours.ent of surgical pathology report of a breast cancer as it focides the selection of adjuvant