Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, USA.
Cancer. 2010 Jun 1;116(11):2549-59. doi: 10.1002/cncr.25016.
Although US year 2000 guidelines recommended characterizing breast cancers by human epidermal growth factor receptor 2 (HER2), national cancer registries do not collect HER2, rendering a population-based understanding of HER2 and clinical "triple subtypes" (estrogen receptor [ER] / progesterone receptor [PR] / HER2) largely unknown. We document the population-based prevalence of HER2 testing / status, triple subtypes and present the first report of subtype incidence rates.
Medical records were searched for HER2 on 1842 metropolitan Atlanta females diagnosed with breast cancer during 2003-2004. HER2 testing/status and triple subtypes were analyzed by age, race/ethnicity, tumor factors, socioeconomic status, and treatment. Age-adjusted incidence rates were calculated.
Over 90% of cases received HER2 testing: 12.6% were positive, 71.7% negative, and 15.7% unknown. HER2 testing compliance was significantly better for women who were younger, of Caucasian or African-American descent, or diagnosed with early stage disease. Incidence rates (per 100,000) were 21.1 for HER2+ tumors and 27.8 for triple-negative tumors, the latter differing by race (36.3 and 19.4 for black and white women, respectively).
HER2 recommendations are not uniformly adhered to. Incidence rates for breast cancer triple subtypes differ by age/race. As biologic knowledge is translated into the clinical setting eg, HER2 as a biomarker, it will be incumbent upon national cancer registries to report this information. Incidence rates cautiously extrapolate to an annual burden of 3000 and 17,000 HER2+ tumors for black and white women, respectively, and triple-negative tumors among 5000 and 16,000 respectively. Testing, rate, and burden variations warrant population-based in-depth exploration and clinical translation.
尽管美国 2000 年的指南建议根据人表皮生长因子受体 2（HER2）对乳腺癌进行分类，但国家癌症登记处并未收集 HER2 数据，这使得人们对 HER2 和临床“三阴性”（雌激素受体 [ER] /孕激素受体 [PR] / HER2）的了解主要局限于人口层面。我们记录了基于人群的 HER2 检测/状态、三阴性以及首次报告的亚型发病率。
我们对 2003 年至 2004 年间在亚特兰大市区诊断为乳腺癌的 1842 名女性的医疗记录进行了 HER2 检测搜索。根据年龄、种族/民族、肿瘤因素、社会经济地位和治疗方法分析 HER2 检测/状态和三阴性。计算了年龄调整后的发病率。
超过 90%的病例接受了 HER2 检测：12.6%为阳性，71.7%为阴性，15.7%为未知。年龄较小、白种人或非裔美国人、或诊断为早期疾病的女性 HER2 检测依从性明显更好。HER2+肿瘤的发病率（每 10 万人）为 21.1，三阴性肿瘤的发病率为 27.8，后者因种族而异（黑人和白人分别为 36.3 和 19.4）。
HER2 推荐并非普遍遵循。乳腺癌三阴性的发病率因年龄/种族而异。随着生物学知识转化为临床实践，例如 HER2 作为生物标志物，国家癌症登记处将有责任报告这些信息。发病率谨慎外推到每年分别有 3000 例和 17000 例 HER2+肿瘤以及每年分别有 5000 例和 16000 例三阴性肿瘤的黑人女性和白人女性。检测、发病率和负担的变化需要进行基于人群的深入探索和临床转化。
