Jalal Poorolajal - Modeling of Noncommunicable Diseases Research Center and Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
Nahid Nafissi - MD Cancer Research Center, Iran University of Medical Sciences, Tehran, Iran,
Mohammad Esmaeil Akbari - Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Ebrahim Babaee - MSc, Epidemiology Department of Pakdasht health center, Vic-chancellor of Health Services, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Background: We conducted this study to estimate the prevalence of biomarkers, including estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) among patients with breast cancer and to explore their effects on the disease mortality. Methods: We conducted this registry based retrospective cohort study in Tehran, in 2014, using the data on 1622 patients with breast cancer, diagnosed pathologically and registered with the Comprehensive Cancer Control Center from 1998 to 2013. The outcome of interest was the survival probability of patients with breast cancer based on receptor status along with other prognostic factors such as age, histopathology, stage/grade of tumor, metastatic status, and surgical procedures using the life table, Kaplan-Meier curves, and multivariate Cox proportional hazard model. Based on expression of ER, PR, and HER2, positive (+) and/or negative (–), we generated different subtypes Results: ER+/PR+/HER2– subtype (51.5%) was the most common form of breast cancer cells. Compared to the ER+/PR+/HER– subtype, the hazard ratio (95% confidence interval) of cancer mortality was 2.14 (1.13, 4.03) for ER–/PR–/HER2– subtype, 1.92 (1.03, 3.59) for ER–/PR– /HER2+ subtype and 5.19 (1.51, 17.86) for ER–/PR+/HER2+ subtype. Conclusion: In this study, breast cancer cases with ER–/HER2+ tumors had a shorter survival than those with ER+/PR+/HER2– tumors. Triple negative tumors were the only other subtype with a statistically significant poorer prognosis. Results of this study in a middle-income country further indicate the importance of receptor status, in particular HER2 status, in the prognosis of breast cancer

Breast Neoplasms; Survival Analysis; Immunohistochemistry; Biological Markers; Cohort Studies; Iran