Characteristics and treatment of human epidermal growth factor receptor 2 positive breast cancer: 43,485 cases from the National Cancer Database treated in 2010 and 2011

Am J Surg. 2017 Feb;213(2):426-432. doi: 10.1016/j.amjsurg.2016.05.018. Epub 2016 Jul 21.

Abstract

Background: Although identification of human epidermal growth factor receptor 2 (Her2) positive breast cancer represents one of the greatest advances over the past 3 decades, it has not been studied extensively on a national level.

Methods: The National Cancer Database is a joint project of the American Cancer Society and the American College of Surgeons and contains data on about 70% of the cancer cases in the United States. Data on Her2 have been collected since 2010 and was used for this study.

Results: Of 298,937 cases of invasive breast cancer with known Her2 status diagnosed in 2010 and 2011, 43,485 (14.5%) were Her2 positive. Her2 positivity was greatest in Asian/Pacific Islanders and least in non-Hispanic Whites and was markedly more common in younger women. The incidence of Her2 positive tumors ranged from a low of 13.9% in the Mountain West region to a high of 16.0% in the West South Central region (P < .001). Compared with Her2 negative tumors, Her2 positive tumors were larger (2.6 vs 2.2 cm, P < .001), more likely to have positive nodes (39% vs 31% P < .001), have lymphovascular invasion (30% vs 20%, P < .001), and be high grade (56% vs 29%, P < .001). There were also differences by histology: invasive ductal 16.4%, invasive lobular 5.5%, tubular 2.3%, inflammatory 36%, and Paget's with invasion 59%. When adjusted for age, race, tumor size, and nodal status Her2 positive tumors were much more likely to receive chemotherapy (odds ratio = 5.5, confidence interval = 5.2 to 6.0) and somewhat less likely to undergo breast preservation (odds ratio = .78, confidence interval = .76 to .80).

Conclusions: Her2 positive tumors have distinct epidemiologic, clinical, and treatment characteristics.

Keywords: Breast cancer; Breast cancer epidemiology; Breast cancer treatment; Her2 positive breast cancer.

MeSH terms

  • Adenocarcinoma / epidemiology
  • Adenocarcinoma / metabolism
  • Adenocarcinoma / pathology
  • Adenocarcinoma / therapy
  • Adult
  • Aged
  • Breast Neoplasms / epidemiology
  • Breast Neoplasms / metabolism*
  • Breast Neoplasms / pathology
  • Breast Neoplasms / therapy*
  • Carcinoma, Ductal, Breast / epidemiology
  • Carcinoma, Ductal, Breast / metabolism
  • Carcinoma, Ductal, Breast / pathology
  • Carcinoma, Ductal, Breast / therapy
  • Carcinoma, Lobular / epidemiology
  • Carcinoma, Lobular / metabolism
  • Carcinoma, Lobular / pathology
  • Carcinoma, Lobular / therapy
  • Chemotherapy, Adjuvant / statistics & numerical data
  • Databases, Factual
  • Female
  • Humans
  • Incidence
  • Inflammatory Breast Neoplasms / epidemiology
  • Inflammatory Breast Neoplasms / metabolism
  • Inflammatory Breast Neoplasms / pathology
  • Inflammatory Breast Neoplasms / therapy
  • Lymphatic Metastasis
  • Male
  • Mastectomy / statistics & numerical data
  • Mastectomy, Segmental / statistics & numerical data
  • Middle Aged
  • Neoplasm Invasiveness
  • Paget's Disease, Mammary / epidemiology
  • Paget's Disease, Mammary / metabolism
  • Paget's Disease, Mammary / pathology
  • Paget's Disease, Mammary / therapy
  • Racial Groups / statistics & numerical data
  • Receptor, ErbB-2 / metabolism*
  • United States / epidemiology

Substances

  • Receptor, ErbB-2