Abstract
Background:
Breast cancer is one of the most common causes of cancer death in women both globally and in Iran. Although medical breakthroughs have improved its prognosis, different characteristics can vary locally, especially in understudied regions. Therefore, the present study was designed and carried out in 2022 to compare the rate of breast cancer recurrence in Luminal A and triple-negative patients referred to the Shahid Rahimi Hospital in Khorramabad from March 2019 to March 2020.
Materials and methods:
This study was a descriptive-analytical cross-sectional study designed and conducted on 59 patients diagnosed with Luminal A and triple-negative breast cancer treated at the Shahid Rahimi Hospital from March 2019 to March 2020. In this study, the data collection instrument was a researcher-designed form that included information such as age, history of recurrence, type of cancer, family history of cancer, personal history of cancer, lymph node involvement, hookah use history, smoking history, breastfeeding history, and material status. Finally, after collecting information, data was analyzed using SPSS software version 25.
Results:
The average age of the patients in this study was 49.45 ± 6.01 years, and the youngest and oldest patients were 35 and 62 years, respectively. Among the studied patients, 34 individuals (57.63%) had Luminal A cancer, and 25 patients (42.37%) had triple negative cancer. Recurrence was reported in 23 patients (38.98%), and lymph node involvement was reported in 21 patients (35.59%). Moreover, 14 patients (23.73%) were positive for a personal history of cancer, and 22 patients (37.29%) had a family history of cancer. In this study, the relationship between recurrence and type of cancer and involvement of lymph nodes was statistically significant (P < 0.05).
Conclusion:
The rate of recurrence in patients with Luminal A cancer was higher than in patients with triple-negative cancer, according to the results of the study. More attention and periodic examinations in terms of recurrence in patients with Luminal A cancer were necessary.
Keywords: breast cancer, Luminal A, malignancy, recurrence, triple-negative
HIGHLIGHTS
The recurrence rate was 38.98%, and lymph node involvement was 35.59%.
Recurrence and involvement of lymph nodes were statistically related.
The recurrence rate in Luminal A patients was higher in this study.
Introduction
Cancer (malignancy) is a life-threatening situation of abnormal and uncontrolled growth of cells[1]. Breast cancer is among the most common and concerning health problems in women all around the world[2]. It makes up about 29% of women’s new cancer in the US[3]. It has the second rank of death caused by cancer after lung cancer[4]. Annually, nearly 40 000 women die because of breast cancer[5]. It has been estimated that by 2050, 3.2 million women will develop breast cancer annually[6]. Breast cancer can impose a great economic burden on patient families and society[7]. The age of diagnosis in patients in developed countries is considerably less than in developing nations[2]. In Iran, the cancer’s incidence is 22.6 per 100 000. The main patient population is 45-54 years old, 10 years lower than in developed countries[4].
There are four subtypes of breast cancer: Luminal A, Luminal B, HER2 positive, and triple negative[8]. It can be metastatic and may be transmitted to other parts of the body like bone, liver, lung, and brain, which makes it incurable[9].
The recurrence rate in women diagnosed with breast cancer is between 8 to 10%[10]. The recurrence rate in the breast is related to its subtype[11]; Each subtype has different prognoses and clinical features. The recurrence rate of the Luminal A subtype is low. Recurrence in Luminal B can occur at any time. The early recurrence rate is high in Hormone receptor-negative subtypes (basal-like and HER2-positive) and usually occurs within 3 years[11,12]. Factors such as age, tumor size, axillary nodal involvement, positive HER2 and negative estrogen receptors, and progesterone receptors are prognostic factors for cancer outcome, metastases, and recurrence[13-15]. Although studies found the recurrence rate in different breast cancer subtypes to be statically significant[16,17]. Some studies did not find cancer subtypes as a factor for recurrence rate[18].
Although recognizing risk factors[9,19], screening tests[20], and treatments[21] for breast cancer have improved its prognosis, genetic mutations[22], molecular characteristics[23], and socioeconomic factors[24] can vary locally and exhibit different survival and recurrence rates, especially in understudied populations. More research could help determine cancer prognosis in these regions and reduce cancer disparities. This study aimed to assess the recurrence rate of Luminal A patients compared to triple-negative cases in patients of Shahid Rahimi Hospital, Khorramabad, Iran, in 2022.
Materials and methods
This study was a descriptive-analytical cross-sectional study that was designed and conducted on 59 patients diagnosed with Luminal A (n = 34, 57.63%) and triple-negative breast cancer (n = 25, 42.37%) from March 2019 to March 2020 in Shahid Rahimi Hospital, Khorramabad, Iran in 2022. Inclusion criteria were patients with Luminal A and triple-negative breast cancer. Exclusion criteria were patients with early-stage breast cancer and patients with incomplete clinical information. The study has been reported in line with the STROCSS criteria[25].
Study design: In this study, the study group included all the patients diagnosed with Luminal A and triple-negative breast cancer in this hospital.
Study variables: A questionnaire was designed to collect information based on the study protocol. The questionnaire included variables such as age, recurrence of cancer, type of cancer, familial history of cancer, personal history of cancer, involvement of lymph nodes, smoking history, history of hookah smoking, breastfeeding history, and marital status.
Data analysis method
After data collection, the data was analyzed using SPSS 25. Mean and standard deviation were used for quantitative variables. Chi-square tests were conducted to compare recurrence rates between different groups. A significance level of 0.05 was considered.
Results
In this study, 59 patients with Luminal A and triple-negative were studied to detect the recurrence rate of breast cancer. The average age of this population was 49.45 ± 6.01 years. The oldest and the youngest patients were 62 and 35 years old. Table 1 summarizes patients’ demographic features and past disease history.
Table 1.
Demographic features of patients
| Category frequency | ||
|---|---|---|
| Marriage status | Single | 13 (22.03%) |
| Married | 46 (77.97%) | |
| History of lactation | Positive | 41 (69.49%) |
| Negative | 18 (30.51%) | |
| History of smoking | Positive | 26 (44.07%) |
| Negative | 33 (55.93%) | |
| History of hookah smoking | Positive | 14 (23.73%) |
| Negative | 45 (76.27%) | |
| Type of cancer | Luminal A | 34 (57.63%) |
| Triple negative | 25 (42.37%) | |
| Recurrence | Positive | 23 (38.98%) |
| Negative | 36 (61.02%) | |
| Lymph node involvement | Positive | 21 (35.59%) |
| Negative | 38 (64.41%) | |
| Personal history of cancer | Positive | 14 (23.73%) |
| Negative | 45 (76.27%) | |
| Family history of cancer | Positive | 22 (37.29%) |
| Negative | 37 (62.71%) | |
According to the information in Table 1, 46 patients (77.97%) were married, 41 patients (69.49%) had a history of lactation, 26 patients (44.07%) had a positive history of smoking, and 45 (76.27%) of them without a history of hookah smoking made up the most of population. 34 patients (57.63%) had Luminal A and 25 patients (42.37%) had triple negative cancer. Recurrence was positive in 23 patients (38.98%), and lymph node involvement was positive in 21 patients (35.59%). 14 patients (23.73%) of patients had a positive history of cancer, and 22 patients (37.29%) had a positive family history of cancer.
Table 2 summarizes the information about cancer types based on patients’ different age groups. The average age for Luminal A cancer was 49.05 ± 6.06 years, and the average age. in triple-negative patients was 50.00 ± 6.02 years. There was no statistically significant difference in the average age of these two populations (P = 0.557).
Table 2.
Comparison of patients’ age group based on cancer type
| Type of cancer | Number | Average ± SD | P value |
|---|---|---|---|
| Luminal A | 34 | 49.05 ± 6.06 | 0.557 |
| Triple negative | 25 | 50.00 ± 6.02 | |
| Total | 59 | 49.45 ± 6.01 |
Table 3 summarizes the recurrence rate in patients by average age. The average age in patients with recurrence was 49.34 ± 6.74 years, and the average age in patients without recurrence was 49.52 ± 5.59 years. No statistically significant difference existed in these two groups’ average age (P = 0.911).
Table 3.
Comparison of patient cancer recurrence based on age groups
| Recurrence | Number | Average ± SD | P value |
|---|---|---|---|
| Positive | 23 | 49.34 ± 6.74 | 0.911 |
| Negative | 36 | 49.52 ± 5.59 | |
| Total | 59 | 49.45 ± 6.01 |
Table 4 shows the relationship between the recurrence rate and different research variables. In 12 patients (35.29%) had Luminal A breast cancer. 11 ones (44.00%) had triple negative. The result of the chi-squared test showed that the correlation between cancer type and the recurrence rate was meaningful (P < 0.05).
Table 4.
Characteristics analysis based on recurrence rate
| Characteristic | Recurrence (yes/no) | P value | ||
|---|---|---|---|---|
| Subtype | Luminal A | 12 (35.29%) | 22 (64.71%) | 0.049 |
| Triple Negative | 11 (44%) | 14 (56%) | ||
| Lymph node involvement | Yes | 15 (71.42%) | 6 (28.58%) | 0.038 |
| No | 8 (21.05%) | 30 (78.95%) | ||
| Marital history | Married | 20 (43.48%) | 26 (56.52%) | 0.183 |
| Single | 3 (23.08%) | 10 (76.92%) | ||
| Lactation history | Positive | 19 (46.34%) | 22 (53.66%) | 0.080 |
| Negative | 4 (22.22%) | 14 (77.78%) | ||
| Smoking history | Positive | 13 (50%) | 13 (50%) | 0.124 |
| Negative | 10 (30.30%) | 23 (69.70%) | ||
| Hookah smoking | Positive | 11 (78.57%) | 3 (21.43%) | 0.112 |
| Negative | 12 (26.67%) | 33 (73.33%) | ||
| Past history of cancer | Positive | 9 (64.29%) | 5 (35.71%) | 0.260 |
| Negative | 14 (31.11%) | 31 (68.89%) | ||
| Family history of cancer | Positive | 12 (54.55%) | 10 (45.45%) | 0.059 |
| Negative | 11 (29.73%) | 26 (70.27%) | ||
Fifteen patients (71.42%) had lymph node involvement. Eight patients (21.05%) did not have lymph node involvement. Lymph node involvement is related to the recurrence rate of cancer (P = 0.038). Twenty patients (43.48%) were married, and 3 (23.08%) were single. Marital status was unrelated to the recurrence rate (P > 0.05). Nineteen patients (46.34%) had lactation and 4 patients (22.22%) did not have lactation. Lactation was not related to the recurrence rate (P > 0.05). Thirteen patients (50.0%) had a positive history of smoking. Ten patients (30.30%) had negative smoking history. Smoking was not related to the recurrence rate (P > 0.05). Eleven patients (78.57%) had a positive history, and 12 patients (26.67%) had a negative history of hookah smoking. Hookah smoking was not related to recurrence rate (P > 0.05). Nine patients (64.29%) had a positive history, and 14 patients (31.11%) had a negative history of cancer. History of cancer was not related to recurrence rate (P > 0.05). Twelve patients (54.55%) had a positive family history, and 11 patients (29.73%) had a negative family history of cancer. A positive family history of cancer was not related to the recurrence rate (P > 0.05).
Discussion
The average age of patients was 49.45 ± 6.01 years in the study, and the results were compatible with other studies done in Iran where the average age was 45–54 years[4]; in the Kashi et al study, the average age of patients was 48 years, and it was compatible with this study[26]. However, it is less than the median age of diagnosis of breast cancer in the US, which is 62[27]. This suggests the possibility of a difference in the biological features and diagnostic abilities in the Iranian population compared to other regions, which needs more research.
This study aimed to compare and assess the recurrence rate of patients based on cancer subtype in Luminal A and triple-negative patients. This rate was higher in the Luminal A group (P < 0.05). It was incompatible with Shim H et al study results in which the rate in the Luminal A group was 5.02%, and the triple-negative was 16.76% which is noticeably lower[12]. Saha et al study showed that the Triple-negative subtype, compared to other subtypes, had an increased death and recurrence likelihood and visceral metastasis, like brain, liver, and lung. Meanwhile, bone metastasis was higher in other groups[28]. Ribelles et al showed that Triple negative recurrence likelihood compared to Luminal A in the first 2 years is three times higher, nearly doubling at 36 months. The recurrence rate is similar at 60 months, which is incompatible with this study[29].
In this study, the recurrence rate of cancer was 38.98%, similar to Ghorbani et al’s study of metastatic patients (34%) in Mashhad, Iran[30]. The result of the Kashi et al study was 17.3% from the Shahid Beheshti University of Medical Sciences cancer research center database, which was lower than this study’s[26].
In a population-based study conducted in Atlanta, it was found that triple-negative breast cancer tends to occur more in younger patients who are between the ages of 20 and 39 years old in comparison to the control group and those with HR+ HER2− tumors[31]. Another study shows that there is a 16% reduction in the chances of triple-negative breast cancer occurring with the passing of a decade of life in people[32]. Based on the data that we have from The National Cancer Data Base (NCDB) between 2010 and 2011, the chances of triple-negative breast cancer in patients aged 30 or younger are 23.3%. It declines by aging in patients as far as it becomes 10% in people older than 70 years old[33]. In another study in the Carolina Breast Cancer Study (CBCS) assessing triple-negative breast cancer, it was found that younger patients had a higher chance of basal-like breast cancer[34]. Other studies also suggested that basal-like triple-negative breast cancer cases make up a bigger proportion in younger patients, whereas nearly 50% of patients >65 years have non-basal subtypes[35]. In another study conducted about the relation between reproductive history and triple-negative breast cancer and comparing it with those with ER+ type, it was demonstrated that women diagnosed with triple-negative breast cancer were generally younger, had a higher chance to have a positive familial history of breast cancer, nulliparity decreased the risk of triple-negative breast cancer, but it increased the chances of ER+ type[36].
Due to current improvements in treatments, the recurrence rate and survival chances are improving[37]. The method used for treatment used to be surgery that was followed by adjuvant systemic chemotherapy, which is crucial in stage II and III triple-negative breast cancer. The use of Neoadjuvant chemotherapy has helped us develop better drugs and reduce the need for surgery of breast and axillary (which can mitigate surgical mortality rates)[38,39].
Triple-negative breast cancer tends to have the highest recurrence and mortality rates among other subtypes of breast cancer[37]. In a cohort study done in Toronto to compare the outcomes of triple-negative breast cancer to other types, it was demonstrated that in an 8.1-year follow-up, the patients with triple-negative breast cancer had a higher risk of distant relapse and death within the first 5 years after the diagnosis but not after that[40]. Patients with Basal-like Breast Cancer often experience recurrence in the period of 3 to 5 years after the initial diagnosis, with about 50% of them having a poor prognosis[41]. The first relapses are likely in the brain, lung, or locoregional sites[42]. With all the current treatments, the median overall survival (OS) is about 10.2 months[43].
There was no meaningful relationship between smoking history and recurrence rate in this study. In Pierce JP et al’s study, the correlation between smoking and breast cancer recurrence was meaningful, and it was reported nearly 41%[44]. This study had a relationship between lymph node involvement and recurrence rate. In Costeria’s study, metastatic axillary lymph nodes had a high rate of breast cancer recurrence rate[45]. In Baek and Komoike’s study, lymph node involvement has been detected as a recurrence factor[46,47]. In the study by Geurts et al, young age was a recurrence factor that was incompatible with our study[48]. A retrospective study by Turkoz et al showed a positive relationship between family history and triple-negative breast cancer that was incompatible with our study[49]. Jobson et al reported increased recurrence risk between positive family histories among young patients, which was incompatible with this study[50]. Three cohort studies reported no relationship between breast cancer and ovarian cancer and the risk of recurrence with positive family history, which was compatible with our study[51-53]. Our study showed no statistical relationship between lactation and recurrence rate. Kwan’s study showed a relationship between breastfeeding. It decreased the risk of recurrence, especially for 6 months or more, especially in Luminal A, but in other subtypes, there was no meaningful correlation[54]. Further research is necessary to investigate these findings.
Conclusion: This study has lightened the correlation between the recurrence rate of breast cancer and its subtypes; it was higher in the Luminal A subtype compared to the Triple Negative group. More research is legitimated to review this relationship in a vaster population-based study.
Footnotes
Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.
Published online 13 May 2025
Contributor Information
Mohammad Joudaki, Email: mohammadjkpv@gmail.com.
Parya Khani, Email: paryakhani13807777@gmail.com.
Simin Farokhi, Email: dr.siminfarokhi1310@gmail.com.
Sarah Rahimi, Email: sararahimi497@gmail.com.
Mania Beiranvand, Email: mania.beyranvand@yahoo.com.
Yaser Mokhayeri, Email: yasermokhayeri@yahoo.com.
Ali Pajouhi, Email: pajuhia@yahoo.com.
Ethical approval
This study was approved by the Lorestan University of Medical Sciences ethics committee (approval ID: IR.LUMS.REC.1402.222). All ethical guidelines were met.
Consent
Written informed consent was obtained from the patient for publication and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request.
Sources of funding
None.
Author contributions
M.B. and A.P.: conceptualization and supervision; M.J., A.P., S.F., and S.A.S.: design, writing – review & editing and resources; A.P., P.K., S.F., and S.R.: investigation, writing – original draft, writing – review & editing. Y.M.: data curation and formal analysis. All authors have read and approved the final version of the manuscript.
Conflicts of interest disclosure
The authors declare no conflict of interest.
Research registration unique identifying number (UIN)
researchregistry10763.
Guarantor
Dr Mania Beiranvand.
Provenance and peer review
Not commissioned, externally peer-reviewed.
Data availability statement
None.
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