Triple Negative Breast Cancer in India: What Is the Real Incidence?

The real incidence of triple negative breast cancer (TNBC) in India has always been a topic of debate. There has been considerable heterogeneity in the reporting of TNBC rates in India. A recent meta-analysis of 34 studies done till 2019 that included 20,678 patients reported a pooled prevalence of 27% (95% confidence interval [CI]: 24–31%).[1] Our previous work in which we collected data from 17 studies done between 1999 and 2015 involving 7,237 patients from all four regions of India reported a TNBC rate of 31% (95% CI: 27–35%).[2]

In this meta-analysis, substantial heterogeneity was observed across the studies (I² of 91.2% [95% CI: 88–94%], p < 0.001). This was unexplained by study level characteristics like study location, definition of HER2 or estrogen receptor, age, proportion of patients who were premenopausal, grade 3 disease, or larger tumor size. We also found that the TNBC rate decreased as the quality of the study increased. Although the rates were not statistically significant, the TNBC rate of lower quality studies was higher when compared to higher quality studies (38% [95% CI: 27–48%] vs. 29% (95% CI: 25–33%]). Quality of studies were assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. One point was given to each parameter if the study described the setting and study participants, reported descriptive data, provided detailed outcome data, and discussed limitations. A good quality study had a score of ≥4 and a lower quality had a score of < 4 with a maximum score of 5.[2]

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Publication History

Article published online:
14 March 2022

• Reference

• 1 Kulkarni A, Kelkar DA, Parikh N, Shashidhara LS, Koppiker CB, Kulkarni M. Meta-analysis of prevalence of triple-negative breast cancer and its clinical features at incidence in Indian patients with breast cancer. JCO Glob Oncol 2020; 6: 1052-1062
• 2 Sandhu GS, Erqou S, Patterson H, Mathew A. Prevalence of triple-negative breast cancer in India: systematic review and meta-analysis. J Glob Oncol 2016; 2 (06) 412-421
• 3 Dhanushkodi M, Sridevi V, Shanta V. et al. Locally advanced breast cancer (LABC): real-world outcome of patients from cancer institute, Chennai. JCO Glob Oncol 2021; 7: 767-781
• 4 Chakraborty S, Wadasadawala T, Ahmed R, Coles C, Chatterjee S. Breast cancer demographics, types and management pathways: can western algorithms be optimally used in eastern countries?. Clin Oncol (R Coll Radiol) 2019; 31 (08) 502-509
• 5 Doval DC, Radhakrishna S, Tripathi R. et al. A multi-institutional real world data study from India of 3453 non-metastatic breast cancer patients undergoing upfront surgery. Sci Rep 2020; 10 (01) 5886
• 6 Shet T. Improving accuracy of breast cancer biomarker testing in India. Indian J Med Res 2017; 146 (04) 449-458
• 7 Chen X, Yuan Y, Gu Z, Shen K. Accuracy of estrogen receptor, progesterone receptor, and HER2 status between core needle and open excision biopsy in breast cancer: a meta-analysis. Breast Cancer Res Treat 2012; 134 (03) 957-967
• 8 Kumar RV, Panwar D, Amirtham U. et al. Estrogen receptor, progesterone receptor, and human epidermal growth factor receptor-2 status in breast cancer: a retrospective study of 5436 women from a regional cancer center in South India. South Asian J Cancer 2018; 7 (01) 7-10
• 9 Collonnaz M, Erpelding ML, Alla F. et al; AEPEI Study Group. Impact of referral bias on prognostic studies outcomes: insights from a population-based cohort study on infective endocarditis. Ann Epidemiol 2021; 54: 29-37
• 10 McDonald JA, Rao R, Gibbons M. et al. Symposium report: breast cancer in India-trends, environmental exposures and clinical implications. Cancer Causes Control 2021; 32 (06) 567-575
• 11 Holm J, Humphreys K, Li J. et al. Risk factors and tumor characteristics of interval cancers by mammographic density. J Clin Oncol 2015; 33 (09) 1030-1037