الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Breast cancer is a global health issue. It constitutes 23% of all cancers and is the second leading cancer worldwide (10.9% of all cancers). More than half of the deaths from breast cancer worldwide occurs in developing countries (269,000 out of 458,000). In Egypt, breast cancer represents 32% of all cancer cases among females.
Age, reproductive factors, personal or family history of breast disease, genetic pre-disposition and environmental factors have been associated with an increased risk for the development of female breast cancer.
It is standard practice that hormone receptor status and HER2/neu over expression are determined prior to the commencement of treatment for breast cancer patients because there has been an established positive correlation between ER and PR with the degree of tumor differentiation.
There exist phenotypic changes between primary and metastatic breast cancer. This has been hypothesized to be the cause of difficulty faced in the treatment and/or management of breast cancer patients with metastasis. Treatment (neoadjuvant, surgery, radiation, chemotherapy, adjuvant therapy and HER-2-targeted therapy) may modify ER, PR and HER-2/neu between primary and metastatic disease.
According to this study, stratification of the 100 patients studied according to ER expression status in the recurrent or metastatic disease in relation to that in the primary lesion was either similar expression (no change) in 73 patients, changed from positive to negative in 19 patients or changed from negative to positive in 8 patients, while PR expression was similar in 78 patients, changed from positive to negative in 15 patients and changed from negative to positive in 7 patients. The relation between this stratification and several factors were studied.
In this study, 50.7% of the cases showing no ER discordance were below or 40 years compared to 62.5% of those who changed to positive denoting no relation between ER discordance and age at diagnosis.
96 patients were diagnosed as IDC, included all patients who had ER change to negative and 95.9% of those with no discordance denoting no relation between ER status and pathology at diagnosis.
Regarding PR status, Patients with IDC constituted 96.2% of the cases showing no discordance and also all cases that changed to negative showing also no significant effect for pathology at diagnosis upon PR discordance.
Regarding ER status, patients who received neoadjuvant therapy constituted 12.3% of the cases with no discordance and 12.5% of those who changed to positive denoting no relation between ER discordance and receiving neoadjuvant therapy.
Patients who did not receive neoadjuvant therapy constituted 89.7% of the cases with no PR discordance and 93.3% of those who changed to positive showing no significant relation between neoadjuvant therapy and PR discordance.
On studying ER discordance according to nodal status, no significant relation was found. The patients with N1 disease constituted 63% of the cases showing no discordance and 62.5% of those who changed to positive.
Regarding PR, the patients with N1 disease constituted 65.4% of the patients with no discordance and 66.7% of those who changed to positive denoting no relation between nodal status and PR discordance as well.
Also, no relation was found for PR discordance where the patients who received adjuvant chemotherapy constituted 94.9% of the cases showing no discordance, 93.3% of those who changed to negative and 85.7% of those who changed to positive.
High tendency to change ER status to negative in patients who received Tamoxifen while no significance was noted for aromatase inhibitors.
Similarly, Tamoxifen raises the liability for PR discordance to negative while aromatase inhibitors have a limited effect.
ER status was not found to be affected by pattern of relapse. Patients suffering local recurrence constituted 52.6% of the cases changing to negative and 62.5% of those changing to positive.
On the contrary, PR change to positive was noted more in patients with local recurrence while patients with distant metastases were the majority of the cases showing no PR change.
68.4% of the cases having ER change to negative had the same change in PR and 62.5% of those having ER change to positive had the same change in PR.