Circulating Tumor Cells may be an Early Diagnostic Marker for Disease Progression in Patients with Breast Carcinoma

Background: Cancer affects millions of people around the world. In Pakistan, breast cancer (BC) is the leading cause of death in women. Once the tumor has established itself, tumor cells shed and enter the blood circulation to metastasize to distant areas of the body. These cells are known as circulating tumor cells (CTCs) and their presence in cancer patients has been documented. The current study was designed to determine CTCs in BC patients. Methods: This was a descriptive cross-sectional study that consisted of 80 newly diagnosed females with BC. Patients were allotted different stages according to the American Joint Committee on Cancer (AJCC) staging system. Stage I comprised 11 subjects, stage II had 30, stage III 31 and stage IV included 8 subjects. After writing informed consent, 3 ml anticoagulated whole blood was collected from each patient, and transported to the Department of Immunology, University of Health Sciences (UHS), Lahore. CTCs were stained with CD45, CD326, and anticytokeratins 8, 18, 19. CTCs were analyzed by FACS calibur flow cytometer (BD) using BD Cell Quest Pro software. Data was entered and analyzed using SPSS 20.0. Results: Twenty-three (28.7%) patients had more than 5 CTCs, while 57 (71.3%) had less than 5 CTCs in their blood samples. Mean ± SD of CTCs was high in stage IV of BC (8±7.92) as compared to stage I (1±1.67), stage II (2±2.91) and stage III (4±4.88) and on comparison there was a statistically significant difference between stage I and IV (p=0.002) and between stage II and IV (p=0.003). Mean ± SD of CTCs was high in patients with metastatic disease (8±7.92) as compared to non-metastatic disease (3±3.99) and on comparison the difference was statistically significant (p= 0.002). Mean ± SD of CTCs was high (5±5.89) in patients with family history of carcinomas including BC and other solid tumors compared to patients who did not have family history of cancer (2±3.36) and on comparison, the difference between these groups was statistically significant (p=0.016). Conclusions: CTCs were higher in stage IV as compared to other stages of BC. CTCs were high in patients with a positive family history of BC compared to subjects without family history of BC. CTCs were higher in patients with metastatic disease as compared to non-metastatic disease.