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A ailable online on h p://www.ijcp .com/
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Sa ka e al. In e na ional Jou nal o Cu en Pha maceu ical Re iew and Resea ch
1101
O iginal Resea ch A icle
Re ospec i e S udy o Su i al and Clinico Pa hological Cha ac e is ics o
Di e en His opa hological G ades o Newly Diagnosed B eas Cance
Pa ien s: A Ru al Cance Cen e Expe ience
Anindya Sa ka 1, Soumi a Podda 2, P em Na h Du a3
1Assis an P o esso , MD, Depa men o Radio he apy, Mu shidabad Medical College Hospi al,
Be hampo e, Mu shidabad, Wes Bengal, India – 742101
2Associa e P o esso , MD, Depa men o Radio he apy, Mu shidabad Medical College Hospi al,
Be hampo e, Mu shidabad, Wes Bengal, India – 742101
3Assis an P o esso , MD, Depa men o Radio he apy & Oncology, Jalpaigu i Go e nmen Medical
College Hospi al, Jalpaigu i, Wes Bengal, India - 735101
Recei ed: 01-06-2025 / Re ised: 16-07-2025 / Accep ed: 14-08-2025
Co esponding Au ho : D . Anindya Sa ka
Con lic o in e es : Nil
Abs ac
Backg ound: His opa hological g ading is an essen ial p ognos ic ool in b eas cance managemen . In u al
India, limi ed heal hca e access o en leads o la e diagnosis and poo su i al. Unde s anding he clinico-
pa hological p o ile o a ious umo g ades can help o op imize ea men s a egies in esou ce-cons ained
se ings.
Aim: To e alua e he clinico-pa hological cha ac e is ics and su i al ou comes associa ed wi h di e en
his ological g ades o newly diagnosed b eas cance pa ien s in a u al cance cen e.
Me hods: A e ospec i e obse a ional s udy was conduc ed on 486 pa ien s diagnosed wi h b eas cance
be ween June 2021 and June 2023. Tumo s we e g aded using he No ingham sys em. Demog aphic,
pa hological, and ea men de ails we e analyzed. Su i al ou comes—disease- ee su i al (DFS) and o e all
su i al (OS)—we e assessed using Kaplan-Meie analysis, and associa ions we e e alua ed using Chi-squa e
and log- ank es s.
Resul s: O he 486 pa ien s, 21.0% had G ade I, 45.7% G ade II, and 33.3% G ade III umo s. Highe umo
g ade was signi ican ly associa ed wi h la ge size, lymph node posi i i y, HER2 posi i i y, and iple-nega i e
pheno ype (p<0.001). Ho mone ecep o posi i i y declined wi h inc easing g ade. G ade I umo s had supe io
3-yea DFS (89.2%) and OS (93.1%) compa ed o G ade III (58.1% and 71.6%, espec i ely) (p<0.001). BMI
was also co ela ed wi h g ade and su i al—obese pa ien s (≥30 kg/m²) had a highe p opo ion o G ade III
umo s and poo e ou comes.
Conclusion: His ological g ade is a s ong p edic o o agg essi e umo biology and poo p ognosis in b eas
cance . In u al se ings, ea ly diagnosis and g ading-based isk s a i ica ion can guide e ec i e ea men
planning. Imp o ing access o diagnos ic ools and a ge ed he apies is i al o educing u al-u ban dispa i ies in
b eas cance ou comes.
Keywo ds: B eas cance , His ological g ade, Ru al heal hca e, Su i al analysis, Ho mone ecep o , T iple-
nega i e, No ingham g ading, BMI.
This is an Open Access a icle ha uses a unding model which does no cha ge eade s o hei ins i u ions o access and dis ibu ed unde
he e ms o he C ea i e Commons A ibu ion License (h p://c ea i ecommons.o g/licenses/by/4.0) and he Budapes Open Access Ini ia i e
(h p://www.budapes openaccessini ia i e.o g/ ead), which pe mi un es ic ed use, dis ibu ion, and ep oduc ion in any medium, p o ided
o iginal wo k is p ope ly c edi ed.
In oduc ion
B eas cance is he mos equen ly diagnosed
malignancy and a leading cause o cance ela ed
dea h among women wo ldwide, accoun ing o
app oxima ely 24.5% o all new cance cases and
15.5% o cance dea hs globally [1]. In India, b eas
cance has su passed ce ical cance o become he
mos common malignancy in emales, wi h ising
incidence and an inc easing bu den on heal hca e,
pa icula ly in u al a eas [2,3]. His opa hological
g ading se es as a i al p ognos ic indica o in
b eas cance . The No ingham His ologic G ade
(also known as he Els on–Ellis modi ica ion o he
Sca –Bloom–Richa dson g ading sys em) emains
one o he mos widely accep ed me hods o
assessing umo di e en ia ion [4]. I e alua es h ee
mo phological ea u es— ubule o ma ion, nuclea
pleomo phism, and mi o ic coun — o assign umo s
as G ade I (well-di e en ia ed), G ade II
(mode a ely di e en ia ed), o G ade III (poo ly
di e en ia ed) [5]. Highe his ologic g ades a e
associa ed wi h poo di e en ia ion, highe
p oli e a i e ac i i y, and wo se p ognosis [6].
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Sa ka e al. In e na ional Jou nal o Cu en Pha maceu ical Re iew and Resea ch
1102
Nume ous s udies ha e demons a ed ha high-
g ade umo s a e signi ican ly co ela ed wi h
ad e se clinico-pa hological ea u es such as la ge
umo size, lymph node posi i i y, ho mone ecep o
(ER/PR) nega i i y, HER2 o e exp ession, and
iple-nega i e pheno ype [7,8]. These agg essi e
biological beha io s con ibu e o sho e disease-
ee su i al (DFS) and o e all su i al (OS) [9].
While u ban cance cen e s in India o en ha e
access o ad anced diagnos ic and he apeu ic
esou ces, pa ien s in u al a eas ace signi ican
ba ie s including delayed diagnosis, lack o
sc eening p og ams, inadequa e in as uc u e, and
socioeconomic cons ain s [10,11]. These dispa i ies
di ec ly impac ea men ou comes and su i al.
Ano he eme ging p ognos ic ac o is Body Mass
Index (BMI). Obesi y has been linked o mo e
agg essi e umo biology, poo e esponse o
ea men , and educed su i al in b eas cance
pa ien s [12]. The mechanism in ol es ch onic
in lamma ion, al e ed ho mone le els, and insulin
esis ance, which can s imula e umo g ow h and
p og ession [13].
Despi e he clinical ele ance o his ological g ading
and BMI, limi ed da a exis om u al Indian
popula ions. Unde s anding hese co ela ions in
esou ce-limi ed se ings is c ucial o de eloping
egion-speci ic ea men p o ocols and imp o ing
ou comes.
This s udy aims o e alua e he clinico-pa hological
cha ac e is ics and su i al ou comes associa ed
wi h di e en his ological g ades o newly
diagnosed b eas cance pa ien s in a u al cance
cen e. I also explo es he associa ion o BMI wi h
umo g ade and su i al, p o iding insigh in o i s
u ili y as a supplemen a y p ognos ic ac o .
Ma e ials and Me hods
S udy Design and Se ing: This was a e ospec i e
obse a ional s udy conduc ed a a u al cance
cen e in India. The s udy aimed o analyse he
su i al ou comes and clinico-pa hological
cha ac e is ics associa ed wi h di e en
his opa hological g ades o newly diagnosed b eas
cance pa ien s. The da a we e collec ed om
medical eco ds o e a pe iod o wo yea s, om
June 2021 o June 2023.
S udy Popula ion: A o al o 486 newly diagnosed
b eas cance pa ien s we e included in he s udy.
Pa ien s we e ca ego ized in o wo g oups:
• Me as a ic b eas cance (MBC) pa ien s: n =
90
• Non-me as a ic b eas cance (NMBC)
pa ien s: n = 396
Inclusion c i e ia we e
• His ologically con i med diagnosis o p ima y
b eas cance .
• Pa ien s who ecei ed hei ini ial diagnosis and
ea men a he u al cance cen e du ing he
s udy pe iod.
• A ailabili y o comple e clinical, pa hological,
and ollow-up da a.
Exclusion c i e ia included
• Recu en b eas cance cases.
• Incomple e eco ds o loss o ollow-up
immedia ely a e diagnosis.
Da a Collec ion: Da a we e ob ained
e ospec i ely om pa ien case iles,
his opa hology epo s, and hospi al da abases. The
ollowing a iables we e eco ded:
• Demog aphic de ails: Age, esidence,
menopausal s a us.
• Clinico-pa hological pa ame e s: Tumo size
(T-s age), lymph node s a us (N-s age),
me as asis (M-s age), his ological ype,
his ological g ade (I, II, III), ho monal ecep o
s a us (ER, PR), HER2 s a us, Ki-67 index.
• T ea men de ails: Type o su ge y,
chemo he apy, adio he apy, a ge ed he apy,
and ho monal he apy.
• Su i al ou comes: Disease-F ee Su i al
(DFS) and O e all Su i al (OS).
• Body Mass Index (BMI): Classi ied as <18.5
(unde weigh ), 18.5–24.9 (no mal), 25–29.9
(o e weigh ), and ≥30 kg/m² (obese).
De ini ions
• His opa hological g ade was assigned based
on he No ingham g ading sys em.
• Disease-F ee Su i al (DFS) was de ined as
he ime om p ima y ea men comple ion o
he da e o ecu ence o las ollow-up wi hou
ecu ence.
• O e all Su i al (OS) was de ined as he ime
om he da e o diagnosis o he da e o dea h
o las ollow-up.
S a is ical Analysis: All s a is ical analyses we e
pe o med using SPSS e sion 21.1. Desc ip i e
s a is ics we e used o summa ize demog aphic and
clinico-pa hological cha ac e is ics. Su i al
analysis was conduc ed using he Kaplan-Meie
me hod, and di e ences be ween g oups we e
e alua ed using he log- ank es . Associa ions
be ween his ological g ade and clinicopa hological
ea u es we e analyzed using he Chi-squa e o
Fishe ’s exac es . A p- alue o <0.05 was
conside ed s a is ically signi ican .
E hical Conside a ions: The s udy p o ocol was
app o ed by he Ins i u ional E hics Commi ee o
he cance cen e. As i was a e ospec i e s udy, he
need o in o med consen was wai ed. Pa ien
con iden iali y was main ained h oughou he s udy.
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Sa ka e al. In e na ional Jou nal o Cu en Pha maceu ical Re iew and Resea ch
1103
Resul s
Table 1: Demog aphic Cha ac e is ics o B eas Cance Pa ien s (n = 486)
Va iable
Ca ego y
F equency (n)
Pe cen age (%)
Age G oup (yea s)
<40
74
15.20%
40–49
148
30.50%
50–59
162
33.30%
≥60
102
21.00%
Menopausal S a us
P emenopausal
208
42.80%
Pos menopausal
278
57.20%
Residence
Ru al
396
81.50%
U ban
90
18.50%
Table 2: Dis ibu ion o Pa ien s by Me as a ic S a us
G oup
Numbe o Pa ien s (n)
Pe cen age (%)
Me as a ic B eas Cance (MBC)
90
18.50%
Non-Me as a ic B eas Cance (NMBC)
396
81.50%
To al
486
100%
Table 3: His opa hological G ades o Tumo s (n = 486)
G ade
Numbe o Pa ien s (n)
Pe cen age (%)
G ade I (Well di e en ia ed)
102
21.00%
G ade II (Mode a ely di e en ia ed)
222
45.70%
G ade III (Poo ly di e en ia ed)
162
33.30%
To al
486
100%
Table 4: Clinico-Pa hological Fea u es by His ological G ade
Va iable
G ade I (n=102)
G ade II (n=222)
G ade III (n=162)
p- alue
Tumo Size >2 cm
36 (35.3%)
128 (57.6%)
122 (75.3%)
<0.001
Lymph Node Posi i e
28 (27.5%)
104 (46.8%)
118 (72.8%)
<0.001
ER Posi i e
88 (86.3%)
166 (74.7%)
96 (59.3%)
<0.001
PR Posi i e
76 (74.5%)
154 (69.4%)
78 (48.1%)
<0.001
HER2 Posi i e
14 (13.7%)
58 (26.1%)
66 (40.7%)
<0.001
T iple Nega i e
6 (5.9%)
28 (12.6%)
54 (33.3%)
<0.001
Table 5: T ea men Modali ies Recei ed by Pa ien s (n = 486)
T ea men Type
Numbe o Pa ien s (n)
Pe cen age (%)
Su ge y
398
81.90%
Chemo he apy
462
95.10%
Radio he apy
376
77.40%
Ho monal The apy
298
61.30%
Ta ge ed The apy T as uzumab)
96
19.80%
Table 6: Su i al Analysis by His ological G ade
G ade
Mean DFS (mon hs)
Mean OS (mon hs)
3-Yea DFS (%)
3-Yea OS (%)
G ade I
32.8 ± 4.2
34.5 ± 3.8
89.20%
93.10%
G ade II
30.4 ± 5.6
32.6 ± 5.2
79.60%
86.40%
G ade III
24.1 ± 7.3
26.8 ± 6.7
58.10%
71.60%
p- alue
<0.001
<0.001
<0.001
<0.001
!
!
!
!
!
!
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Sa ka e al. In e na ional Jou nal o Cu en Pha maceu ical Re iew and Resea ch
1104
Table 7: Rela ionship be ween BMI, His ological G ade, and Su i al Ou comes (n = 486)
BMI Ca ego y
(kg/m²)
G ade
I<b >(
n=102)
G ade
II<b >(n=2
22)
G ade
III<b >(n=1
62)
p-
alue
Mean
DFS
(mon h
s)
Mean
OS
(mon h
s)
3-
Yea
DFS
(%)
3-
Yea
OS
(%)
<18.5
(Unde weigh )
8
(7.8%)
10 (4.5%)
6 (3.7%)
0.21
30.6 ±
5.3
32.4 ±
4.9
82.60
%
85.40
%
18.5–24.9
(No mal)
52
(51.0%)
98 (44.1%)
48 (29.6%)
0.002
31.8 ±
4.6
33.7 ±
4.1
86.90
%
90.10
%
25.0–29.9
(O e weigh )
30
(29.4%)
76 (34.2%)
58 (35.8%)
28.4 ±
6.1
30.3 ±
5.8
73.30
%
80.20
%
≥30.0 (Obese)
12
(11.8%)
38 (17.1%)
50 (30.9%)
<0.00
1
23.9 ±
6.9
26.1 ±
6.3
59.10
%
70.60
%
Table 8: Kaplan-Meie Su i al Analysis Summa y
Va iable
Log-Rank p- alue
His ological G ade
<0.001
Ho mone Recep o S a us
<0.01
HER2 S a us
<0.05
Me as a ic S a us
<0.001
Figu e 1: Su i al Analysis by His ological G ade
Figu e 2: Rela ionship be ween BMI, His ological G ade, and Su i al Ou comes (n = 486)
In ou s udy popula ion, he majo i y o pa icipan s
we e be ween 50 and 59 yea s o age, accoun ing o
33.3% (n = 162), ollowed by hose aged 40–49
yea s a 30.5% (n = 148). Pa icipan s unde 40 yea s
cons i u ed 15.2% (n = 74), while hose aged 60
yea s and abo e made up 21.0% (n = 102).
Rega ding menopausal s a us, 57.2% (n = 278) o
he pa icipan s we e pos menopausal, whe eas
42.8% (n = 208) we e p emenopausal. The majo i y
o he s udy popula ion esided in u al a eas,
ep esen ing 81.5% (n = 396), while 18.5% (n = 90)
li ed in u ban a eas.
Among he s udy pa icipan s, 396 pa ien s (81.5%)
we e diagnosed wi h non-me as a ic b eas cance
(NMBC), while 90 pa ien s (18.5%) had me as a ic
b eas cance (MBC), making up he o al s udy
popula ion o 486 pa icipan s.
In he s udy popula ion, he majo i y o pa ien s had
mode a ely di e en ia ed umo s (G ade II),
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Sa ka e al. In e na ional Jou nal o Cu en Pha maceu ical Re iew and Resea ch
1105
accoun ing o 45.7% (n = 222). Well-di e en ia ed
umo s (G ade I) we e obse ed in 21.0% o pa ien s
(n = 102), while poo ly di e en ia ed umo s (G ade
III) we e p esen in 33.3% o pa ien s (n = 162). In
he s udy, signi ican di e ences we e obse ed
ac oss he umo g ades in a ious clinical
cha ac e is ics. The pe cen age o pa ien s wi h
umo s la ge han 2 cm inc eased om 35.3% in
G ade I o 57.6% in G ade II, and 75.3% in G ade
III (p < 0.001). Lymph node posi i i y was also
highe in G ade III (72.8%) compa ed o G ade II
(46.8%) and G ade I (27.5%), wi h a signi ican
di e ence (p < 0.001). The p opo ion o es ogen
ecep o (ER)-posi i e pa ien s dec eased om
86.3% in G ade I o 74.7% in G ade II, and 59.3%
in G ade III (p < 0.001). Simila ends we e seen
wi h p oges e one ecep o (PR)-posi i i y, wi h
74.5% in G ade I, 69.4% in G ade II, and 48.1% in
G ade III (p < 0.001). HER2 posi i i y was no ably
highe in G ade III (40.7%) compa ed o G ade II
(26.1%) and G ade I (13.7%) (p < 0.001). The
p opo ion o iple-nega i e b eas cance pa ien s
signi ican ly inc eased om 5.9% in G ade I o
12.6% in G ade II and 33.3% in G ade III (p <
0.001).
In he s udy, he mos common ea men modali y
was chemo he apy, adminis e ed o 95.1% (n = 462)
o pa ien s. Su ge y was pe o med in 81.9% (n =
398) o pa ien s, while adio he apy was gi en o
77.4% (n = 376) o pa icipan s. Ho monal he apy
was used in 61.3% (n = 298) o pa ien s. Ta ge ed
he apy, speci ically as uzumab, was adminis e ed
o 19.8% (n = 96) o he pa ien s.
In e ms o su i al ou comes, signi ican
di e ences we e obse ed ac oss umo g ades. The
mean disease- ee su i al (DFS) was highes o
G ade I a 32.8 ± 4.2 mon hs, ollowed by G ade II
a 30.4 ± 5.6 mon hs, and G ade III a 24.1 ± 7.3
mon hs (p < 0.001). Simila ly, he mean o e all
su i al (OS) was signi ican ly be e in G ade I
(34.5 ± 3.8 mon hs), compa ed o G ade II (32.6 ±
5.2 mon hs) and G ade III (26.8 ± 6.7 mon hs) (p <
0.001). The 3-yea DFS was 89.2% o G ade I,
79.6% o G ade II, and 58.1% o G ade III (p <
0.001), while he 3-yea OS was 93.1% o G ade I,
86.4% o G ade II, and 71.6% o G ade III (p <
0.001).
In ou s udy, a signi ican associa ion was ound
be ween body mass index (BMI) ca ego y and bo h
disease- ee su i al (DFS) and o e all su i al
(OS) ac oss umo g ades. Fo pa ien s wi h a BMI
in he no mal ange (18.5–24.9 kg/m²), G ade I
pa ien s had he highes mean DFS (31.8 ± 4.6
mon hs) and OS (33.7 ± 4.1 mon hs), wi h 3-yea
DFS a 86.9% and 3-yea OS a 90.1%. In
compa ison, G ade III pa ien s in he same BMI
ca ego y had a lowe mean DFS (28.4 ± 6.1 mon hs)
and OS (30.3 ± 5.8 mon hs), wi h 3-yea DFS a
73.3% and 3-yea OS a 80.2%. BMI ca ego ies
unde 18.5 (unde weigh ) and 25.0–29.9
(o e weigh ) showed p og essi ely wo se
ou comes, wi h 3-yea DFS and OS dec easing as
BMI inc eased. Pa icula ly in he obese ca ego y
(BMI ≥30.0 kg/m²), G ade III pa ien s expe ienced
he lowes mean DFS (23.9 ± 6.9 mon hs) and OS
(26.1 ± 6.3 mon hs), wi h 3-yea DFS a 59.1% and
3-yea OS a 70.6% (p < 0.001).
The su i al analysis in ou s udy e ealed
signi ican di e ences in su i al ou comes based
on se e al a iables. The log- ank es showed ha
his ological g ade (p < 0.001), ho mone ecep o
s a us (p < 0.01), HER2 s a us (p < 0.05), and
me as a ic s a us (p < 0.001).
Discussion
In his e ospec i e s udy in ol ing 486 newly
diagnosed b eas cance pa ien s a a u al cance
cen e in India, we examined he clinico-
pa hological cha ac e is ics and su i al ou comes
in ela ion o his ological g ade and BMI. Ou
indings a i m he p ognos ic ele ance o umo
g ade and unde sco e BMI as a po en ial modi iable
ac o in luencing b eas cance agg essi eness and
p ognosis. The dis ibu ion o his ological g ades in
ou coho —G ade I (21.0%), G ade II (45.7%), and
G ade III (33.3%)—is consis en wi h p e ious
Indian s udies, which also epo a p edominance o
G ade II umo s [11,14]. Highe -g ade umo s we e
signi ican ly associa ed wi h ad e se ea u es,
including la ge umo size, inc eased lymph node
posi i i y, HER2 posi i i y, and a iple-nega i e
pheno ype. These obse a ions align wi h ea lie
indings ha poo ly di e en ia ed umo s exhibi
highe p oli e a i e ac i i y and in asi e po en ial
[5,6,7]. Es ogen ecep o (ER) and p oges e one
ecep o (PR) posi i i y showed a ma ked decline
wi h inc easing g ade—ER posi i i y d opped om
86.3% in G ade I o 59.3% in G ade III. Simila
ends ha e been epo ed in global s udies and
suppo he iew ha lowe -g ade umo s end o
ha e mo e a o able ho mone ecep o p o iles,
making hem mo e amenable o endoc ine he apy
[17,18].T iple-nega i e b eas cance (TNBC), a
clinically agg essi e sub ype lacking ER, PR, and
HER2 exp ession, was signi ican ly mo e common
in G ade III umo s (33.3%) compa ed o only 5.9%
in G ade I. TNBC is widely ecognized o i s poo
p ognosis and limi ed ea men op ions, pa icula ly
in u al o esou ce-limi ed se ings [15,16]. Su i al
analysis e ealed a s ong in e se ela ionship
be ween his ological g ade and ou comes. G ade I
umo s demons a ed he bes 3-yea disease- ee
su i al (DFS: 89.2%) and o e all su i al (OS:
93.1%), while G ade III umo s had signi ican ly
lowe DFS (58.1%) and OS (71.6%) (p<0.001).
These esul s a e in acco dance wi h mul iple la ge-
scale s udies highligh ing his ological g ade as a
obus p ognos ic ma ke [4,6,9]. A no el aspec o
ou s udy is he e alua ion o BMI in ela ion o
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Sa ka e al. In e na ional Jou nal o Cu en Pha maceu ical Re iew and Resea ch
1106
umo g ade and su i al. Obesi y (BMI ≥30 kg/m²)
was signi ican ly associa ed wi h highe umo g ade
and poo e su i al ou comes—G ade III umo s
accoun ed o 30.9% o obese pa ien s, wi h
co esponding declines in DFS (59.1%) and OS
(70.6%). This suppo s exis ing li e a u e sugges ing
ha obesi y p omo es umo p og ession h ough
ch onic in lamma ion, al e ed adipokine p o iles,
insulin esis ance, and inc eased es ogen syn hesis
om adipose issue [12,13,19]. Fu he mo e,
unde weigh and o e weigh pa ien s also showed
subop imal ou comes compa ed o hose wi h
no mal BMI, indica ing a U-shaped ela ionship
be ween BMI and p ognosis. This inding sugges s
he impo ance o main aining a heal hy BMI o
po en ially imp o e b eas cance ou comes, a
conside a ion pa icula ly ele an in u al
popula ions whe e die a y habi s and access o ca e
may in luence body weigh . T ea men modali y
analysis e ealed ha pa ien s wi h G ade I umo s
we e mo e likely o ecei e ho monal he apy, while
hose wi h highe -g ade umo s we e ea ed mo e
agg essi ely wi h chemo he apy.
T as uzumab use was limi ed (19.8%), e lec ing
bo h HER2-posi i i y a es and likely es ic ed
access o a ge ed he apies in u al se ings. These
ea men dispa i ies could also con ibu e o
di e ences in su i al be ween g ades. Impo an ly,
his s udy highligh s he challenges in u al cance
managemen . La e p esen a ion, lack o awa eness,
and limi ed access o pa hology se ices can delay
diagnosis and g ading, he eby impac ing ea men
decisions and p ognosis [10,11].
In eg a ing umo g ading wi h BMI assessmen in
ou ine e alua ion could enhance isk s a i ica ion
and aid in ailo ing ea men plans e en in esou ce-
cons ained se ings.
Conclusion
His ological g ade is a key p ognos ic ac o in
b eas cance , s ongly associa ed wi h umo
agg essi eness and su i al ou comes. Highe
g ades co ela e wi h la ge umo s, lymph node
in ol emen , iple-nega i e pheno ype, and poo e
p ognosis.
Addi ionally, ele a ed BMI, pa icula ly obesi y, is
linked o highe -g ade umo s and educed su i al.
In u al se ings, ea ly his ological g ading and BMI
assessmen can guide e ec i e, pe sonalized
ea men . In eg a ing hese low-cos ma ke s in o
ou ine p ac ice may imp o e ou comes and educe
dispa i ies in b eas cance ca e.
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