Differences in biological features of breast cancer between Caucasian (Italian) and African (Tanzanian) populations

Abstract

Information on hormone receptor and human epidermal growth factor receptor-2 (HER2) expression in breast cancer is acknowledged as mandatory for prognostic stratification and treatment planning. Data on the biological features of African breast cancers are poor. We decided to compare histopathological and biomolecular characteristics (estrogen and progesterone receptor—ER, PgR, and HER2) of Tanzanian and Italian breast cancers. Differences in proliferating index and androgen receptor (AR) expression in triple-negative patients from the two case series were also assessed. Of the 103 consecutive patients seen at the Bugando Medical Center (Mwanza, Tanzania) from 2003 to 2010, who underwent biopsy or surgical resection of primary breast cancer, 69 patients had tissue samples that were evaluable for estrogen receptor (ER), progesterone receptor (PgR), and HER2. Histopathological assessment and biomolecular determinations were performed at the Cancer Institute of Romagna (IRST IRCCS, Meldola, Italy). Caucasian breast cancers were randomly extracted from an electronic database and matched (1:2 ratio) for year of diagnosis and age at diagnosis. Median age of both populations was 51 years (range 27–84). With respect to Caucasian tumors, Tanzanian breast cancers at diagnosis more frequently showed high histological grade (mainly grade 3) (P = 0.03), advanced clinical stage (III or IV) (P\0.001), ER negativity (52.2 %, P\0.001) and high proliferation (P = 0.0002). Triple-negative tumors were over-represented in Tanzanian women. AR was positive in 38.5 and 38 %of triple-negative Tanzanian and Italian breast cancers, respectively. Our results show that histopathological and biomolecular characteristics in Tanzanian and Italian breast cancers differ substantially. The high frequency of poorly differentiated, ER-negative, highly proliferating tumors, together with advanced stage at presentation, could be considered as the main prognostic factors linked to the high mortality rates for breast cancer in the African population.

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“…The same trend has been observed in Native Africans. At the same time, as reported in our previous paper, [27] Tanzanian and Italian BCs present different histopathological and biomolecular characteristics: African patients have a higher frequency of negative prognostic markers, such as poor differentiation grade, ER-negative status, high proliferation index or advanced stage at diagnosis [28]. …”

Comparative Study on the Clinicopathological Profiles of Breast Cancer Among Iraqi and British Patients

“…A former survey conducted to identify potential molecular differences between breast cancers in Europe and the Middle East demonstrated that the incidence of low-grade disease was 14 times lower in Saudi than Swiss women suggesting differences in genetic susceptibility [25]. Further research from developing countries showed that the African Tanzanian women had poorly differentiated breast cancers that expressed higher ER and/or PR negative contents and presented at significantly late stages compared to the Caucasian Italian women [35]. Identical findings were presented in a descriptive survey that analyzed the pathological behavior of breast cancer among Ghanaian Sub-Saharan African women versus the Norwegian coordinate [36].…”

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“…In Sub-Saharan Africa, the incidence of breast cancer ranged from 15 to 53 per 100,000 women, which are lower than those in industrialized countries [2]. However, the cancer burden reported for sub-Saharan Africa may be underestimated due to the lack or insufficient awareness, a lack of appropriate diagnosis, poor access to care, limitations in the technical workforce and infrastructure, and low quality of cancer data systems compared to those in high resource countries [3] [4]. In Guinea, the incidence of breast cancer is estimated at 14.5 new cases per 100,000 [5] and breast cancer accounts for over 26% of all cancers at our surgical oncology unit [6].…”