Is breast cancer from Sub Saharan Africa truly receptor poor? Prevalence of ER/PR/HER2 in breast cancer from Kenya

Sayed, Shahin; Moloo, Zahir; Wasike, Ronald; Bird, Peter; Oigara, Raymond; Govender, Dhirendra; Kibera, Joshua; Carrara, Henri; Saleh, Mansoor N.

doi:10.1016/j.breast.2014.06.006

Cited by 59 publications

(68 citation statements)

References 13 publications

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“…Nearly half of cases had high-grade tumours and over 80% of those with available lymph node information had lymph node involvement. One potential explanation for this may be that women with more aggressive tumours seek care and receive diagnostic services compared to women with slower progressing tumours 4 . A majority of cases occurred in women under 50 years of age, and the mean age was 48.6 years.…”

Section: Discussionmentioning

confidence: 99%

“…In particular, the absence of HR status testing in most African settings is a major deficiency in care that requires correction, not only in Malawi but throughout the region. HR positivity varies widely across Africa, 4,12,13 and routine testing would ensure that women with HR-negative cancers are spared ineffective hormonal therapy. It would also identify many women who would benefit from tamoxifen, which is relatively inexpensive, well-tolerated, and available in Malawi.…”

Section: Discussionmentioning

confidence: 99%

“…Some studies in African settings have shown high frequencies of aggressive tumour types with poorly differentiated tumours that are often hormone receptor (HR) negative. However, HR status assessment is not routinely done in many countries including Malawi [4][5][6] . This is partly due to an extreme scarcity of diagnostic pathology services in Africa .…”

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confidence: 99%

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Pathologically confirmed breast cancer in Malawi: a descriptive study: Clinical profile of breast cancer

Kohler¹,

Moses

Krysiak³

et al. 2015

Mal. Med. J

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BackgroundBreast cancer is the most common female cancer in Africa, yet no published studies have investigated breast cancer in Malawi. Understanding the clinical profile of breast cancer is important to develop early diagnosis efforts. AimTo describe clinical and pathological characteristics of breast specimens from a pathology laboratory at a national teaching hospital. MethodsSecondary analysis of pathology reports from July 2011 to September 2013. ResultsAmong 85 breast cancer cases, 55% were < 50 years. Median tumor size was 4 cm and 49% were grade 3. Median symptom duration was eight months. ConclusionsMalawian women with breast cancer commonly have long symptom durations prior to diagnosis, young age, and poorly differentiated tumors. Improved clinical and pathological characterization, including hormone receptor status, are urgently needed to better understand this disease in Malawi.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Pathologically confirmed breast cancer in Malawi: a descriptive study: Clinical profile of breast cancer

Kohler¹,

Moses

Krysiak³

et al. 2015

Mal. Med. J

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“…It is also important to point out that although most of the studies have attributed a high incidence of TNBC in African women [van Bogaert et al, 2013;Yarney et al, 2008;Ly et al, 2012;McCormack et al, 2013;Galukande et al, 2014], some have reported that hormone receptor-negative cases can be overestimated, due, as mentioned above, to technical difficulties encountered by pathologists in low-income countries in tissue handling and hormone receptors IHC evaluation and scoring [Anderson et al, 2006;AkaroloAntony et al, 2010]. Therefore, the accurate percentage of cases in Sub-Saharan Africa that are hormone receptor negative remains unclear, with highly variable data ranging from 30-75% [Huo et al, 2009;Sayed et al, 2014]. This wide variability of both hormone receptors and ERBB2 status has a direct impact on patient treatment in South Africa where the selection of patients to immune and/or endocrine therapy could be inappropriately based [Akarolo-Antony et al, 2010;Galukande et al, 2014].…”

Section: Discussionmentioning

confidence: 99%

Copy Number Analysis of the DLX4 and ERBB2 Genes in South African Breast Cancer Patients

Langa

Oliveira

Pereira

et al. 2015

Cytogenet Genome Res

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Breast cancer is one of the main causes of cancer death among South African women. Although several risk factors can be attributed to the observed high mortality rate, the biology of the tumors is not extensively investigated. Copy number gain of the DLX4 homeobox gene has been observed in breast cancer in association with poor prognosis and specific racial groups. Therefore, we aimed to assess the copy number and prognostic role of DLX4 in breast cancer from South African patients. Due to the co-location of ERBB2 and DLX4 in the 17q21 region, its copy number was also evaluated. Our results in the analysis of 66 cases demonstrated copy number gains of DLX4 and ERBB2 in 24.1 and 29.7% of the cases, respectively. Linear regression analysis showed no dependency between the copy number alterations in these genes. Although not significant, patients with DLX4 and ERBB2 gains presented a higher frequency of advanced-grade tumors. In addition, copy number alterations of these genes were not significantly differently observed in the 3 main racial groups of the Western Cape population: Colored, White, and Black. These findings indicate that gains of DLX4 and ERBB2 occur in South African breast cancer patients irrespectively of their race and factors known to influence prognosis.

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“…Tumor size, tumor grade, presence of lympho-vascular invasion, lymph node metastases and extra nodal extension were documented. ER/PR/HER2 status was analyzed on the Dako Automated platform as previously reported,[10] and tumors were assigned into 3 major breast cancer molecular subtypes based on immunohistochemistry: ER and/or PR positive and HER2 positive or negative (Luminal A/B), ER/PR negative and HER2 positive (HER2 enriched), and ER/PR and HER2 negative (Triple Negative).…”

Section: Methodsmentioning

confidence: 99%

Ethnicity and breast cancer characteristics in Kenya

Sayed

Moloo

Wasike

et al. 2017

Breast Cancer Res Treat

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Purpose There are no published data from specific regions of sub-Saharan Africa describing the clinical and pathological characteristics and molecular subtypes of invasive breast cancer by ethnic group. The purpose of this study was to investigate these characteristics among the three major ethno-cultural groupings in Kenya. Methods The study included women with pathologically-confirmed breast cancer seen between March 2012 and May 2015 at 11 hospitals throughout Kenya. Socio-demographic, clinical, and reproductive data were collected by questionnaire, and pathology review and immunohistochemistry were performed centrally. Results The 846 cases included 661 Bantus (78.1%), 143 Nilotes (16.9%), 19 Cushites (2.3%), and 23 patients of mixed ethnicity (2.7%). In analyses comparing the two major ethnic groups, Bantus were more educated, more overweight, had an older age at first birth and had a younger age at menopause than Nilotes (p<0.05 for all comparisons). In analyses restricted to definitive surgery specimens, there were no statistically significant differences in tumour characteristics or molecular subtypes, although the Nilote tumours tended to be larger (OR for ≥ 5 cm vs. < 2 cm: 3.86, 95%CI: 0.77, 19.30) and were somewhat more likely to be HER2-enriched (OR for HER2-enriched vs. Luminal A/B: 1.41, 95%CI: 0.79, 2.49). Conclusion This case series showed no significant differences in breast cancer tumour characteristics or molecular subtypes, but significant differences in socio-demographic characteristics and reproductive factors, among the three major ethnic groups in Kenya. We suggest further evaluation of ethnic differences in breast cancer throughout the genetically and culturally diverse populations of sub-Saharan Africa.

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Is breast cancer from Sub Saharan Africa truly receptor poor? Prevalence of ER/PR/HER2 in breast cancer from Kenya

Abstract: We present a definitive prospective analysis of ER/PR/HER2 from a single center and demonstrate that prevalence of receptor status from SSA is comparable with that in the West.

Cited by 59 publications

References 13 publications

Pathologically confirmed breast cancer in Malawi: a descriptive study: Clinical profile of breast cancer

Pathologically confirmed breast cancer in Malawi: a descriptive study: Clinical profile of breast cancer

Copy Number Analysis of the <b><i>DLX4</i></b> and <b><i>ERBB2 </i></b>Genes in South African Breast Cancer Patients

Ethnicity and breast cancer characteristics in Kenya

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