Report of clinico-pathological features of breast cancer in HIV-infected and uninfected women in Botswana

Abstract

BackgroundTo characterize the clinico-pathological features including estrogen receptor (ER), progesterone receptor (PR) and Her-2/neu (HER2) expression in breast cancers in Botswana, and to compare them by HIV status.MethodsThis was a retrospective study using data from the National Health Laboratory and Diagnofirm Medical Laboratory in Gaborone from January 1, 2011 to December 31, 2015. Clinico-pathological details of patients were abstracted from electronic medical records.ResultsA total of 384 unique breast cancer reports met our inclusion criteria. Of the patients with known HIV status, 42.7% (50/117) were HIV-infected. Median age at the time of breast cancer diagnosis was 54 years (IQR 44–66 years). HIV-infected individuals were more likely to be diagnosed before age 50 years compared to HIV-uninfected individuals (68.2% vs 23.8%, p < 0.001). The majority of patients (68.6%, 35/51) presented with stage III at diagnosis. Stage IV disease was not presented because of the lack of data in pathology records surveyed, and additionally these patients may not present to clinic if the disease is advanced. Overall, 68.9% (151/219) of tumors were ER+ or PR+ and 16.0% (35/219) were HER2+. ER+ or PR+ or both, and HER2- was the most prevalent profile (62.6%, 132/211), followed by triple negative (ER−/PR−/HER2-, 21.3%, 45/211), ER+ or PR+ or both, and HER2+, (9.0%, 19/211) and ER−/PR−/HER2+ (7.1%, 15/211). There was no significant difference in receptor status noted between HIV-infected and HIV-uninfected individuals.ConclusionsMajority of breast cancer patients in Botswana present with advanced disease (stage III) at diagnosis and hormone receptor positive disease. HIV-infected breast cancer patients tended to present at a younger age compared to HIV-uninfected patients. HIV status does not appear to be associated with the distribution of receptor status in breast cancers in Botswana.

Impact of HIV infection on baseline characteristics and survival of women with breast cancer

“…The systematic search of literature provided 10,174 unique citations, of which 62 were reviewed as full text (Figure 1). Among them, 20 publications reporting on 18 studies (including 3,174 WLWH [0.13%] and 2,394,598 HIV-negative women [99.87%]) were included: 15 assessed the likelihood of stage III/IV [6,7,[9][10][11]14,17,[24][25][26][27][28][29][30][31], 10 described each stage at diagnosis [6,7,9,14,17,24,25,27,29,31], nine reported on classic subtypes and ER status [7,9,14,17,25,26,29,31,32], four described surrogate subtypes [17,26,29,31] and seven assessed overall survival [14][15][16][17]27,33,34] -Table 1.…”

Relative Dose Intensity and Pathologic Response Rates in Patients With Breast Cancer and With and Without HIV Who Received Neoadjuvant Chemotherapy

“…8 Additionally, 25%-30% of patients with breast cancer are WLWH. 9 Recent data from the region suggest worse survival in WLWH with breast cancer compared with patients who are HIV-negative, 5 which represents a huge public health burden. is a strong predictor of event-free survival (EFS) within specific molecular subtypes.…”

Provider Barriers and Facilitators of Breast Cancer Guideline-Concordant Therapy Delivery in Botswana: A Consolidated Framework for Implementation Research Analysis

“…18 Despite these efforts, breast cancer still remains the one of the five leading causes of cancer mortality in the country, with an age standardized mortality rate of 7 per 100,000. [19][20][21] As part of its breast cancer response, the Botswana Ministry of Health and Wellness (MoHW), together with its partners, developed national guidelines for breast cancer management, which were introduced at the Botswana National Cancer Symposium in 2016 but, for unknown reasons, not disseminated. There have been no studies evaluating the use of any breast cancer guidelines in clinical practice by oncology providers in the public healthcare sector in Botswana.…”

“…Botswana is an upper–middle‐income country in SSA, and the government currently provides free access to all cancer care including essential cytotoxic chemotherapy and targeted medicines [ 17 ], as well as radiation therapy, to its citizens [ 18 ]. Despite these efforts, breast cancer still remains the one of the five leading causes of cancer mortality in the country, with an age‐standardized mortality rate of 7 per 100,000 [ 19 , 20 , 21 ]. As part of its breast cancer response, the Botswana Ministry of Health and Wellness (MoHW), together with its partners, developed national guidelines for breast cancer management, which were introduced at the Botswana National Cancer Symposium in 2016 but, for unknown reasons, not disseminated.…”