Breast cancer in women under 30 years of age

Association between epidemiological and clinico-pathological features of breast cancer with prognosis, family history, Ki-67 proliferation index and survival in Tunisian breast cancer patients

Breast cancer has different epidemio-clinical characteristics in Middle East and North-African populations compared to those reported in the Western countries. The aim of this study is to analyze the epidemiological and clinico-pathological features of breast cancer in Tunisia and to determine prognostic factors with special interest to family history, Ki-67 proliferation index and comorbidity. We retrospectively reviewed epidemiological and clinico-pathological data from patients’ medical records, treated in the Medical Oncology Department at Abderrahmane Mami Hospital, in the period 2011–2015. Data has been collected on 602 breast cancer patients and analyzed using SPSS software V.23.0. Our study showed high fractions of young breast cancer patients and cases with dense breasts. The most prevalent comorbidities observed in the studied cohort were cardiovascular diseases and diabetes. Familial breast cancer was found in 23.3% of cases and was associated with younger age at diagnosis (p<0.001) and advanced stage (p = 0.015). Ki-67 index >20% was significantly associated with early age at diagnosis, lymph node involvement (p = 0.002), advanced tumor grade (p<0.001) and high risk of relapse (p = 0.007). Ki-67 cut-off 30% predicted survival in luminal cases. Survival was worse in patients with triple negative breast cancer compared to non-triple negative breast cancer, inflammatory breast cancer compared to non-inflammatory breast cancer, moderately to poorly differentiated tumors compared to well-differentiated tumors and with positive lymph nodes compared to pN0 (p<0.05). Our study showed new insights into epidemiological and clinico-pathological characteristics of breast cancer that are not well explored in Tunisian population. Considering our findings along with the implementation of electronic health record system may improve patient health care quality and disease management.

Risk factors for inflammatory and non-inflammatory breast cancer in North Africa

PURPOSE

Studies of the etiology of inflammatory breast cancer (IBC), a rare but aggressive breast cancer, have been hampered by limited risk factor information. We extend previous studies by evaluating a broader range of risk factors.

METHODS

Between 2009 and 2015, we conducted a case-control study of IBC at six centers in Egypt, Tunisia, and Morocco; enrolled were 267 IBC cases and for comparison 274 non-IBC cases and 275 controls, both matched on age and geographic area to the IBC cases. We administered questionnaires and collected anthropometric measurements for all study subjects. We used multiple imputation methods to account for missing values and calculated odds ratios (ORs) and 95% confidence intervals (CIs) using polytomous logistic regression comparing each of the two case groups to the controls, with statistical tests for the difference between the coefficients for the two case groups.

RESULTS

After multivariable adjustment, a livebirth within the previous 2 years (OR 4.6; 95% CI 1.8 to 11.7) and diabetes (OR 1.8; 95% CI 1.1 to 3.0) were associated with increased risk of IBC, but not non-IBC (OR 0.9; 95% CI 0.3 to 2.5 and OR 0.9; 95% CI 0.5 to 1.6 for livebirth and diabetes, respectively). A family history of breast cancer, inflammatory-like breast problems, breast trauma, and low socioeconomic status were associated with increased risk of both tumor types.

CONCLUSIONS

We identified novel risk factors for IBC and non-IBC, some of which preferentially increased risk of IBC compared to non-IBC. Upon confirmation, these findings could help illuminate the etiology and aid in prevention of this aggressive cancer.

[Epidemiological and anatomopathological profile of breast cancer at the Ibn Rochd University Hospital, Casablanca]

Réaliser une revue récente comportant les particularités épidémiologiques, histologiques des patients nouvellement diagnostiqués d’un cancer de sein à Casablanca durant l’année 2018. Nous avons colligé 668 cas pendant l’année 2018, l’âge moyen était 51,6 ans, le sexe féminin était le plus représenté avec 662 cas (99,1%) et les hommes avec 6 cas (0,9%), soit un sexe ratio (H/F) de 0,009. L’âge moyen de la ménopause était 49,8 ans et l’âge moyen de la ménarche était 13,5 ans, 31,7% avait un antécédent de cancer (le sein 14,1%, l’estomac 9% et le foie 7%). Le délai moyen de consultation était 10 mois, la pathologie la plus représentée était la pathologie thyroïdienne. Selon la localisation, le sein gauche était atteint dans 50,2% et le sein droit dans 44,7% et une localisation bilatérale 1,3%, le siège le plus fréquent était le quadrant supérieur externe avec 28,7%, les stades T1 et T2 représentaient 73,6% et les stades T3 et T4 représentaient 26,4%, les tumeurs épithéliales infiltrantes carcinome canalaire infiltrant (CCI) étaient les plus fréquentes (73,2%). La présence des emboles vasculaires et lymphatiques a été notée chez 42,2%, les ganglions axillaires étaient atteints chez 71,1% des patients. Le grade histopronostique de Scarff Bloom et Richardson (SBR) avait révélé une prédominance du grade II dans 55,9% des cas. Le Luminal B continue à constituer le phénotype le plus fréquent (46%) suivi du Triple Negatif (15,3%) et du Luminal A (14,2%) et enfin le HER2 (7,4%). Le pronostic immédiat demeure inquiétant du fait du retard de diagnostic. Il nous paraît urgent de mettre en place une politique sanitaire d’information et d’éducation.

Breast cancer by age at diagnosis in the Gharbiah, Egypt, population-based registry compared to the United States Surveillance, Epidemiology, and End Results Program, 2004-2008

Objective. Although breast cancers (BCs) in young women often display more aggressive features, younger women are generally not screened for early detection. It is important to understand the characteristics of young onset breast cancer to increase awareness in this population. This analysis includes all ages, with emphasis placed on younger onset BC in Egypt as compared to the United States. Methods. BC cases in the Gharbiah cancer registry (GCR), Egypt, were compared to those in the Surveillance, Epidemiology, and End Results (SEER) database. This analysis included 3,819 cases from the GCR and 273,019 from SEER diagnosed 2004–2008. Results. GCR cases were diagnosed at later stages, with <5% diagnosed at Stage I and 12% diagnosed at Stage IV. 48% of all SEER cases were diagnosed at Stage I, dropping to 30% among those ≤40. Significant differences in age, tumor grade, hormone receptor status, histology, and stage exist between GCR and SEER BCs. After adjustment, GCR cases were nearly 45 times more likely to be diagnosed at stage III and 16 times more likely to be diagnosed at stage IV than SEER cases. Conclusions. Future research should examine ways to increase literacy about early detection and prompt therapy in young cases.

Breast cancer characteristics at diagnosis and survival among Arab-American women compared to European- and African-American women

BACKGROUND

Data from Arab world studies suggest that Arab women may experience a more aggressive breast cancer phenotype. To investigate this finding, we focused on one of the largest settlements of Arabs and Iraqi Christians (Chaldeans) in the US, metropolitan Detroit- a SEER reporting site since 1973.

MATERIALS AND METHODS

We identified a cohort of primary breast cancer cases diagnosed 1973-2003. Using a validated name algorithm, women were identified as being of Arab/Chaldean descent if they had an Arab last or maiden name. We compared characteristics at diagnosis (age, grade, histology, SEER stage, and marker status) and overall survival between Arab-, European-, and African-Americans.

RESULTS

The cohort included 1,652 (2%) women of Arab descent, 13,855 (18%) African-American women, and 63,615 (80%) European-American women. There were statistically significant differences between the racial groups for all characteristics at diagnosis. Survival analyses overall and for each SEER stage showed that Arab-American women had the best survival, followed by European-American women. African-American women had the poorest overall survival and were 1.37 (95% confidence interval: 1.23-1.52) times more likely to be diagnosed with an aggressive tumor (adjusting for age, grade, marker status, and year of diagnosis).

CONCLUSION

Overall, Arab-American women have a distribution of breast cancer histology similar to European-American women. In contrast, the stage, age, and hormone receptor status at diagnosis among Arab-Americans was more similar to African-American women. However, Arab-American women have a better overall survival than even European-American women.

Epidemiology of inflammatory breast cancer (IBC)

Inflammatory breast cancer (IBC) is a rare and aggressive form of breast cancer with unknown etiology and generally poor outcome. It is characterized by diffuse edema (peau d'orange) and redness (erythema), although either the disease itself or case definitions have varied over time and place, confounding temporal trends and geographic variations. In this review, we discuss case definitions for IBC and its clinical characteristics; describe its geographic variation, age and racial distribution, incidence and survival patterns, and summarize the very limited information on its epidemiologic risk factors. We also incorporate emerging data from the National Cancer Institute's (NCI) Surveillance, Epidemiology, and End Results (SEER) Program.

The current understanding of the molecular determinants of inflammatory breast cancer metastasis

Inflammatory breast cancer is a highly aggressive and metastatic form of locally advanced breast cancer that carries a significantly worse prognosis than non-inflammatory breast cancers. Unfortunately, the molecular basis of this deadly form of breast cancer has been understudied. Over the past 10 years new studies have begun to reveal a unique molecular profile of IBC shedding light on its unique ability to rapidly invade and metastasize via the dermal lymphatic system of the skin overlying the breast. The goal of this review is to introduce IBC to the reader and provide a brief overview of what is known about the metastatic mechanisms of the disease.

Rho-regulatory proteins in breast cancer cell motility and invasion

The importance of the Rho-GTPases in cancer progression, particularly in the area of metastasis, is becoming increasingly evident. This review will provide an overview of the role of the Rho-regulatory proteins in breast cancer metastatis.

Frequency and genome load of Epstein-Barr virus in 509 breast cancers from different geographical areas

Since the few data exploring a possible association between Epstein-Barr virus (EBV) and breast cancer are conflicting, we investigated this association together with the influences of geographical areas. 509 breast cancers were sampled from areas with varying risks of nasopharynx carcinoma (NPC) such as North Africa (Algeria and Tunisia, high-risk area); southern France (Marseille, intermediate-risk area); and northern Europe (northern France, the Netherlands and Denmark; low-risk areas). Polymerase chain reaction (PCR) of a subregion of EBV BamHIC encoding the EBERs demonstrated that 31.8% of the tumours contained the viral genome. No significant differences were observed among the geographical areas. However, positive samples showed higher loads of the EBV genome in the NPC high- and intermediate-risk areas than in the low-risk areas. EBV type 1 was the dominant strain. In situ hybridization studies using a(35)S-labelled riboprobe for EBER1 and a laser capture microdissection, combined with quantitative PCR, showed that EBV localization was restricted to some tumour epithelial cell clusters. EBV could not be detected in the stroma. Considering the whole population covered, the presence of the EBV genome was not correlated with age, menopausal status, tumour, size, nodal status or histological grade.

Breast masses in African American teenage girls

PURPOSE

The aim of this study was to evaluate the incidence of malignancy in breast lumps excised from African American teenagers.

METHODS

The authors reviewed the pathology records at King's County Hospital Center between January 1982 and December 1992. The pathology reports and charts of all patients who had breast masses excised during this period were reviewed. Data for this study were derived from the group of African American and black Caribbean American teenage patients who underwent breast biopsies and whose pathology reports and medical records were available. The age of patients, size of the lesion, and diagnosis were recorded.

RESULTS

Medical records from 155 African American and black Caribbean American girls between the ages of 13 and 19 years (inclusive) who underwent breast biopsies between January 1982 and December 1992 were reviewed. Fibroadenoma was the most common diagnosis (127 of 155; 82%). This was followed in frequency by fibrocystic mastopathy (18 of 155; 11.6%) and breast abscess (3 of 155; 2%). None of the patients had a malignancy. Review of tumor registry data from the same time period at Kings County Hospital Center and the University Hospital of Brooklyn showed that the youngest African American or black Caribbean American patient diagnosed with breast cancer was 21 years of age.

CONCLUSIONS

The incidence of malignant breast lumps in African American and black Caribbean American teenagers is distinctly low. Conservative treatment in this population is warranted, and diagnosis can be made easily in most cases with either needle aspiration for cytology or core biopsy of any lesions discovered.

Inflammatory symptoms in breast cancer. Correlations with growth rate, clinicopathologic variables, and evolution

Based on two pretreatment evaluations, doubling time (DT) was calculated in 75 cases of invasive breast cancer (BC). The cases studied were more or less equally distributed between three DT groups: fast-growing tumors (DT less than 90 days), intermediate cases (DT between 90 and 180 days), and slow-growing tumors (DT greater than 180 days. A correlation was found to exist between DT and patient age and, to an even greater extent, between DT and pathologic prognostic indicators such as histologic grading and nuclear grade. Inflammatory symptoms were not associated with DT, but were closely related to the size of the tumor and regional lymph node involvement. The date of detection of distant metastases depended heavily on the DT of the BC:BC with shorter DT = earlier metastatic spread. The presence of inflammatory signs was also decisive: within each DT category, inflammatory BC metastases were both more frequent and precocious.

Serum hormone levels in breast cancer patients and controls in Egypt and Great Britain. The Anglo-Egyptian Health Agreement Collaborative Study

The levels of serum prolactin, progesterone, oestradiol and sex hormone binding globulin (SHBG) have been measured in premenopausal and postmenopausal normal women and patients with breast cancer living in Egypt or Britain. In addition, the percentage of non-protein-bound oestradiol (free oestradiol) was determined. The breast cancer patients had attended the Tanta Cancer Institute, Cairo Cancer Institute, Guy's Hospital, London or the Western Infirmary, Glasgow. The respective control women were unaffected volunteers living in Tanta, Cairo, Guernsey or Glasgow. The concentration of serum prolactin, oestradiol and progesterone was similar for cancers and controls within, or between centres. There was no difference between patients and their respective controls in SHBG levels for the four centres. In premenopausal women a comparison of combined patient and control groups showed that women from Tanta had significantly raised SHBG levels compared with similarly combined groups from the other three centres. Egyptian women (cancers plus controls) had a higher percentage free oestradiol (1.61%) than British women (1.42%). In all four centres there was a significant linear correlation between the percentage free oestradiol and SHBG levels for pre- and postmenopausal women. The regression line for British women was significantly lower than that of Egyptian women. Thus, for a given serum SHBG level, Egyptian women have a higher free oestradiol than British women. The results may be associated with the claim that Egyptian women present with a more aggressive form of breast cancer than British women.