[Breast cancer in young patient in Morrocco]

Prevalence and prognosis of molecular phenotypes in breast cancer patients by age: a population-based retrospective cohort study in western Algeria

Introduction

breast cancer is related to age. The young age remains a controversial issue as a prognostic factor and have more aggressive clinical behavior with poor outcome. We aimed for the first time in Algeria to explore on a large cohort of patients the prevalence of the molecular phenotypes and to describe their clinical characteristics and survival.

Methods

medical record of 1140 Algerian patients were analysed and categorized into three age groups: “young” when women were aged below 40 years; “middle-age” when women were aged from 41 to 54 years old and “elder” when women were over 54 years. Baseline categorical variables were analysed using the Chi-square test and survival curves were constructed using Kaplan Meir method.

Results

the distribution of the various prognostic factors did not differ significativelly by age groups except for histological types, hormone receptors status and molecular phenotypes. Most patients were luminal A, indeed, young and intermediate age patients were most likely to be luminal A whereas the aged patients were triple negative with the highest mean DFS. Elsewhere young women are considered as human epidermal growth factor receptor 2 (HER2+) or triple negative molecular subtypes involving more rigorous therapeutic monitoring. The high rate of triple negative breast cancer in aged patients may due to genetic predispositions.

Conclusion

this study sheds light on the histoclinical and molecular characteristics of breast cancer in young patients, which has a good prognosis than their older counterparts. Our results are therefore surprisingly different from what the literature suggests. A further study should understand this uncommon finding.

Male breast cancer: a report of 25 cases

Male breast cancer is a rare disease accounting for less than 1% of all breast cancer diagnoses worldwide to our knowledge. The aim of this retrospective study is to analyse the epidemiologic, clinical, therapeutic and evolutive profiles of this disease and to compare some cancer aspects between male and female in 25 cases collected at Mohamed VI Oncology Center at the University Hospital of Casablanca between 2012 and 2018. Of all breast cancers, men with breast cancer make up a minority. Male compared to female breast cancers occurred later in life with higher stage and more estrogen receptor-positive tumors. The median age was 67.7 years. The average diagnosis delay was 15.7 month. Cancer was discovered through self examination in 76.1% of cases. The mean diameter was 3.5 cm and range from 1-6 cm. According to the tumor-node-metastasis (TNM) classification, tumors were classified as T1-T2 (40%) and T3-T4 (60%). Infiltrating ductal carcinoma was the most frequent (92%) and 1 case of lobular carcinoma. Axillary nodal involvement was present in 82.4% of cases. Hormonal receptors were positive in 83% of cases. 86.6% of our cases present metastasis. Bone was the most representative site. Surgery was usually mastectomy with axillary clearance. It was possible to follow 21 of the patients. The median of follow-up was 12 months. The evolution has been characterized by local recurrence in 6 cases. There was 9 cases of death. Death was usually due to comorbid disease and to the advanced age. The 5 years overall survival rates were 57%.

Worldwide Age at Onset of Female Breast Cancer: A 25-Year Population-Based Cancer Registry Study

A higher frequency of early onset female breast cancers (BC) has been observed in low/middle income countries than in high income countries. We quantified the role of population ageing to this pattern using data from all population-based cancer registries (CRs) worldwide. Patients’ median age at BC onset and that of the general population were extracted for CRs listed in volumes VI (1983–1987 years) through XI (2008–2012 years) of Cancer Incidence in Five Continents. Their association was assessed at cross-sectional level by linear regression model and longitudinally considering 25-year ageing of the population in long-standing CRs listed at the beginning and at the end of the study. During 2008–2012, each one-year increase of population ageing was associated with a nearly ½ year increase of age at BC diagnosis. Population demographics explained forty-two percent of the age variance for BC. In 1983–1987, long-standing CRs with a median age at BC below age 61.8 years showed an increase of age at BC after 25-years. Worldwide, age at BC diagnosis essentially reflected the median age of the population. Changes in BC detection methodology likely lessened this association. Nevertheless, the elevated absolute number of BCs in young populations deserves strategies of BC prevention.

Characteristics and follow-up of metastatic breast cancer in Ethiopia: A cohort study of 573 women

OBJECTIVES

There is little information on characteristics, treatment and outcome of metastatic breast cancer (mBC) patients in low-income countries. This study aims to describe mBC in the setting of Ethiopia.

MATERIALS AND METHODS

A retrospective cohort study was conducted among all female mBC patients from the only oncologic hospital in Addis Ababa 01/2006 to 12/2010. Time between first metastasis and known death or loss to follow-up for more than six months as surrogate for death were used for Cox proportional hazards model.

RESULTS

A total of 573 patients were included; 188 (32.8%) women with de novo mBC (dnmBC) and 385 women with recurrent mBC (rmBC). The average age at time of first metastasis was 43.7 (standard deviation 11.9) years with an average survival probability of twelve months. Negative hormone receptor status, only present in 29% (Hazard ratio HR = 2.28 [95% confidence interval CI 1.56-3.32] p < 0.001), and grade 3 (HR = 1.72 [95% CI 1.15-2.55] p = 0.008) had significant influence on survival. Patients with initial bone metastasis (HR = 0.63 [95% CI 0.48-0.83] p = 0.001) had best chances of survival compared to more common initial visceral metastasis. About 35% of the patients received chemotherapy and 30.5% were on endocrine therapy.

CONCLUSION

The lower survival for mBC in Addis Ababa compared to that from Western countries is presumably due to the later presentation at the hospital and lack of standard therapy. An unexpected high proportion of patients with hormone receptor positive mBC encourage consequent utilization of endocrine therapy to improve the quality of palliative care in this cohort.

Clinicopathologic and prognostic features of breast cancer in young women: a series from North of Morocco

BACKGROUND

Literature data reported a higher frequency of breast cancer in young women (BCYW) in developing countries. BCYW is associated with delayed diagnosis, aggressive biology and poor prognosis. However, our knowledge of biological profile, treatment received and outcome of young patients is still limited in Morocco. We propose to analyze clinicopathologic, therapeutic and prognostic features of BCYW among a series of patients native and/or inhabitant of North of Morocco.

METHODS

We carried out a retro-prospective study of 331 infiltrating breast cancer cases registered between January 2010 and December 2015. Details of tumor pathology, treatment and outcome were collected. Disease-Free Survival (DFS) and Overall Survival (OS) were assessed by Kaplan-Meier analysis.

RESULTS

A total of 82 patients were diagnosed with breast cancer at the age of 40 or younger (24.8%). Median age was 36 years. More than one quarter (26%) of patients had family history of breast or ovarian cancer. Advanced stages accounted for 34.2% of cases. Median tumor diameter was 2.8 cm. Intermediate and high-grade tumors represented 47.6% and 40.2%, respectively. Nodal involvement was present in 58.5% and lymphovascular invasion was found in 47.7% of the patients. About two thirds (66.2%) of tumors were hormone receptor positive, 29.2% over-expressed HER2 receptor and 23% were triple negative. Patients underwent breast conserving surgery in 38.2% of cases, 61.7% were offered adjuvant chemotherapy and 84.6% received hormone therapy. Five-year DFS and OS were respectively 88.9% and 75.6%. Locoregional recurrence occurred in 2.8% of cases and 8.3% of patients developed distant metastases.

CONCLUSION

Our findings are in accordance with previous studies that have shown a higher frequency of breast cancer among Moroccan young women. In line with literature data, clinicopathologic profile seems to be aggressive and prognosis is pejorative in our series.

Female Breast Cancer Incidence and Mortality in Morocco: Comparison with Other Countries

Background: Breast cancer is the most frequently diagnosed malignancy and the leading cause of cancer death among women worldwide. In Morocco, there have been few recent descriptive studies on female breast cancer. The aim of this study was to describe the latest available incidence and mortality rates of breast cancer among Moroccan women and to compare them with rates in other regional and Western countries. Methods: For this descriptive study, Moroccan incidence data were obtained from the most recent reports of the cancer registries of Casablanca and Rabat. Information on breast cancer incidence for different countries were obtained primarily from publicly available cancer registries and Cancer Incidence in Five Continents, Volume X. Mortality data were extracted from the GLOBOCAN 2012 published by the International Agency for Research on Cancer. Results: The age-standardized incidence (World) rate of breast cancer in Moroccan women increased from 35.0 to 39.0 per 100,000 women between 2004 and 2008, showing an annual increase of 2.85 %. The highest incidence rates were registered in the age groups of 45-49, 50-54 and 55-59 years (106.1, 108.2 and 108.5 respectively). Sixty-nine percent of female breast cancer cases were diagnosed at stages II and III. In 2012, the estimated number of women who died of breast cancer in Morocco was 2,878. The crude, age-standardized (World) mortality rates were 17.3 and 18.0 per 100,000, respectively. Conclusion: Although the incidence of female breast cancer in Morocco is lower than in Western countries, evidence shows that the rate is rising. This increase of breast cancer incidence has been observed in parallel with changes in reproductive behavior and adoption of a Western lifestyle. Prevention policies need to be implemented.

Outcome of Breast Cancer in Moroccan Young Women Correlated to Clinic-Pathological Features, Risk Factors and Treatment: A Comparative Study of 716 Cases in a Single Institution

BACKGROUND

Breast cancer in young women is quite uncommon and shows more aggressive characteristics with major disparities between worldwide populations. Prognosis and outcome of breast cancer in young patients are widely studied, but still no consensus is available.

METHODS

We retrospectively included 716 cases of breast cancer women diagnosed in 2009 at the National Institute of Oncology of Rabat. Patients were divided into two groups according to their age: women aged ≤40 years (Group 1) and women aged >40 years (Group 2). Data were recorded from patients' medical files and analyzed using SPSS 13.0 software (IBM).

RESULTS

Young patients represent 24.9% of all patients with breast cancer. The comparison between the two groups displayed significant differences regarding nulliparity (p = 0.001) and progesterone receptor negativity (p = 0.01). Moreover, more progression (Metastases/Relapse) was registered in young women as compared to older women with breast cancer (p = 0.03). The estimated median follow-up period was 31 months. The 5-years Event-Free Survival (EFS) of patients with local disease was 64.6% in young women and 71.5% in older women with breast cancer (p = 0.04). Multivariate analysis in young women showed that nulliparity (HR: 7.2; 95%CI: 1.16-44.54; p = 0.03), T3 tumors (HR: 17.39; 95%CI: 1.74-173.34; p = 0.01) and negative PgR status (HR: 19.85; 95%CI: 1.07-366.54; p = 0.04) can be considered as risk factors for poorer event free survival while hormone therapy was associated with better EFS (HR: 0.11; 95%CI: 0.00-0.75; p = 0.03). In Group 2, multivariate analysis showed that patients with inflammatory breast cancer, N+ status, absence of radiotherapy, absence of chemotherapy, and absence of hormone therapy are at increased risk of recurrence.

CONCLUSIONS

In Morocco, breast cancer is more frequent in young women as compared to western countries. Breast cancer in young women is more aggressive and is diagnosed late, leading to an intensive treatment. Moreover, the main factors associated with breast cancer development in young women would be hormonal and reproductive status. Analysis of other genetic biomarkers is needed to explain the high prevalence of breast cancer in young women to improve breast cancer management in Morocco.

Breast cancer in young women in southern Tunisia: Anatomical study and clinical prognostic factors: About a series of 83 patients

PURPOSE

To define epidemiological, clinical, therapeutic and prognostic factors influencing survival of breast cancer in young women younger than 35 in southern Tunisia.

MATERIAL AND METHODS

This is a retrospective study of 83 patients younger than 35 years and treated within tumors mammary committee of Sfax.

RESULTS

The mean age was 31.7 years. T2 stage, high grade with positive node tumors were frequent. Breast surgery was performed for 73 patients. Chemotherapy was neo-adjuvant, adjuvant and palliative for respectively 10, 62 and 13 patients. Radiotherapy was delivered for 65 patients with curative intent and for 8 metastatic patients. Endocrine therapy was adjuvant in 38 patients and palliative in 6 cases. The overall survival (OS) at 5 years was 66.8%. Pejorative prognostic factors in uni-variate analysis were clinical T stage (T3, T4), and the number of involved lymph nodes.

CONCLUSION

Despite adequate treatment, the prognosis of breast cancer in young women remains worse. Early diagnosis is necessary to promote outcome.

[Synchronous bilateral breast cancer in Morocco: epidemiological and clinical characteristics]

Préciser la fréquence, les facteurs de risque et le pronostic du cancer du sein bilatéral, à partir d'une étude rétrospective de 22 cas de cancer du sein bilatéral synchrone dans un pays du Maghreb. De 2002 à 2010, 625 patientes étaient prises en charge pour cancer du sein au service de Gynécologie-Obstétrique «C» du centre hospitalier universitaire de Casablanca. 22 cas de cancer bilatéral synchrone étaient diagnostiqués. Nos résultats sont comparés avec ceux de la littérature. La fréquence de la bilatéralité du cancer du sein synchrone était de 3,52% (22/625). L'intervalle de temps moyen entre les deux cancers est de 4 mois (0 à 6 mois). Les patientes âgées de moins de 40 ans lors du premier cancer avaient six fois plus de risque de développer un cancer au niveau du sein controlatéral que les femmes âgées de plus de 40 ans. Les patientes atteintes d'une tumeur T3 ou T4 avaient un risque neuf fois plus élevé que les autres. 90,9% (2/22) des cas des premiers cancers sont des adénocarcinomes infiltrants. Les types histologiques du premier et du douzième cancer étaient identiques dans 86,4% (19/22) des cas. Quant au pronostic, il dépend à la fois du stade du premier et du deuxième cancer et le traitement de ce dernier doit obéir aux mêmes règles du traitement du premier cancer. L'incidence du cancer bilatéral synchrone du sein est de 3,52% dans notre série. Le cancer du sein unilatéral constitue un facteur de risque de développement d'un cancer du sein controlatéral. Une surveillance à vie est nécessaire au cours d'un cancer du sein pour détecter un cancer controlatéral.

Breast cancer in Morocco: a literature review

In Morocco, breast cancer is the most prevalent cancer in women and a major public health problem. Several Moroccan studies have focused on studying this disease, but more are needed, especially at the genetic and molecular levels. It is therefore interesting to establish the genetic and molecular profile of Moroccan patients with breast cancer. In this paper, we will highlight some pertinent hypotheses that may enhance breast cancer care in Moroccan patients. This review will give a precise description of breast cancer in Morocco and propose some new markers for detection and prediction of breast cancer prognosis.

Receptor-defined subtypes of breast cancer in indigenous populations in Africa: a systematic review and meta-analysis

BACKGROUND

Breast cancer is the most common female cancer in Africa. Receptor-defined subtypes are a major determinant of treatment options and disease outcomes but there is considerable uncertainty regarding the frequency of poor prognosis estrogen receptor (ER) negative subtypes in Africa. We systematically reviewed publications reporting on the frequency of breast cancer receptor-defined subtypes in indigenous populations in Africa.

METHODS AND FINDINGS

Medline, Embase, and Global Health were searched for studies published between 1st January 1980 and 15th April 2014. Reported proportions of ER positive (ER+), progesterone receptor positive (PR+), and human epidermal growth factor receptor-2 positive (HER2+) disease were extracted and 95% CI calculated. Random effects meta-analyses were used to pool estimates. Fifty-four studies from North Africa (n=12,284 women with breast cancer) and 26 from sub-Saharan Africa (n=4,737) were eligible. There was marked between-study heterogeneity in the ER+ estimates in both regions (I2>90%), with the majority reporting proportions between 0.40 and 0.80 in North Africa and between 0.20 and 0.70 in sub-Saharan Africa. Similarly, large between-study heterogeneity was observed for PR+ and HER2+ estimates (I2>80%, in all instances). Meta-regression analyses showed that the proportion of ER+ disease was 10% (4%-17%) lower for studies based on archived tumor blocks rather than prospectively collected specimens, and 9% (2%-17%) lower for those with ≥ 40% versus those with <40% grade 3 tumors. For prospectively collected samples, the pooled proportions for ER+ and triple negative tumors were 0.59 (0.56-0.62) and 0.21 (0.17-0.25), respectively, regardless of region. Limitations of the study include the lack of standardized procedures across the various studies; the low methodological quality of many studies in terms of the representativeness of their case series and the quality of the procedures for collection, fixation, and receptor testing; and the possibility that women with breast cancer may have contributed to more than one study.

CONCLUSIONS

The published data from the more appropriate prospectively measured specimens are consistent with the majority of breast cancers in Africa being ER+. As no single subtype dominates in the continent availability of receptor testing should be a priority, especially for young women with early stage disease where appropriate receptor-specific treatment modalities offer the greatest potential for reducing years of life lost. Please see later in the article for the Editors' Summary.

[Breast cancer in woman younger than 35 years in Tunisia: retrospective study about 124 cases]

OBJECTIVES

Our aim was to report the epidemiological and clinical characteristics of breast cancer in young women and to evaluate the therapeutic results in the central part of Tunisia.

PATIENTS AND METHODS

We report the results of a retrospective study including 124 patients under 35years old treated for breast cancer between 1995 and 2007 in the Radiotherapy Department of CHU Farhat Hached, Sousse.

RESULTS

The mean age of our patients was 31.3years. T2N0, node positive (N+), high grade (SBRII and III) and endocrine responsive tumors were the most frequent. Fourteen patients had metastatic disease. One hundred and fifteen patients underwent a surgical treatment, which was conservative in 35 cases and radical for the others followed by radiotherapy on 114 patients. Chemotherapy, especially based on the FEC protocol, was administrated to 89% of all patients. Forty-five patients received also hormonotherapy. After a median follow-up of 48.5months, 51 patients remained free of disease. The 5years overall survival was 67.7%, the 5years free disease survival was 58.2%.

DISCUSSION AND CONCLUSION

The 5years overall survival of breast cancer in young women varies between 55 and 75%, it was 67.7% on our study. These results can be improved by early diagnosis, adapted treatment and nowadays with targeted therapies.

Idiopathic granulomatous mastitis: a report of twenty cases

INTRODUCTION

Idiopathic granulomatous mastitis is a benign lesion of the mammary gland characterised by the presence of non-infectious inflammatory breast lesions limited to the lobules.

OBJECTIVE

We report twenty cases of idiopathic granulomatous mastitis (IGM) with a discussion of epidemiology, clinical and diagnostic features, treatment and progress of this pathological entity.

MATERIALS AND METHODS

A retrospective study of twenty cases compiled from a ten-year period, from 952 pathological anatomy examinations carried out to investigate various breast pathologies.

RESULTS

The patients had a mean age of 45.5 years. Clinical examinations revealed a tumefaction measuring between 2.5 and 18 cm in diameter. The mean size was 5.5 cm. Mammography showed nodular lesions and sonography demonstrated hypoechoic nodules. On histological examination there was a granulomatous inflammatory infiltrate of epithelioid and giant cells, without caseation necrosis, made up of lymphocytes, plasma cells and neutrophils. Microbiology investigations were negative. Lesion involvement was principally lobulocentric. Surgical excision of the lesions was combined with corticosteroid therapy in twelve cases, with non-steroidal anti-inflammatory drugs in another four and with antibiotic therapy in four cases. The patients made good progress in the short-term.

DISCUSSION AND CONCLUSION

IGM is a rare entity. It poses a problem of differential diagnosis because it clinically resembles other forms of mastitis. The diagnosis can be made with certainty on histological studies. The treatment is medical alongside surgical excision. The prognosis of this disease remains favourable.