1
|
Price MD, Mali ME, Dedey F, Dzefi-Tettey K, Li Y, Almeida C, Brownson KE, Price RR, Sutherland EK. Mammography and Breast Ultrasonography Services in Ghana, Availability, and Geographic Access. JCO Glob Oncol 2024; 10:e2400218. [PMID: 39208381 DOI: 10.1200/go.24.00218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 07/11/2024] [Accepted: 07/29/2024] [Indexed: 09/04/2024] Open
Abstract
PURPOSE Breast cancer is the leading type of cancer diagnosed and the second leading cause of cancer-related death in Ghana. Mammography and ultrasound have proven benefits in the early detection of breast cancer. This study evaluates mammography, breast ultrasound, and radiology work force availability throughout Ghana. METHODS A survey was administered to all hospitals in Ghana from November 2020 to October 2021. Mammography, breast ultrasound services, and the number of radiologists were assessed. For mammography, the number performed per month, cost incurred by the patient, where images were read, and how long it took to receive reports were also assessed. Health Facilities Regulatory Authority records on diagnostic centers were obtained to identify additional in-country breast imaging services. RESULTS Three hundred and twenty-eight of 346 hospitals participated in the survey (95%). Only 21 hospitals reported on-site mammography. One hospital reported performing >100 mammographies per month. The average cost to the patient ranged from 100 to 500 Cedis ($17-87 US dollars [USD]), although three hospitals performed mammography at no cost. An additional 10 mammography machines were identified at diagnostic centers throughout the country, with 41.3% of the female population living within 1 hour of mammography services. There were 135 hospital-based breast ultrasound services identified with 69.5% of the female population living within 1 hour of these services. There were an additional 190 ultrasound machines at diagnostic centers. There were 96 in-country radiologists identified. CONCLUSION Although there is limited availability and utilization of mammography in Ghana, there is more readily available ultrasonography. A focus on increasing breast cancer early diagnostic capabilities with breast ultrasound should be prioritized in addition to further expansion of the radiology workforce.
Collapse
Affiliation(s)
- Matthew D Price
- Center for Global Surgery, The University of Utah, Salt Lake City, UT
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Meghan E Mali
- Center for Global Surgery, The University of Utah, Salt Lake City, UT
- Department of Surgery, The University of Utah School of Medicine, Salt Lake City, UT
| | - Florence Dedey
- Department of Surgery, University of Ghana Medical School, Accra, Ghana
| | | | - Yao Li
- Department of Geography & Earth Sciences, The University of North Carolina at Charlotte, Charlotte, NC
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Cameron Almeida
- University of Alabama Birmingham School of Medicine, Birmingham, AL
| | - Kirstyn E Brownson
- Center for Global Surgery, The University of Utah, Salt Lake City, UT
- Department of Surgery, The University of Utah School of Medicine, Salt Lake City, UT
- Huntsman Cancer Institute, Salt Lake City, UT
| | - Raymond R Price
- Center for Global Surgery, The University of Utah, Salt Lake City, UT
- Department of Surgery, The University of Utah School of Medicine, Salt Lake City, UT
- Intermountain Health, Salt Lake City, UT
| | - Edward Kofi Sutherland
- Center for Global Surgery, The University of Utah, Salt Lake City, UT
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Ensign Global College, Kpong, Ghana
| |
Collapse
|
2
|
Duduyemi BM, Ayibor WG, Agyemang-Yeboah F. Tissue Microarray Immunohistochemical Staining for Androgen Receptor in Breast Cancer in a Ghanaian Cohort. Ann Afr Med 2024; 23:452-458. [PMID: 39034572 PMCID: PMC11364299 DOI: 10.4103/aam.aam_83_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 10/20/2023] [Accepted: 11/27/2023] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND Despite the advancement in therapy, breast cancer still remains the most common malignancy in women globally due in part to its heterogeneity. Triple-negative breast cancer (TNBC) represents up to 20% of all breast cancer variants, an aggressive disease with poorer outcomes compared to other breast cancer subtypes. No targeted therapies are currently approved for TNBC, and newer treatment approaches are seriously needed. Androgen receptor (AR), another hormonal receptor, is often expressed in breast cancer, and its role depends on the relative levels of circulating estrogens and androgens. This study aimed to assess the expression of AR in breast cancer in a tertiary hospital in Ghana. METHODOLOGY Immunohistochemical staining for AR was performed on tissue microarray (TMA) blocks, of which estrogen receptor, progesterone receptor, and Her-2/neu had already been done. 197 cases were suitable for the study. Results from the immunostaining were analyzed using the SPSS version 23 for descriptive statistics and correlations (χ2 and Pearson tests). RESULTS 197 TMA cases were used. TNBCs constitute 61.9% of the cancers. The majority of these tumors were grade III, ductal carcinoma NST. The mean age was 49.86 ± 14.09, and the modal age group was 40-49 years. Our cases showed 23% AR expression in triple-negative cancers. The study also established that AR is more frequently expressed in low-grade tumors compared to high-grade ones. CONCLUSION There is an appreciable level of AR expression in our cases; however, most are quadruple negative. However, AR is more frequently expressed in low-grade tumors than high-grade ones.
Collapse
Affiliation(s)
- Babatunde M. Duduyemi
- Department of Pathology, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Department of Pathology, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone
| | - William G. Ayibor
- Department of Pathology, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Francis Agyemang-Yeboah
- Department of Molecular Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| |
Collapse
|
3
|
Sandoval-Ato R, Coral-Gonzales P, Coronel-Arias S, Espinoza-Mantilla L, Terrones-Chaparro G, Serna-Alarcón V. Clinical and radiological manifestations associated with triple-negative breast cancer in women from northern Peru. A case-control study. Ecancermedicalscience 2024; 18:1720. [PMID: 39021537 PMCID: PMC11254400 DOI: 10.3332/ecancer.2024.1720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Indexed: 07/20/2024] Open
Abstract
Objective Triple-negative breast cancer (TNBC) has an aggressive clinical behaviour, with advanced stages at initial diagnostic evaluation, early recurrences and poor survival, so the purpose was to determine the clinical and radiological manifestations associated with TNBC. Materials and methods A case-control study in women diagnosed with breast cancer from January 2015 to August 2022 at the 'Instituto Regional de Enfermedades Neoplásicas del Norte'. We classified cases (Triple Negative subtype) and controls (Luminal A, Luminal B and HER2) according to immunohistochemistry ical analysis. Bivariate and multivariate logistic regression models were used to calculate the odds ratio (OR) with their respective 95% confidence intervals (CIs). Results The medical reports of 88 cases and 236 controls were reviewed. Cases were more likely to report pain (p = 0.001), nodules on ultrasound (p = 0.01) and mammography (p = 0.003), superior median size (p < 0.05), posterior enhancement (p = 0.001) and moderate density (p = 0.003). Multivariate analysis identified that TNBC was more likely to have a nodular type lesion by ultrasound (OR: 9.73, 95% CI: 1.10-86.16; p = 0.04), ultrasound lesion larger than 36 mm (OR: 4.99, 95% CI: 1.75-14.17; p = 0.003) and moderate density (OR: 3.83, 95% CI: 1.44-10.14; p = 0.007). Conclusion There are particular clinical and imaging manifestations of TNBC, showing that radiological lesions that presented characteristics in ultrasound as nodular type lesions larger than 36 mm and in mammography moderate grade density, were associated with this subtype of breast tumours in a Peruvian population.
Collapse
Affiliation(s)
- Raúl Sandoval-Ato
- Escuela de Posgrado, Facultad de Medicina, Universidad Privada Antenor Orrego, Trujillo 13008, Perú
- Unidad de Investigación Clínica, Scientia Clinical and Epidemiological Research Institute, Trujillo 13001, Perú
- https://orcid.org/0000-0001-8666-7188
| | - Patricia Coral-Gonzales
- Servicio de Radiodiagnóstico, Instituto Regional de Enfermedades Neoplásicas Norte, Trujillo 13008, Perú
- Escuela Profesional de Medicina, Facultad de Medicina, Universidad Privada Antenor Orrego, Trujillo 13008, Perú
- https://orcid.org/0000-0002-8734-4687
| | - Sebastian Coronel-Arias
- Servicio de Radiodiagnóstico, Instituto Regional de Enfermedades Neoplásicas Norte, Trujillo 13008, Perú
- https://orcid.org/0000-0002-2607-7191
| | - Luisa Espinoza-Mantilla
- Servicio de Radiodiagnóstico, Instituto Regional de Enfermedades Neoplásicas Norte, Trujillo 13008, Perú
- https://orcid.org/0000-0002-5465-7775
| | - Grace Terrones-Chaparro
- Servicio de Radiodiagnóstico, Instituto Regional de Enfermedades Neoplásicas Norte, Trujillo 13008, Perú
- https://orcid.org/0000-0001-6938-1401
| | - Victor Serna-Alarcón
- Escuela Profesional de Medicina, Facultad de Medicina, Universidad Privada Antenor Orrego, Trujillo 13008, Perú
- https://orcid.org/0000-0002-9803-6217
| |
Collapse
|
4
|
Gnangnon FHR, Parenté A, Aboubakar M, Kiki-Migan Y, Totah T, Gbessi DG, Tonato-Bagnan JA, Laleye A, Preux PM, Denakpo JL, Blanquet V, Houinato DS. Prognostic factors and overall survival of breast cancer in Benin: a hospital-based study. BMC Womens Health 2024; 24:295. [PMID: 38762733 PMCID: PMC11102149 DOI: 10.1186/s12905-024-03114-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 04/24/2024] [Indexed: 05/20/2024] Open
Abstract
BACKGROUND In Benin, a country in West Africa, breast cancer is the leading cancer in women, both in terms of incidence and mortality. However, evidence on the mortality of breast cancer and its associated factors is lacking in this country. Our aim was to describe and analyze the clinical, histopathological, and prognostic aspects of breast cancer in Benin. METHODS A descriptive and analytical study was carried out at the CNHU-HKM and the CHU-MEL, two major tertiary referral hospitals for breast cancer management located in Cotonou, the capital city of Benin. All breast cancer medical records with histological evidence and immunohistochemistry studies were retrospectively collected between January 1, 2014, and September 30, 2020, in these two tertiary referral hospitals and analyzed in the current study. RESULTS Finally, 319 medical records were included. The mean age at diagnosis was 48.74 years. The tumors were most frequently classified as T4 (47.6%) with lymph node involvement N2 (34.5%), and metastases were clinically noted in 21.9% of cases. Stage was reported in the medical records of 284 patients. Tumors were diagnosed at very late AJCC stages: stage III (47.5%) and stage IV (24.7%). Grades SBR 2 (49.2%) and SBR 3 (32.6%) were the most frequent grades. Triple-negative breast cancer (31.3%) was the most common molecular type. The overall 5-year survival was 48.49%. In multivariable analysis, the poor prognostic factors were lymph node invasion (HR = 2.63; p = 0.026; CI: [1.12, 6.17]), the presence of metastasis (HR = 3.64; p < 0.001); CI: [2.36, 5.62] and the immunohistochemical profile (HR = 1.29; p < 0.001; CI: [1.13, 1.48]). CONCLUSIONS Breast cancer in Beninese is predominant in young adults and is often diagnosed at a late stage. The survival of breast cancer patients in Benin can be improved by enhancing early diagnosis and multidisciplinary management.
Collapse
Affiliation(s)
- Freddy Houéhanou Rodrigue Gnangnon
- Laboratory of Epidemiology of Chronic and Neurological Diseases, Lemacen, Cotonou, Benin.
- Department of Visceral Surgery, National Teaching Hospital-Hubert Koutoukou Maga, CNHU-HKM, Cotonou, Benin.
- EpiMaCT - Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, Limoges, France.
- Department of Surgical Oncology, Faculty of Health Sciences - University of Abomey-Calavi, Cotonou, Benin.
| | - Alexis Parenté
- Laboratory of Epidemiology of Chronic and Neurological Diseases, Lemacen, Cotonou, Benin
- EpiMaCT - Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, Limoges, France
| | - Moufalilou Aboubakar
- Department of Gynecological Obstetrics, National Teaching Hospital-Hubert Koutoukou Maga, CNHU-HKM, Cotonou, Benin
| | - Yannick Kiki-Migan
- Laboratory of Epidemiology of Chronic and Neurological Diseases, Lemacen, Cotonou, Benin
| | - Terence Totah
- Laboratory of Epidemiology of Chronic and Neurological Diseases, Lemacen, Cotonou, Benin
| | - Dansou Gaspard Gbessi
- Department of Visceral Surgery, National Teaching Hospital-Hubert Koutoukou Maga, CNHU-HKM, Cotonou, Benin
| | | | - Anatole Laleye
- Laboratory of Histology, Reproductive Biology, Cytogenetics and Medical Genetics, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - Pierre-Marie Preux
- EpiMaCT - Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, Limoges, France
| | - Justin Lewis Denakpo
- Department of Gynecological Obstetrics, National Teaching Hospital-Hubert Koutoukou Maga, CNHU-HKM, Cotonou, Benin
| | - Véronique Blanquet
- EpiMaCT - Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, Limoges, France
| | - Dismand Stephan Houinato
- Laboratory of Epidemiology of Chronic and Neurological Diseases, Lemacen, Cotonou, Benin
- EpiMaCT - Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, Limoges, France
| |
Collapse
|
5
|
Barnes P, Mensah A, Derkyi-Kwarteng L, Adankwa E, Agbo E, Yahaya ES, Amoani B, Adjei G, Apewe Ka-Chungu SM, Akakpo PK, Halm-Lai F, Dankwa K, Amoako-Sakyi D, Nuvor SV, Obiri-Yeboah D, Saahene RO. Prognostic Significance of Nuclear Factor Kappa B (p65) among Breast Cancer Patients in Cape Coast Teaching Hospital. Med Princ Pract 2024; 33:1-11. [PMID: 38723618 PMCID: PMC11324227 DOI: 10.1159/000539241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 05/06/2024] [Indexed: 06/13/2024] Open
Abstract
Breast cancer is the most prevalent cancer among African women, with high mortality rates in Ghana. Nuclear factor kappa B (NF-kB) has been associated with tumor progression in breast cancer. However, its clinical validation is controversial and understudied with no known published data on NF-kB (p65) among breast cancer patients in Ghana and other African countries. This study assessed the prognostic significance of NF-kB (p65) expression and its association with various clinicopathological features in breast cancer patients. Ninety formalin-fixed breast cancer tissues and 15 normal breast tissues were used to determine the expression of NF-kB (p65) using immunohistochemistry. We explored the correlation between expression of NF-kB (p65) and clinicopathological features. NF-kB (p65) was expressed in 86.7% of breast cancer tissues. There was a significant relationship between NF-kB (p65) expression and tumor grade, proliferation index (Ki67), and molecular subtype. High NF-kB (p65) expression in tumor grade 3 was about 10 times that of grade 1 (54.2% vs. 5.1%), and Ki67 > 20 was 79.7% compared to 20.3% for Ki67 ≤ 20. Patients with triple-negative breast cancer (TNBC) had 49.1% overexpression of NF-kB (p65) compared to 17%, 25.4%, and 8.5% for luminal A, luminal B, and HER2 cases, respectively. This study demonstrates that NF-kB (p65) was highly expressed among breast cancer patients at Cape Coast Teaching Hospital, Ghana, especially in TNBC. NF-kB (p65) could serve as a biomarker for cancer stage, progression, prognosis and as a therapeutic target.
Collapse
Affiliation(s)
- Precious Barnes
- Department of Physician Assistant Studies, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Abraham Mensah
- Department of Microbiology and Immunology, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Leonard Derkyi-Kwarteng
- Department of Pathology, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Ernest Adankwa
- Department of Medical Diagnostics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Elvis Agbo
- Department of Human Anatomy, Histology and Embryology, College of Medicine, Jinggangshan University, Ji’an, China
| | - Ewura Seidu Yahaya
- Department of Pharmacology, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Benjamin Amoani
- Department of Biomedical Sciences, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - George Adjei
- Department of Community Medicine, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | | | - Patrick Kafui Akakpo
- Department of Pathology, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Faustina Halm-Lai
- Department of Microbiology and Immunology, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Kwabena Dankwa
- Department of Microbiology and Immunology, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Daniel Amoako-Sakyi
- Department of Microbiology and Immunology, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Samuel Victor Nuvor
- Department of Microbiology and Immunology, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Dorcas Obiri-Yeboah
- Department of Microbiology and Immunology, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Roland Osei Saahene
- Department of Microbiology and Immunology, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| |
Collapse
|
6
|
Newman L. Oncologic anthropology: Global variations in breast cancer risk, biology, and outcome. J Surg Oncol 2023; 128:959-966. [PMID: 37814598 DOI: 10.1002/jso.27459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 10/11/2023]
Abstract
The global breast cancer burden is growing. Of 19.3 million new cancers diagnosed in 2020, 2.26 million were breast, surpassing lung as the most commonly diagnosed worldwide. Breast cancer is the fourth most common cause of cancer deaths worldwide, and the leading cause of death in females. Incidence and mortality rates are projected to rise disproportionately in low and middle-income countries, a consequence of socioeconomic factors and differences in tumor biology related to genetic ancestry.
Collapse
Affiliation(s)
- Lisa Newman
- Division of Breast Surgery, Interdisciplinary Breast Program, International Center for theStudy of Breast Cancer, Weill Cornell Medicine/New York Presbyterian Hospital Network, New York, New York, USA
| |
Collapse
|
7
|
Ssentongo P, Oh JS, Amponsah-Manu F, Wong W, Candela X, Acharya Y, Ssentongo AE, Dodge DG. Breast Cancer Survival in Eastern Region of Ghana. Front Public Health 2022; 10:880789. [PMID: 35719670 PMCID: PMC9201058 DOI: 10.3389/fpubh.2022.880789] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/10/2022] [Indexed: 12/29/2022] Open
Abstract
Objective Five-year overall survival rate of breast cancer in low-income countries (LICs) is significantly lower than in high-resource countries. This study explored clinical and pathological factors influencing mortality in the Eastern region of Ghana. Methods We performed a retrospective medical chart review for patients undergoing surgery and chemotherapy for breast cancer at a regional hospital in Ghana from January 2014 to January 2017. Descriptive and survival analysis was done. Results One hundred and twenty-nine patients were included in the study. The median age at presentation was 51 years. Sixty percent of patients presented with poorly differential histological grade III. The most common histological type was invasive ductal carcinoma (83%). Based on stage assessment using only tumor size and lymph node status, 60% presented at stage 3. Only 25% were tested for hormone receptor proteins and HER2 status. Of these, 57% had triple-negative breast cancer (TNBC). The 3-year overall survival rate was only 52%. Conclusion The cumulative 3-year survival was 52%. Despite success in reducing cancer mortality in northern Africa, survival in sub-Saharan Africa remains poor. A significantly higher percentage of GIII and TNBC is found in breast cancers seen in Ghana. When combined with limited capacity for accurate diagnosis, cancer subtype analysis, adequate therapy, and follow-up, late-stage presentation leads to poor outcomes. Future studies should emphasize the identification of barriers to care and opportunities for cost-effective and sustainable improvements in diagnosing and treating breast cancer in LICs.
Collapse
Affiliation(s)
- Paddy Ssentongo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States
| | - John S Oh
- Department of Surgery, Penn State Hershey Medical Center, Hershey, PA, United States
| | | | - William Wong
- Department of Surgery, Penn State Hershey Medical Center, Hershey, PA, United States
| | - Xavier Candela
- Department of Surgery, Penn State Hershey Medical Center, Hershey, PA, United States
| | - Yubraj Acharya
- Department of Health Policy and Administration, College of Health and Human Development, The Pennsylvania State University, University Park, PA, United States
| | - Anna E Ssentongo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States.,Department of Surgery, Penn State Hershey Medical Center, Hershey, PA, United States
| | - Daleela G Dodge
- Department of Surgery, Penn State Hershey Medical Center, Hershey, PA, United States
| |
Collapse
|
8
|
Oncologic Anthropology: An Interdisciplinary Approach to Understanding the Association Between Genetically Defined African Ancestry and Susceptibility for Triple Negative Breast Cancer. CURRENT BREAST CANCER REPORTS 2021. [DOI: 10.1007/s12609-021-00426-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
9
|
Nwagu GC, Bhattarai S, Swahn M, Ahmed S, Aneja R. Prevalence and Mortality of Triple-Negative Breast Cancer in West Africa: Biologic and Sociocultural Factors. JCO Glob Oncol 2021; 7:1129-1140. [PMID: 34264759 PMCID: PMC8457872 DOI: 10.1200/go.21.00082] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/05/2021] [Accepted: 06/08/2021] [Indexed: 12/24/2022] Open
Affiliation(s)
- Gift C. Nwagu
- Department of Biology, Georgia State University, Atlanta, GA
| | | | - Monica Swahn
- International Consortium for Advancing Research on Triple Negative Breast Cancer, Georgia State University, Atlanta, GA
- Department of Population Health Sciences, Georgia State University, Atlanta, GA
| | - Saad Ahmed
- International Consortium for Advancing Research on Triple Negative Breast Cancer, Georgia State University, Atlanta, GA
- Department of Pathology, Ahmadu Bello University, Zaria, Nigeria
| | - Ritu Aneja
- Department of Biology, Georgia State University, Atlanta, GA
- International Consortium for Advancing Research on Triple Negative Breast Cancer, Georgia State University, Atlanta, GA
| |
Collapse
|
10
|
Batai K, Hooker S, Kittles RA. Leveraging genetic ancestry to study health disparities. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2021; 175:363-375. [PMID: 32935870 PMCID: PMC8246846 DOI: 10.1002/ajpa.24144] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/22/2020] [Accepted: 08/20/2020] [Indexed: 12/14/2022]
Abstract
Research to understand human genomic variation and its implications in health has great potential to contribute in the reduction of health disparities. Biological anthropology can play important roles in genomics and health disparities research using a biocultural approach. This paper argues that racial/ethnic categories should not be used as a surrogate for sociocultural factors or global genomic clusters in biomedical research or clinical settings, because of the high genetic heterogeneity that exists within traditional racial/ethnic groups. Genetic ancestry is used to show variation in ancestral genomic contributions to recently admixed populations in the United States, such as African Americans and Hispanic/Latino Americans. Genetic ancestry estimates are also used to examine the relationship between ancestry-related biological and sociocultural factors affecting health disparities. To localize areas of genomes that contribute to health disparities, admixture mapping and genome-wide association studies (GWAS) are often used. Recent GWAS have identified many genetic variants that are highly differentiated among human populations that are associated with disease risk. Some of these are population-specific variants. Many of these variants may impact disease risk and help explain a portion of the difference in disease burden among racial/ethnic groups. Genetic ancestry is also of particular interest in precision medicine and disparities in drug efficacy and outcomes. By using genetic ancestry, we can learn about potential biological differences that may contribute to the heterogeneity observed across self-reported racial groups.
Collapse
Affiliation(s)
- Ken Batai
- Department of UrologyUniversity of ArizonaTucsonArizonaUSA
| | - Stanley Hooker
- Division of Health Equities, Department of Population SciencesCity of Hope Comprehensive Cancer CenterDuarteCaliforniaUSA
| | - Rick A. Kittles
- Division of Health Equities, Department of Population SciencesCity of Hope Comprehensive Cancer CenterDuarteCaliforniaUSA
| |
Collapse
|
11
|
Mathieu KM, YouYou TG, Hicks ML, Mutombo A, Anaclet MM, Sylvain MK, Pinder L, Hicks MM, Kanda L, Kanda M, Parham GP, Henry-Tillman R. Building a breast cancer detection and treatment platform in the Democratic Republic of the Congo by integrating training, service and infrastructure development. Ecancermedicalscience 2021; 15:1233. [PMID: 34221116 PMCID: PMC8225335 DOI: 10.3332/ecancer.2021.1233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Indexed: 11/06/2022] Open
Abstract
Background Breast cancer is a leading cause of cancer-related morbidity and mortality in sub-Saharan Africa, a global region where opportunities for breast care of any type are extremely limited due to insufficient infrastructure, a paucity of clinical services and vast shortages of trained human resources. Methods A team of Zambian and US gynaecologic and breast oncology experts and nurse-specialists made multiple visits (each lasting 5 working days) to the Democratic Republic of the Congo (DRC), over a 2-year period. During each of five week-long site visits, hands-on training of local Congolese health providers was conducted during which time they were taught clinical breast exam (CBE), breast and axillary ultrasound, ultrasound-guided core needle biopsy/fine needle aspiration (FNA) and breast surgery. Simultaneous with the training exercises, a new breast care clinic was established and operationalised, and existing surgical theatres were upgraded. All activities were implemented in a private sector health care facility - Biamba Marie Mutombo Hospital - in the capital city of Kinshasa. Results From April 2017 to August 2020, a total of 5,211 women were identified as having breast abnormalities on CBE. Ages ranged from 26 to 86 years; median age: 42.0 (±14.1) years. Ultrasound abnormalities were noted in 1,420 (27%) clients, of which 516 (36%) met the criteria (indeterminate cystic lesion, solid or suspicious masses) for ultrasound-guided core needle biopsy or FNA. Pathology reports were available for 368 (71%) of the 516 clients who underwent biopsy, of which 164 were malignant and 204 benign. The majority (88%) of the cancers were advanced (TNM stages 3 and 4). Surgical procedures consisted of 183 lumpectomies, 58 modified radical mastectomies and 45 axillary lymph node dissections. Clinical competency for diagnostic and surgical procedures was reached early in the course of the training programme. Conclusion By integrating onsite training with simultaneous investments in clinical service and infrastructure development, the barriers to breast cancer diagnosis and treatment were disrupted and a modern breast care service platform was established in a private sector health care facility in the DRC.
Collapse
Affiliation(s)
- Kabongo Mukuta Mathieu
- Biamba Marie Mutombo Hospital, No. 9777, Boulevard Lumumba, Commune de Masina, Kinshasa, Democratic Republic of the Congo
| | - Tankoy Gombo YouYou
- Biamba Marie Mutombo Hospital, No. 9777, Boulevard Lumumba, Commune de Masina, Kinshasa, Democratic Republic of the Congo
| | - Michael L Hicks
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, 101 Manning Dr, Chapel Hill, NC 27514, USA.,Department of Obstetrics and Gynecology, University Teaching Hospital - Women and Newborn Hospital, 10101 Nationalist Way, Lusaka, Zambia.,St Mary Mercy Cancer Center, 36475 Five Mile Rd, Livonia, MI 48154, USA.,St Joseph Mercy Oakland Cancer Center, 44405 Woodward Ave, Suite 202, Pontiac, MI 48341, USA.,McLaren Macomb Medical Center, 1000 Harrington Blvd, Mount Clemens, MI 48043, USA.,https://orcid.org/0000-0002-1819-155X
| | - Alex Mutombo
- Biamba Marie Mutombo Hospital, No. 9777, Boulevard Lumumba, Commune de Masina, Kinshasa, Democratic Republic of the Congo
| | - Mukanya Mpalata Anaclet
- Biamba Marie Mutombo Hospital, No. 9777, Boulevard Lumumba, Commune de Masina, Kinshasa, Democratic Republic of the Congo
| | - Mulumba Kapuku Sylvain
- Biamba Marie Mutombo Hospital, No. 9777, Boulevard Lumumba, Commune de Masina, Kinshasa, Democratic Republic of the Congo
| | - Leeya Pinder
- Department of Oncology, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA.,https://orcid.org/0000-0002-8929-7810
| | - Maya M Hicks
- Howard University College of Medicine, 520 W St NW, Washington, DC 20059, USA.,https://orcid.org/0000-0002-1993-3367
| | - Louis Kanda
- Dikembe Mutombo Foundation, 400 Interstate N Pkwy, Suite 1040, Atlanta, GA 30339, USA
| | - Mirielle Kanda
- Dikembe Mutombo Foundation, 400 Interstate N Pkwy, Suite 1040, Atlanta, GA 30339, USA
| | - Groesbeck P Parham
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, 101 Manning Dr, Chapel Hill, NC 27514, USA.,Department of Obstetrics and Gynecology, University Teaching Hospital - Women and Newborn Hospital, 10101 Nationalist Way, Lusaka, Zambia.,https://orcid.org/0000-0002-1782-9523
| | - Ronda Henry-Tillman
- Winthrop P Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, 4301 West Markham St, Slot #725, Little Rock, AR 72205, USA
| |
Collapse
|
12
|
Mensah KB, Mensah ABB, Yamoah P, Attakorah J, Bangalee V, Oosthuizen F. Knowledge assessment and barriers to cancer screening among Ghanaian community pharmacists. J Oncol Pharm Pract 2021; 28:64-73. [PMID: 33430692 DOI: 10.1177/1078155220983413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Though there are controversies, cancer screening has been suggested to decrease mortality. Over the years, the most accessible primary healthcare provider; the community pharmacist, has developed an interest in being part of cancer screening activities and prevention of a wide range of other non-communicable diseases. To achieve this, community pharmacists need a working knowledge of the basic screening test and recommendations. Also, it's important to acknowledge the barriers that may prevent the implementation of cancer-screening efforts at the community pharmacy. This study aims to determine the knowledge and barriers to cancer screening among Ghanaian community pharmacists. METHODOLOGY Knowledge and barriers to cancer screening was assessed using an online questionnaire in 435 community pharmacists. Descriptive statistics and Pearson's chi-squared tests were used to analyze the data. RESULTS The reliability and validity assessment of the questionnaire after data collection revealed a Cronbach's alpha value of 0.82 for knowledge on cancer screening. The SD and mean age of study participants were 2.48 ± 20.08. Only 25.7% of the participants had good knowledge. The most identified barrier was the lack of established guidelines (60.9%). There was no association between participants' demographics and their knowledge scores. CONCLUSIONS Community pharmacists can potentially have a large impact on early detection of cancer through screening. However, they have to improve their knowledge on general screening guidelines and be aware of available educational resources to increase their knowledge. It is also important for all stakeholders to come together to establish local screening modalities and recommendations for the country.
Collapse
Affiliation(s)
- Kofi B Mensah
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology, Ghana.,College of Health Sciences, University of KwaZulu-Natal, Discipline of Pharmaceutical Sciences, Durban, South Africa
| | - Adwoa Bemah Boamah Mensah
- Department of Nursing, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Ghana
| | - Peter Yamoah
- School of Pharmacy, University of Health and Allied Sciences, Ghana
| | - Joseph Attakorah
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology, Ghana
| | - Varsha Bangalee
- College of Health Sciences, University of KwaZulu-Natal, Discipline of Pharmaceutical Sciences, Durban, South Africa
| | - Frasia Oosthuizen
- College of Health Sciences, University of KwaZulu-Natal, Discipline of Pharmaceutical Sciences, Durban, South Africa
| |
Collapse
|
13
|
Jimenez T, Friedman T, Vadgama J, Singh V, Tucker A, Collazo J, Sinha S, Hikim AS, Singh R, Pervin S. Nicotine Synergizes with High-Fat Diet to Induce an Anti-Inflammatory Microenvironment to Promote Breast Tumor Growth. Mediators Inflamm 2020; 2020:5239419. [PMID: 33414685 PMCID: PMC7752272 DOI: 10.1155/2020/5239419] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/26/2020] [Accepted: 11/25/2020] [Indexed: 01/03/2023] Open
Abstract
Breast cancer results from a complex interplay of genetics and environment that alters immune and inflammatory systems to promote tumorigenesis. Obesity and cigarette smoking are well-known risk factors associated breast cancer development. Nicotine known to decrease inflammatory signals also modulates immune responses that favor breast cancer development. However, the mechanisms by which nicotine and obesity contribute to breast cancer remain poorly understood. In this study, we examined potential mechanisms by which nicotine (NIC) and high-fat diet (HFD) promote growth of HCC70 and HCC1806 xenografts from African American (AA) triple negative (TN) breast cancer cells. Immunodeficient mice fed on HFD and treated with NIC generated larger HCC70 and HCC1806 tumors when compared to NIC or HFD alone. Increased xenograft growth in the presence of NIC and HFD was accompanied by higher levels of tissue-resident macrophage markers and anti-inflammatory cytokines including IL4, IL13, and IL10. We further validated the involvement of these players by in vitro and ex vivo experiments. We found a proinflammatory milieu with increased expression of IL6 and IL12 in xenografts with HFD. In addition, nicotine or nicotine plus HFD increased a subset of mammary cancer stem cells (MCSCs) and key adipose browning markers CD137 and TMEM26. Interestingly, there was upregulation of stress-induced pp38 MAPK and pERK1/2 in xenografts exposed to HFD alone or nicotine plus HFD. Scratch-wound assay showed marked reduction in proliferation/migration of nicotine and palmitate-treated breast cancer cells with mecamylamine (MEC), a nicotine acetylcholine receptor (nAchR) antagonist. Furthermore, xenograft development in immune-deficient mice, fed HFD plus nicotine, was reduced upon cotreatment with MEC and SB 203580, a pp38MAPK inhibitor. Our study demonstrates the presence of nicotine and HFD in facilitating an anti-inflammatory tumor microenvironment that influences breast tumor growth. This study also shows potential efficacy of combination therapy in obese breast cancer patients who smoke.
Collapse
Affiliation(s)
- Thalia Jimenez
- Division of Endocrinology and Metabolism, Department of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA
| | - Theodore Friedman
- Division of Endocrinology and Metabolism, Department of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Jaydutt Vadgama
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
- Jonsson Comprehensive Cancer Center, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
- Division of Cancer Research and Training, Department of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA
| | - Vineeta Singh
- Division of Endocrinology and Metabolism, Department of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA
| | - Alexandria Tucker
- Division of Endocrinology and Metabolism, Department of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA
| | - Javier Collazo
- Division of Endocrinology and Metabolism, Department of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA
| | - Satyesh Sinha
- Division of Endocrinology and Metabolism, Department of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Amiya Sinha Hikim
- Division of Endocrinology and Metabolism, Department of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Rajan Singh
- Division of Endocrinology and Metabolism, Department of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA
- Jonsson Comprehensive Cancer Center, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Shehla Pervin
- Division of Endocrinology and Metabolism, Department of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA
- Jonsson Comprehensive Cancer Center, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| |
Collapse
|
14
|
|
15
|
Zevallos A, Bravo L, Bretel D, Paez K, Infante U, Cárdenas N, Alvarado H, Posada AM, Pinto JA. The hispanic landscape of triple negative breast cancer. Crit Rev Oncol Hematol 2020; 155:103094. [PMID: 33027724 DOI: 10.1016/j.critrevonc.2020.103094] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 08/26/2020] [Accepted: 08/28/2020] [Indexed: 10/23/2022] Open
Abstract
Triple-negative breast cancer (TNBC) is a heterogeneous and complex disease characterized by the absence of immunohistochemical expression of estrogen receptor, progesterone receptor and HER2. These breast tumors present an aggressive biology and offer few opportunities to be treated with targeted therapy resulting in bad disease outcomes. The epidemiology of TNBC is intriguing where the understanding of its biology has progressed quickly. One of the peculiarities of this type of cancer is a high prevalence in Afrodescendants and Hispanic patients compared to Caucasian women. In this review we describe some features of TNBC, focusing in the Hispanic population, such as epidemiological, clinicopathological features and molecular features and the correlation between TNBC prevalence and the human development index.
Collapse
Affiliation(s)
- Alejandra Zevallos
- Escuela de Medicina Humana, Universidad Privada San Juan Bautista, Lima, Peru
| | - Leny Bravo
- Escuela de Medicina Humana, Universidad Privada San Juan Bautista, Lima, Peru
| | - Denisse Bretel
- Grupo de Estudios Clínicos Oncológicos Peruano, GECOPERU, Lima, Peru
| | - Kevin Paez
- Facultad de Ciencias Biológicas, Universidad Nacional San Luis Gonzaga de Ica, Ica, Peru
| | - Ulises Infante
- Facultad de Ciencias Biológicas, Universidad Nacional San Luis Gonzaga de Ica, Ica, Peru
| | - Nadezhda Cárdenas
- Escuela de Medicina Humana-Filial Ica, Universidad Privada San Juan Bautista, Ica, Peru
| | - Hober Alvarado
- Facultad de Ciencias Biológicas, Universidad Nacional San Luis Gonzaga de Ica, Ica, Peru
| | | | - Joseph A Pinto
- Unidad de Investigación Básica y Traslacional, Oncosalud - AUNA, Lima, Peru.
| |
Collapse
|
16
|
Ziegenhorn HV, Frie KG, Ekanem IO, Ebughe G, Kamate B, Traore C, Dzamalala C, Ogunbiyi O, Igbinoba F, Liu B, Bauer M, Thomssen C, Parkin DM, Wickenhauser C, Kantelhardt EJ. Breast cancer pathology services in sub-Saharan Africa: a survey within population-based cancer registries. BMC Health Serv Res 2020; 20:912. [PMID: 33008380 PMCID: PMC7531092 DOI: 10.1186/s12913-020-05752-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/21/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Pathologists face major challenges in breast cancer diagnostics in sub-Saharan Africa (SSA). The major problems identified as impairing the quality of pathology reports are shortcomings of equipment, organization and insufficiently qualified personnel. In addition, in the context of breast cancer, immunohistochemistry (IHC) needs to be available for the evaluation of biomarkers. In the study presented, we aim to describe the current state of breast cancer pathology in order to highlight the unmet needs. METHODS We obtained information on breast cancer pathology services within population-based cancer registries in SSA. A survey of 20 participating pathology centres was carried out. These centres represent large, rather well-equipped pathologies. The data obtained were related to the known population and breast cancer incidence of the registry areas. RESULTS The responding pathologists served populations of between 30,000 and 1.8 million and the centres surveyed dealt with 10-386 breast cancer cases per year. Time to fixation and formalin fixation time varied from overnight to more than 72 h. Only five centres processed core needle biopsies as a daily routine. Technical problems were common, with 14 centres reporting temporary power outages and 18 centres claiming to own faulty equipment with no access to technical support. Only half of the centres carried out IHC in their own laboratory. For three centres, IHC was only accessible outside of the country and one centre could not obtain any IHC results. A tumour board was established in 13 centres. CONCLUSIONS We conclude that breast cancer pathology services ensuring state-of-the-art therapy are only available in a small fraction of centres in SSA. To overcome these limitations, many of the centres require larger numbers of experienced pathologists and technical staff. Furthermore, equipment maintenance, standardization of processing guidelines and establishment of an IHC service are needed to comply with international standards of breast cancer pathology.
Collapse
Affiliation(s)
- Hannes-Viktor Ziegenhorn
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Magdeburgerstrasse 8, 06097, Halle, Germany
| | - Kirstin Grosse Frie
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Magdeburgerstrasse 8, 06097, Halle, Germany
| | - Ima-Obong Ekanem
- Department of Pathology, University of Calabar, Cancer Registry, Calabar, Nigeria
- University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Godwin Ebughe
- Department of Pathology, University of Calabar, Cancer Registry, Calabar, Nigeria
- University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Bakarou Kamate
- Department of Pathology, University of Bamako, Bamako Cancer Registry, Bamako, Mali
| | - Cheick Traore
- Department of Pathology, University of Bamako, Bamako Cancer Registry, Bamako, Mali
| | - Charles Dzamalala
- University of Malawi College of Medicine, Cancer Registry, Blantyre, Malawi
| | - Olufemi Ogunbiyi
- University of Ibadan, Cancer registry, Ibadan, Nigeria
- University of Ibadan College of Medicine, Ibadan, Nigeria
| | | | - Biying Liu
- The African Cancer Registry Network, INCTR African Registry Program, Oxford, UK
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Marcus Bauer
- Institute of Pathology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Christoph Thomssen
- Department of Gynaecology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Donald Maxwell Parkin
- The African Cancer Registry Network, INCTR African Registry Program, Oxford, UK
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- International Agency for Research on Cancer, Lyon, France
| | - Claudia Wickenhauser
- Institute of Pathology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Eva Johanna Kantelhardt
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Magdeburgerstrasse 8, 06097, Halle, Germany.
- Department of Gynaecology, Martin-Luther-University Halle-Wittenberg, Halle, Germany.
| |
Collapse
|
17
|
Mouh FZ, Slaoui M, Razine R, El Mzibri M, Amrani M. Clinicopathological, Treatment and Event-Free Survival Characteristics in a Moroccan Population of Triple-Negative Breast Cancer. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2020; 14:1178223420906428. [PMID: 32425539 PMCID: PMC7218339 DOI: 10.1177/1178223420906428] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 01/23/2020] [Indexed: 12/31/2022]
Abstract
Introduction: Triple-negative breast cancer (TNBC) is a group of breast carcinoma
characterized by the lack of expression of estrogen and progesterone hormone
receptors (ER, PgR) and HER2. This form is also characterized by its
aggressiveness, a low survival rate, and the absence of targeted therapies.
This study was planned to evaluate the clinical features, treatment, and
prognosis characteristics of TNBC in a population of Moroccan patients. Methods: In this retrospective study, a total of 905 patients diagnosed with breast
cancer at the National Institute of Oncology in Rabat, Morocco, have been
included. Based on molecular subtype, patients were divided into 2
categories: TNBC and non-TNBC patients. Data were recorded from patients’
medical files and analyzed using SPSS 13.0 software (IBM). Results: Overall, 17% of the patients had TNBC. At diagnosis, the median age of TNBC
cases was 47 years, with extreme ages of 40 and 55 years. The median
follow-up time was 30 months (10-53 months) and the 3-year survival rate was
76%. No significant difference was observed among the patients in terms of
age at diagnosis, age at menarche, age at the time of first birth,
nulliparity, oral contraception, and family history of breast cancer.
Menopausal status and the number of pregnancy were significantly higher in
the non-TNBC group. The percentage of grade 3 (G3) tumors was higher in the
TNBC group (P < .001). Using neoadjuvant, adjuvant
chemotherapy and radiotherapy, a net benefit in the event-free survival was
registered for the 2 groups. Conclusions: This retrospective study was very informative and showed that women with TNBC
had a less favorable prognosis than non-TNBC cases. Clinical data
demonstrated that risk factors including age, premenopausal status, parity,
hormonal contraceptive use, advanced disease, and a high histologic grade
were independently associated with TNBC. However, large tumors and high
Scarff-Bloom and Richardson grade prevail in TNBC cases with a higher
incidence of lymph node metastases.
Collapse
Affiliation(s)
- Fatima Zahra Mouh
- Equipe de recherche ONCOGYMA, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University of Rabat, Rabat, Morocco.,Unité de Biologie et Recherche Médicale, Centre National de l'Energie, des Sciences et des Techniques Nucléaires, Rabat, Morocco
| | - Meriem Slaoui
- Equipe de recherche ONCOGYMA, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University of Rabat, Rabat, Morocco.,Unité de Biologie et Recherche Médicale, Centre National de l'Energie, des Sciences et des Techniques Nucléaires, Rabat, Morocco
| | - Rachid Razine
- Laboratory of Biostatistics, Epidemiology and Clinical Research, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University of Rabat, Rabat, Morocco
| | - Mohammed El Mzibri
- Unité de Biologie et Recherche Médicale, Centre National de l'Energie, des Sciences et des Techniques Nucléaires, Rabat, Morocco
| | - Mariam Amrani
- Equipe de recherche ONCOGYMA, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University of Rabat, Rabat, Morocco
| |
Collapse
|
18
|
Davis M, Martini R, Newman L, Elemento O, White J, Verma A, Datta I, Adrianto I, Chen Y, Gardner K, Kim HG, Colomb WD, Eltoum IE, Frost AR, Grizzle WE, Sboner A, Manne U, Yates C. Identification of Distinct Heterogenic Subtypes and Molecular Signatures Associated with African Ancestry in Triple Negative Breast Cancer Using Quantified Genetic Ancestry Models in Admixed Race Populations. Cancers (Basel) 2020; 12:E1220. [PMID: 32414099 PMCID: PMC7281131 DOI: 10.3390/cancers12051220] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/07/2020] [Accepted: 05/11/2020] [Indexed: 12/12/2022] Open
Abstract
Triple negative breast cancers (TNBCs) are molecularly heterogeneous, and the link between their aggressiveness with African ancestry is not established. We investigated primary TNBCs for gene expression among self-reported race (SRR) groups of African American (AA, n = 42) and European American (EA, n = 33) women. RNA sequencing data were analyzed to measure changes in genome-wide expression, and we utilized logistic regressions to identify ancestry-associated gene expression signatures. Using SNVs identified from our RNA sequencing data, global ancestry was estimated. We identified 156 African ancestry-associated genes and found that, compared to SRR, quantitative genetic analysis was a more robust method to identify racial/ethnic-specific genes that were differentially expressed. A subset of African ancestry-specific genes that were upregulated in TNBCs of our AA patients were validated in TCGA data. In AA patients, there was a higher incidence of basal-like two tumors and altered TP53, NFB1, and AKT pathways. The distinct distribution of TNBC subtypes and altered oncologic pathways show that the ethnic variations in TNBCs are driven by shared genetic ancestry. Thus, to appreciate the molecular diversity of TNBCs, tumors from patients of various ancestral origins should be evaluated.
Collapse
Affiliation(s)
- Melissa Davis
- Department of Surgery, Weill Cornell Medicine, New York, NY 10065, USA; (M.D.); (R.M.); (L.N.)
| | - Rachel Martini
- Department of Surgery, Weill Cornell Medicine, New York, NY 10065, USA; (M.D.); (R.M.); (L.N.)
| | - Lisa Newman
- Department of Surgery, Weill Cornell Medicine, New York, NY 10065, USA; (M.D.); (R.M.); (L.N.)
| | - Olivier Elemento
- Department of Physiology and Biophysics, Weill Cornell Medicine, New York, NY 10065, USA;
- Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY 10065, USA;
- Institute for Computational Biomedicine, Weill Cornell Medicine, New York, NY 10065, USA
| | - Jason White
- Department of Biology and Center for Cancer Research, Tuskegee University, Tuskegee, AL 36088, USA; (J.W.); (W.D.C.)
| | - Akanksha Verma
- Department of Computational Biology, Weill Cornell Medicine, New York, NY 10065, USA;
| | - Indrani Datta
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI 48202, USA; (I.D.); (I.A.); (Y.C.)
| | - Indra Adrianto
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI 48202, USA; (I.D.); (I.A.); (Y.C.)
| | - Yalei Chen
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI 48202, USA; (I.D.); (I.A.); (Y.C.)
| | - Kevin Gardner
- Department of Pathology and Cell Biology, Columbia University, New York, NY 10027, USA;
| | - Hyung-Gyoon Kim
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35233, USA; (H.-G.K.); (I.-E.E.); (A.R.F.); (W.E.G.)
| | - Windy D. Colomb
- Department of Biology and Center for Cancer Research, Tuskegee University, Tuskegee, AL 36088, USA; (J.W.); (W.D.C.)
- Department of Hematology and Oncology, Our Lady of Lourdes JD Moncus Cancer Center, Lafayette, LA 70508, USA
| | - Isam-Eldin Eltoum
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35233, USA; (H.-G.K.); (I.-E.E.); (A.R.F.); (W.E.G.)
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Andra R. Frost
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35233, USA; (H.-G.K.); (I.-E.E.); (A.R.F.); (W.E.G.)
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - William E. Grizzle
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35233, USA; (H.-G.K.); (I.-E.E.); (A.R.F.); (W.E.G.)
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL 35233, USA
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Andrea Sboner
- Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY 10065, USA;
- Institute for Computational Biomedicine, Weill Cornell Medicine, New York, NY 10065, USA
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY 10062, USA
| | - Upender Manne
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35233, USA; (H.-G.K.); (I.-E.E.); (A.R.F.); (W.E.G.)
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Clayton Yates
- Department of Biology and Center for Cancer Research, Tuskegee University, Tuskegee, AL 36088, USA; (J.W.); (W.D.C.)
| |
Collapse
|
19
|
Expression of Tumour-Associated MUC1 Is a Poor Prognostic Marker in Breast Cancer in Kumasi, Ghana. JOURNAL OF ONCOLOGY 2020; 2020:9752952. [PMID: 32377198 PMCID: PMC7193303 DOI: 10.1155/2020/9752952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/23/2020] [Accepted: 04/02/2020] [Indexed: 12/24/2022]
Abstract
Background Immunohistochemical assessment of breast cancer and stratification into the basic molecular subtypes afford a much deeper insight into the biology of breast cancer, while presenting with opportunities to exploit personalized, targeted treatment. Traditionally, the oestrogen, progesterone, and epidermal growth factor receptors are assessed. MUC1, a transmembrane mucin, has been demonstrated a potential prognostic and metastatic marker in breast cancer. However, there have been a limited number of studies addressing the predictive and prognostic features of MUC1 in African breast cancer. This study aims at addressing the expression profiles of MUC1 and other biomarkers in Ghanaian breast cancer and determines its predictive and prognostic characteristics, in relation to other clinicopathological features. Methods Haematoxylin and eosin (H&E) slides of breast cancer cases were reviewed and 203 suitable cases were selected for tissue microarray (TMA) construction and immunohistochemistry. Anti-ER, PR, HER2, Ki-67, and MUC1 antibodies were used. Results from the immunostaining were analysed using SPSS version 23. Results About 59% of cases expressed MUC1. Majority of cases in the study showed a lack of expression of all three traditional markers (29% expressed ER, 10.9% PR, and 20.7% HER2). Ki-67 index were 62.1% (low), 16.5% (moderate), and 21.4% (high). MUC1 expressions among the molecular classes were luminal A (60.7%), luminal B (68.8%), HER2 overexpression (87.5%), and triple negative (56.6%). There were significant associations between MUC1 and HER2 overexpression (p=0.01) and triple negative (p < 0.01). Conclusion The high proportion of breast cancer cases expressing MUC1, as well as its association with the two most aggressive molecular classes, indicate a substantial role in the biology of breast cancer in our cohort, and it is an indication of poor prognosis.
Collapse
|
20
|
Hercules SM, Hercules JC, Ansari A, Date SAJ, Skeete DHA, Smith Connell SP, Pond GR, Daniel JM. High triple-negative breast cancer prevalence and aggressive prognostic factors in Barbadian women with breast cancer. Cancer 2020; 126:2217-2224. [PMID: 32154924 DOI: 10.1002/cncr.32771] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 01/17/2020] [Accepted: 01/22/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Women of African ancestry (WAA) are disproportionately affected by triple-negative breast cancer (TNBC), which remains one of the most clinically challenging breast cancer (BCa) subtypes. This study investigated the prevalence of TNBC and epidemiological trends for BCa in Barbados, a Caribbean island with a high percentage of African ancestry. METHODS Pathology reports for all BCa cases between 2007 and 2016 were collected from the sole hospital in Barbados and reviewed. The clinicopathological data collected included age, tumor grade, lymph node status, and hormone receptor status as determined by immunohistochemistry. BCa data for non-Hispanic white (NHW) and non-Hispanic black (NHB) American populations were accessed from the Surveillance, Epidemiology, and End Results database. RESULTS There were 1997 BCa cases in Barbados between 2007 and 2016 for an estimated incidence rate of 135.1 per 100,000 women in Barbados (standardized to the US population, where the standardized incidence rates for NHBs and NHWs were 141.4 and 152.6 per 100,000, respectively). Age-specific incidence rates in Barbados for this period were consistently higher in younger age groups (15-59 years) in comparison with NHWs and NHBs. Between 2010 and 2016 in Barbados, a TNBC prevalence of 25% was observed, whereas TNBC prevalences of 21% and 10% were observed in NHBs and NHWs, respectively. CONCLUSIONS The BCa incidence was higher in younger Barbadian women than NHWs and NHBs, and the TNBC prevalence was ~2.5 times higher than the prevalence in NHWs. This hints at a possible genetic predisposition and other socioeconomic factors that could explain the high TNBC prevalence and aggressive clinical course in WAA globally.
Collapse
Affiliation(s)
- Shawn M Hercules
- Department of Biology, McMaster University, Hamilton, Ontario, Canada.,African Caribbean Cancer Consortium, Philadelphia, Pennsylvania
| | - Jevon C Hercules
- Department of Mathematics, University of the West Indies at Mona, Kingston, Jamaica
| | - Amna Ansari
- Department of Biology, McMaster University, Hamilton, Ontario, Canada
| | - Stephanie A J Date
- African Caribbean Cancer Consortium, Philadelphia, Pennsylvania.,Faculty of Medical Sciences, University of the West Indies at Cave Hill, Bridgetown, Barbados
| | - Desiree H A Skeete
- African Caribbean Cancer Consortium, Philadelphia, Pennsylvania.,Faculty of Medical Sciences, University of the West Indies at Cave Hill, Bridgetown, Barbados.,Department of Pathology, Queen Elizabeth Hospital, Bridgetown, Barbados
| | - Suzanne P Smith Connell
- Faculty of Medical Sciences, University of the West Indies at Cave Hill, Bridgetown, Barbados.,Department of Radiation Oncology, Queen Elizabeth Hospital, Bridgetown, Barbados
| | - Gregory R Pond
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Juliet M Daniel
- Department of Biology, McMaster University, Hamilton, Ontario, Canada.,African Caribbean Cancer Consortium, Philadelphia, Pennsylvania
| |
Collapse
|
21
|
Youngblood VM, Nyirenda R, Nyasosela R, Zuze T, Yang Y, Kudowa E, Moses A, Kincaid J, Kajombo C, Kampani C, Chimzimu F, Mulenga M, Chilima C, Ellis GK, Seguin R, Chagomerana M, Maine R, Jordan S, Charles A, Lee C, Gopal S, Tomoka T. Outcomes and prognostic factors for women with breast cancer in Malawi. Cancer Causes Control 2020; 31:393-402. [PMID: 32124187 DOI: 10.1007/s10552-020-01282-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 02/18/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Breast cancer incidence in sub-Saharan Africa (SSA) is increasing, and SSA has the highest age-standardized breast cancer mortality rate worldwide. However, high-quality breast cancer data are limited in SSA. MATERIALS AND METHODS We examined breast cancer patient and tumor characteristics among women in Lilongwe, Malawi and evaluated risk factor associations with patient outcomes. We consecutively enrolled 100 women ≥ 18 years with newly diagnosed, pathologically confirmed breast cancer into a prospective longitudinal cohort with systematically assessed demographic data, HIV status, and clinical characteristics. Tumor subtypes were further determined by immunohistochemistry, overall survival (OS) was estimated using Kaplan-Meier methods, and hazards ratios (HR) were calculated by Cox proportional hazard analyses. RESULTS Of the 100 participants, median age was 49 years, 19 were HIV-positive, and 75 presented with late stage (III/IV) disease. HER2-enriched and triple-negative/basal-like subtypes represented 17% and 25% tumors, respectively. One-year OS for the cohort was 74% (95% CI 62-83%). Multivariable analyses revealed mortality was associated with HIV (HR, 5.15; 95% CI 1.58-16.76; p = 0.006), stage IV disease (HR, 8.86; 95% CI 1.07-73.25; p = 0.043), and HER2-enriched (HR, 7.46; 95% CI 1.21-46.07; p = 0.031), and triple-negative subtypes (HR, 7.80; 95% CI 1.39-43.69; p = 0.020). CONCLUSION Late stage presentation, HER2-enriched and triple-negative subtypes, and HIV coinfection were overrepresented in our cohort relative to resource-rich settings and were associated with mortality. These findings highlight robust opportunities for population- and patient-level interventions across the entire cascade of care to improve breast cancer outcomes in low-income countries in SSA.
Collapse
Affiliation(s)
- Victoria M Youngblood
- UNC-Project Malawi, Private Bag A-104, Lilongwe, Malawi.,University of North Carolina At Chapel Hill, Chapel Hill, USA
| | | | | | - Takondwa Zuze
- UNC-Project Malawi, Private Bag A-104, Lilongwe, Malawi
| | - Yi Yang
- Aventura Hospital, Aventura, USA
| | | | | | - Jennifer Kincaid
- UNC-Project Malawi, Private Bag A-104, Lilongwe, Malawi.,Thomas Jefferson University, Philadelphia, USA
| | | | | | - Fred Chimzimu
- UNC-Project Malawi, Private Bag A-104, Lilongwe, Malawi
| | | | | | - Grace K Ellis
- UNC-Project Malawi, Private Bag A-104, Lilongwe, Malawi
| | - Ryan Seguin
- UNC-Project Malawi, Private Bag A-104, Lilongwe, Malawi
| | - Maganizo Chagomerana
- UNC-Project Malawi, Private Bag A-104, Lilongwe, Malawi.,University of North Carolina At Chapel Hill, Chapel Hill, USA
| | - Rebecca Maine
- UNC-Project Malawi, Private Bag A-104, Lilongwe, Malawi.,University of North Carolina At Chapel Hill, Chapel Hill, USA
| | - Sheryl Jordan
- UNC-Project Malawi, Private Bag A-104, Lilongwe, Malawi.,University of North Carolina At Chapel Hill, Chapel Hill, USA
| | - Anthony Charles
- UNC-Project Malawi, Private Bag A-104, Lilongwe, Malawi.,University of North Carolina At Chapel Hill, Chapel Hill, USA
| | - Clara Lee
- UNC-Project Malawi, Private Bag A-104, Lilongwe, Malawi.,Ohio State University, Columbus, USA
| | - Satish Gopal
- UNC-Project Malawi, Private Bag A-104, Lilongwe, Malawi. .,University of North Carolina At Chapel Hill, Chapel Hill, USA.
| | - Tamiwe Tomoka
- UNC-Project Malawi, Private Bag A-104, Lilongwe, Malawi. .,University of North Carolina At Chapel Hill, Chapel Hill, USA.
| |
Collapse
|
22
|
Jiagge E, Jibril AS, Davis M, Murga-Zamalloa C, Kleer CG, Gyan K, Divine G, Hoenerhoff M, Bensenhave J, Awuah B, Oppong J, Adjei E, Salem B, Toy K, Merajver S, Wicha M, Newman L. Androgen Receptor and ALDH1 Expression Among Internationally Diverse Patient Populations. J Glob Oncol 2019; 4:1-8. [PMID: 30307804 PMCID: PMC6818279 DOI: 10.1200/jgo.18.00056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose Population-based incidence rates of breast cancers that are negative for
estrogen receptor (ER), progesterone receptor, and human epidermal growth
factor receptor 2/neu (triple-negative breast cancer
[TNBC]) are higher among African American (AA) compared with white American
(WA) women, and TNBC prevalence is elevated among selected populations of
African patients. The extent to which TNBC risk is related to East African
versus West African ancestry, and whether these associations extend to
expression of other biomarkers, is uncertain. Methods We used immunohistochemistry to evaluate estrogen receptor, progesterone
receptor, human epidermal growth factor receptor 2/neu,
androgen receptor and aldehyde dehydrogenase 1 (ALDH1) expression among WA
(n = 153), AA (n = 76), Ethiopian (Eth)/East African (n = 90), and Ghanaian
(Gh)/West African (n = 286) patients with breast cancer through an
institutional review board–approved international research
program. Results Mean age at diagnosis was 43, 49, 60, and 57 years for the Eth, Gh, AA, and
WA patients, respectively. TNBC frequency was higher for AA and Gh patients
(41% and 54%, respectively) compared with WA and Eth patients (23% and 15%,
respectively; P < .001) Frequency of ALDH1 positivity
was higher for AA and Gh patients (32% and 36%, respectively) compared with
WA and Eth patients (23% and 17%, respectively; P = .007).
Significant differences were observed for distribution of androgen receptor
positivity: 71%, 55%, 42%, and 50% for the WA, AA, Gh, and Eth patients,
respectively (P = .008). Conclusion Extent of African ancestry seems to be associated with particular breast
cancer phenotypes. West African ancestry correlates with increased risk of
TNBC and breast cancers that are positive for ALDH1.
Collapse
Affiliation(s)
- Evelyn Jiagge
- Evelyn Jiagge, Carlos Murga-Zamalloa, Celina G. Kleer, Mark Hoenerhoff, Kathy Toy, Sofia Merajver, Barbara Salem, and Max Wicha, University of Michigan, Ann Arbor; George Divine, Jessica Bensenhaver, Henry Ford Health System, Detroit, MI; Evelyn Jiagge, Baffour Awuah, Joseph Oppong, and Ernest Adjei, Komfo Anokye Teaching Hospital, Kumasi, Ghana; and Aisha Souleiman Jibril, St. Paul's Hospital, Millenium Medical Center, Addis Ababa, Ethiopia; Lisa Newman, Melissa Davis, and Kofi Gyan, Weill Cornell Medicine, New York, NY
| | - Aisha Souleiman Jibril
- Evelyn Jiagge, Carlos Murga-Zamalloa, Celina G. Kleer, Mark Hoenerhoff, Kathy Toy, Sofia Merajver, Barbara Salem, and Max Wicha, University of Michigan, Ann Arbor; George Divine, Jessica Bensenhaver, Henry Ford Health System, Detroit, MI; Evelyn Jiagge, Baffour Awuah, Joseph Oppong, and Ernest Adjei, Komfo Anokye Teaching Hospital, Kumasi, Ghana; and Aisha Souleiman Jibril, St. Paul's Hospital, Millenium Medical Center, Addis Ababa, Ethiopia; Lisa Newman, Melissa Davis, and Kofi Gyan, Weill Cornell Medicine, New York, NY
| | - Melissa Davis
- Evelyn Jiagge, Carlos Murga-Zamalloa, Celina G. Kleer, Mark Hoenerhoff, Kathy Toy, Sofia Merajver, Barbara Salem, and Max Wicha, University of Michigan, Ann Arbor; George Divine, Jessica Bensenhaver, Henry Ford Health System, Detroit, MI; Evelyn Jiagge, Baffour Awuah, Joseph Oppong, and Ernest Adjei, Komfo Anokye Teaching Hospital, Kumasi, Ghana; and Aisha Souleiman Jibril, St. Paul's Hospital, Millenium Medical Center, Addis Ababa, Ethiopia; Lisa Newman, Melissa Davis, and Kofi Gyan, Weill Cornell Medicine, New York, NY
| | - Carlos Murga-Zamalloa
- Evelyn Jiagge, Carlos Murga-Zamalloa, Celina G. Kleer, Mark Hoenerhoff, Kathy Toy, Sofia Merajver, Barbara Salem, and Max Wicha, University of Michigan, Ann Arbor; George Divine, Jessica Bensenhaver, Henry Ford Health System, Detroit, MI; Evelyn Jiagge, Baffour Awuah, Joseph Oppong, and Ernest Adjei, Komfo Anokye Teaching Hospital, Kumasi, Ghana; and Aisha Souleiman Jibril, St. Paul's Hospital, Millenium Medical Center, Addis Ababa, Ethiopia; Lisa Newman, Melissa Davis, and Kofi Gyan, Weill Cornell Medicine, New York, NY
| | - Celina G Kleer
- Evelyn Jiagge, Carlos Murga-Zamalloa, Celina G. Kleer, Mark Hoenerhoff, Kathy Toy, Sofia Merajver, Barbara Salem, and Max Wicha, University of Michigan, Ann Arbor; George Divine, Jessica Bensenhaver, Henry Ford Health System, Detroit, MI; Evelyn Jiagge, Baffour Awuah, Joseph Oppong, and Ernest Adjei, Komfo Anokye Teaching Hospital, Kumasi, Ghana; and Aisha Souleiman Jibril, St. Paul's Hospital, Millenium Medical Center, Addis Ababa, Ethiopia; Lisa Newman, Melissa Davis, and Kofi Gyan, Weill Cornell Medicine, New York, NY
| | - Kofi Gyan
- Evelyn Jiagge, Carlos Murga-Zamalloa, Celina G. Kleer, Mark Hoenerhoff, Kathy Toy, Sofia Merajver, Barbara Salem, and Max Wicha, University of Michigan, Ann Arbor; George Divine, Jessica Bensenhaver, Henry Ford Health System, Detroit, MI; Evelyn Jiagge, Baffour Awuah, Joseph Oppong, and Ernest Adjei, Komfo Anokye Teaching Hospital, Kumasi, Ghana; and Aisha Souleiman Jibril, St. Paul's Hospital, Millenium Medical Center, Addis Ababa, Ethiopia; Lisa Newman, Melissa Davis, and Kofi Gyan, Weill Cornell Medicine, New York, NY
| | - George Divine
- Evelyn Jiagge, Carlos Murga-Zamalloa, Celina G. Kleer, Mark Hoenerhoff, Kathy Toy, Sofia Merajver, Barbara Salem, and Max Wicha, University of Michigan, Ann Arbor; George Divine, Jessica Bensenhaver, Henry Ford Health System, Detroit, MI; Evelyn Jiagge, Baffour Awuah, Joseph Oppong, and Ernest Adjei, Komfo Anokye Teaching Hospital, Kumasi, Ghana; and Aisha Souleiman Jibril, St. Paul's Hospital, Millenium Medical Center, Addis Ababa, Ethiopia; Lisa Newman, Melissa Davis, and Kofi Gyan, Weill Cornell Medicine, New York, NY
| | - Mark Hoenerhoff
- Evelyn Jiagge, Carlos Murga-Zamalloa, Celina G. Kleer, Mark Hoenerhoff, Kathy Toy, Sofia Merajver, Barbara Salem, and Max Wicha, University of Michigan, Ann Arbor; George Divine, Jessica Bensenhaver, Henry Ford Health System, Detroit, MI; Evelyn Jiagge, Baffour Awuah, Joseph Oppong, and Ernest Adjei, Komfo Anokye Teaching Hospital, Kumasi, Ghana; and Aisha Souleiman Jibril, St. Paul's Hospital, Millenium Medical Center, Addis Ababa, Ethiopia; Lisa Newman, Melissa Davis, and Kofi Gyan, Weill Cornell Medicine, New York, NY
| | - Jessica Bensenhave
- Evelyn Jiagge, Carlos Murga-Zamalloa, Celina G. Kleer, Mark Hoenerhoff, Kathy Toy, Sofia Merajver, Barbara Salem, and Max Wicha, University of Michigan, Ann Arbor; George Divine, Jessica Bensenhaver, Henry Ford Health System, Detroit, MI; Evelyn Jiagge, Baffour Awuah, Joseph Oppong, and Ernest Adjei, Komfo Anokye Teaching Hospital, Kumasi, Ghana; and Aisha Souleiman Jibril, St. Paul's Hospital, Millenium Medical Center, Addis Ababa, Ethiopia; Lisa Newman, Melissa Davis, and Kofi Gyan, Weill Cornell Medicine, New York, NY
| | - Baffour Awuah
- Evelyn Jiagge, Carlos Murga-Zamalloa, Celina G. Kleer, Mark Hoenerhoff, Kathy Toy, Sofia Merajver, Barbara Salem, and Max Wicha, University of Michigan, Ann Arbor; George Divine, Jessica Bensenhaver, Henry Ford Health System, Detroit, MI; Evelyn Jiagge, Baffour Awuah, Joseph Oppong, and Ernest Adjei, Komfo Anokye Teaching Hospital, Kumasi, Ghana; and Aisha Souleiman Jibril, St. Paul's Hospital, Millenium Medical Center, Addis Ababa, Ethiopia; Lisa Newman, Melissa Davis, and Kofi Gyan, Weill Cornell Medicine, New York, NY
| | - Joseph Oppong
- Evelyn Jiagge, Carlos Murga-Zamalloa, Celina G. Kleer, Mark Hoenerhoff, Kathy Toy, Sofia Merajver, Barbara Salem, and Max Wicha, University of Michigan, Ann Arbor; George Divine, Jessica Bensenhaver, Henry Ford Health System, Detroit, MI; Evelyn Jiagge, Baffour Awuah, Joseph Oppong, and Ernest Adjei, Komfo Anokye Teaching Hospital, Kumasi, Ghana; and Aisha Souleiman Jibril, St. Paul's Hospital, Millenium Medical Center, Addis Ababa, Ethiopia; Lisa Newman, Melissa Davis, and Kofi Gyan, Weill Cornell Medicine, New York, NY
| | - Ernest Adjei
- Evelyn Jiagge, Carlos Murga-Zamalloa, Celina G. Kleer, Mark Hoenerhoff, Kathy Toy, Sofia Merajver, Barbara Salem, and Max Wicha, University of Michigan, Ann Arbor; George Divine, Jessica Bensenhaver, Henry Ford Health System, Detroit, MI; Evelyn Jiagge, Baffour Awuah, Joseph Oppong, and Ernest Adjei, Komfo Anokye Teaching Hospital, Kumasi, Ghana; and Aisha Souleiman Jibril, St. Paul's Hospital, Millenium Medical Center, Addis Ababa, Ethiopia; Lisa Newman, Melissa Davis, and Kofi Gyan, Weill Cornell Medicine, New York, NY
| | - Barbara Salem
- Evelyn Jiagge, Carlos Murga-Zamalloa, Celina G. Kleer, Mark Hoenerhoff, Kathy Toy, Sofia Merajver, Barbara Salem, and Max Wicha, University of Michigan, Ann Arbor; George Divine, Jessica Bensenhaver, Henry Ford Health System, Detroit, MI; Evelyn Jiagge, Baffour Awuah, Joseph Oppong, and Ernest Adjei, Komfo Anokye Teaching Hospital, Kumasi, Ghana; and Aisha Souleiman Jibril, St. Paul's Hospital, Millenium Medical Center, Addis Ababa, Ethiopia; Lisa Newman, Melissa Davis, and Kofi Gyan, Weill Cornell Medicine, New York, NY
| | - Kathy Toy
- Evelyn Jiagge, Carlos Murga-Zamalloa, Celina G. Kleer, Mark Hoenerhoff, Kathy Toy, Sofia Merajver, Barbara Salem, and Max Wicha, University of Michigan, Ann Arbor; George Divine, Jessica Bensenhaver, Henry Ford Health System, Detroit, MI; Evelyn Jiagge, Baffour Awuah, Joseph Oppong, and Ernest Adjei, Komfo Anokye Teaching Hospital, Kumasi, Ghana; and Aisha Souleiman Jibril, St. Paul's Hospital, Millenium Medical Center, Addis Ababa, Ethiopia; Lisa Newman, Melissa Davis, and Kofi Gyan, Weill Cornell Medicine, New York, NY
| | - Sofia Merajver
- Evelyn Jiagge, Carlos Murga-Zamalloa, Celina G. Kleer, Mark Hoenerhoff, Kathy Toy, Sofia Merajver, Barbara Salem, and Max Wicha, University of Michigan, Ann Arbor; George Divine, Jessica Bensenhaver, Henry Ford Health System, Detroit, MI; Evelyn Jiagge, Baffour Awuah, Joseph Oppong, and Ernest Adjei, Komfo Anokye Teaching Hospital, Kumasi, Ghana; and Aisha Souleiman Jibril, St. Paul's Hospital, Millenium Medical Center, Addis Ababa, Ethiopia; Lisa Newman, Melissa Davis, and Kofi Gyan, Weill Cornell Medicine, New York, NY
| | - Max Wicha
- Evelyn Jiagge, Carlos Murga-Zamalloa, Celina G. Kleer, Mark Hoenerhoff, Kathy Toy, Sofia Merajver, Barbara Salem, and Max Wicha, University of Michigan, Ann Arbor; George Divine, Jessica Bensenhaver, Henry Ford Health System, Detroit, MI; Evelyn Jiagge, Baffour Awuah, Joseph Oppong, and Ernest Adjei, Komfo Anokye Teaching Hospital, Kumasi, Ghana; and Aisha Souleiman Jibril, St. Paul's Hospital, Millenium Medical Center, Addis Ababa, Ethiopia; Lisa Newman, Melissa Davis, and Kofi Gyan, Weill Cornell Medicine, New York, NY
| | - Lisa Newman
- Evelyn Jiagge, Carlos Murga-Zamalloa, Celina G. Kleer, Mark Hoenerhoff, Kathy Toy, Sofia Merajver, Barbara Salem, and Max Wicha, University of Michigan, Ann Arbor; George Divine, Jessica Bensenhaver, Henry Ford Health System, Detroit, MI; Evelyn Jiagge, Baffour Awuah, Joseph Oppong, and Ernest Adjei, Komfo Anokye Teaching Hospital, Kumasi, Ghana; and Aisha Souleiman Jibril, St. Paul's Hospital, Millenium Medical Center, Addis Ababa, Ethiopia; Lisa Newman, Melissa Davis, and Kofi Gyan, Weill Cornell Medicine, New York, NY
| |
Collapse
|
23
|
Hereditary Susceptibility for Triple Negative Breast Cancer Associated With Western Sub-Saharan African Ancestry. Ann Surg 2019; 270:484-492. [DOI: 10.1097/sla.0000000000003459] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
24
|
Lee S, Gedleh A, Hill JA, Qaiser S, Umukunda Y, Odiyo P, Kitonyi G, Dimaras H. In Their Own Words: A Qualitative Study of Kenyan Breast Cancer Survivors' Knowledge, Experiences, and Attitudes Regarding Breast Cancer Genetics. J Glob Oncol 2018; 4:1-9. [PMID: 30241137 PMCID: PMC6180770 DOI: 10.1200/jgo.17.00061] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Breast cancer ranks among the most common adult cancers in Kenya. Individuals with a family history of the disease are at increased risk. Mutations most commonly associated with breast cancer affect BRCA1 and BRCA2; mutations in several other genes may also confer breast cancer risk. Genetic testing and counseling can help patients understand their risk and assist clinicians in choosing therapies. We aimed to uncover what patients know, experience, and think with regard to breast cancer genetics in Kenya. METHODS Participants included breast cancer survivors age > 18 years. Participants completed a demographic questionnaire before participating in focus group discussions to uncover knowledge of, experiences with, and attitudes toward the genetics of breast cancer. Data were analyzed by inductive thematic analysis. RESULTS Four focus groups were conducted. Participants had rudimentary knowledge about genetics and cancer development, and although they understood breast cancer could be familial, many suspected environmental factors causing spontaneous disease. They reported limited experience with counseling about genetic risk, perceiving that their physicians were too busy to provide comprehensive information. Many indicated they promoted cancer screening among family to promote early diagnosis. Participants expressed a need for more comprehensive counseling and access to genetic testing, recognizing the added clarity it would bring to their families' risk of cancer. CONCLUSION Improved communication from health care teams could clarify the risk of cancer for affected families. The introduction of affordable genetic testing and counseling for breast cancer in Kenya is welcomed by survivors.
Collapse
Affiliation(s)
- Siwon Lee
- Siwon Lee, Amal Gedleh, Seemi
Qaiser, Yvonne Umukunda, and Helen Dimaras,
University of Toronto; Jessica A. Hill and Helen
Dimaras, The Hospital for Sick Children; Helen Dimaras,
SickKids Research Institute, Toronto, Ontario, Canada; Grace
Kitonyi, and Helen Dimaras, University of Nairobi; and
Philip Odiyo, Faraja Cancer Support Trust, Nairobi,
Kenya
| | - Amal Gedleh
- Siwon Lee, Amal Gedleh, Seemi
Qaiser, Yvonne Umukunda, and Helen Dimaras,
University of Toronto; Jessica A. Hill and Helen
Dimaras, The Hospital for Sick Children; Helen Dimaras,
SickKids Research Institute, Toronto, Ontario, Canada; Grace
Kitonyi, and Helen Dimaras, University of Nairobi; and
Philip Odiyo, Faraja Cancer Support Trust, Nairobi,
Kenya
| | - Jessica A. Hill
- Siwon Lee, Amal Gedleh, Seemi
Qaiser, Yvonne Umukunda, and Helen Dimaras,
University of Toronto; Jessica A. Hill and Helen
Dimaras, The Hospital for Sick Children; Helen Dimaras,
SickKids Research Institute, Toronto, Ontario, Canada; Grace
Kitonyi, and Helen Dimaras, University of Nairobi; and
Philip Odiyo, Faraja Cancer Support Trust, Nairobi,
Kenya
| | - Seemi Qaiser
- Siwon Lee, Amal Gedleh, Seemi
Qaiser, Yvonne Umukunda, and Helen Dimaras,
University of Toronto; Jessica A. Hill and Helen
Dimaras, The Hospital for Sick Children; Helen Dimaras,
SickKids Research Institute, Toronto, Ontario, Canada; Grace
Kitonyi, and Helen Dimaras, University of Nairobi; and
Philip Odiyo, Faraja Cancer Support Trust, Nairobi,
Kenya
| | - Yvonne Umukunda
- Siwon Lee, Amal Gedleh, Seemi
Qaiser, Yvonne Umukunda, and Helen Dimaras,
University of Toronto; Jessica A. Hill and Helen
Dimaras, The Hospital for Sick Children; Helen Dimaras,
SickKids Research Institute, Toronto, Ontario, Canada; Grace
Kitonyi, and Helen Dimaras, University of Nairobi; and
Philip Odiyo, Faraja Cancer Support Trust, Nairobi,
Kenya
| | - Philip Odiyo
- Siwon Lee, Amal Gedleh, Seemi
Qaiser, Yvonne Umukunda, and Helen Dimaras,
University of Toronto; Jessica A. Hill and Helen
Dimaras, The Hospital for Sick Children; Helen Dimaras,
SickKids Research Institute, Toronto, Ontario, Canada; Grace
Kitonyi, and Helen Dimaras, University of Nairobi; and
Philip Odiyo, Faraja Cancer Support Trust, Nairobi,
Kenya
| | - Grace Kitonyi
- Siwon Lee, Amal Gedleh, Seemi
Qaiser, Yvonne Umukunda, and Helen Dimaras,
University of Toronto; Jessica A. Hill and Helen
Dimaras, The Hospital for Sick Children; Helen Dimaras,
SickKids Research Institute, Toronto, Ontario, Canada; Grace
Kitonyi, and Helen Dimaras, University of Nairobi; and
Philip Odiyo, Faraja Cancer Support Trust, Nairobi,
Kenya
| | - Helen Dimaras
- Siwon Lee, Amal Gedleh, Seemi
Qaiser, Yvonne Umukunda, and Helen Dimaras,
University of Toronto; Jessica A. Hill and Helen
Dimaras, The Hospital for Sick Children; Helen Dimaras,
SickKids Research Institute, Toronto, Ontario, Canada; Grace
Kitonyi, and Helen Dimaras, University of Nairobi; and
Philip Odiyo, Faraja Cancer Support Trust, Nairobi,
Kenya
| |
Collapse
|
25
|
Martei YM, Vanderpuye V, Jones BA. Fear of Mastectomy Associated with Delayed Breast Cancer Presentation Among Ghanaian Women. Oncologist 2018; 23:1446-1452. [PMID: 29959283 DOI: 10.1634/theoncologist.2017-0409] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 04/17/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Breast cancer is the leading cause of cancer mortality among women globally. Most women in Ghana present with advanced stage disease. The aim of this study is to characterize sociocultural factors associated with delayed presentation. MATERIALS AND METHODS Qualitative study (grounded theory, constant comparative method) using individual in-depth interviews with breast cancer patients seen at the Korle Bu Teaching Hospital in Accra, Ghana. Interviews were conducted in English and three local languages. We achieved theoretical saturation with 31 participants. RESULTS The mean length of delay reported by patients was approximately 1 year. Five recurrent themes were related to delayed presentation: (a) Women with a confirmed breast cancer diagnosis delay treatment because of the fear of mastectomy due to self and societal stigma; (b) role of the church as a social support system given the societal stigma associated with breast cancer; (c) study participants expressed some awareness of breast cancer, but with varying depths of breast cancer knowledge encompassing both myths and misconceptions about breast cancer; (d) most patients present late because they do not associate a "painless" breast lump with possible breast malignancy; and (e) delayed presentation linked to significant financial burden associated with breast cancer treatment. CONCLUSION Despite current efforts to increase breast cancer awareness, the fear of mastectomy remains one of the main reasons for delayed presentation. Successful breast cancer education programs will need to be framed within the broader sociocultural dimensions of femininity that address some of the stigma associated with mastectomy reported in the Ghanaian context. IMPLICATIONS FOR PRACTICE Most women in Ghana present with advanced-stage disease. The aim of this study was to characterize sociocultural factors associated with delayed presentation. Although several quantitative studies have been conducted on delays in presentation in sub-Saharan Africa (SSA), this study is one of the few to identify fear of mastectomy as a reason for delayed presentation. Anecdotal data from current clinical experiences in SSA suggest that this is still an issue that has not been adequately reported and addressed in most SSA countries. The research results presented here will hopefully guide health providers and national organizations in designing breast cancer education programs in Ghana and other parts of SSA.
Collapse
Affiliation(s)
- Yehoda M Martei
- Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Verna Vanderpuye
- National Center for Radiotherapy and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, Ghana
| | - Beth A Jones
- Yale School of Public Health, Yale Comprehensive Cancer Center, New Haven, Connecticut, USA
| |
Collapse
|
26
|
Davis MB, Newman LA. Breast Cancer Disparities: How Can We Leverage Genomics to Improve Outcomes? Surg Oncol Clin N Am 2018; 27:217-234. [PMID: 29132562 DOI: 10.1016/j.soc.2017.07.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Breast cancer mortality rates are higher in African American compared with white American women. Disproportionately rising incidence rates, coupled with higher rates of biologically aggressive disease among African Americans is resulting in a widening of the mortality disparity. Higher rates of triple-negative breast cancer among African American women, as well as women from western sub-Saharan Africa, has prompted questions regarding the role of African ancestry as a marker of hereditary susceptibility for specific disease phenotypes. Advances in germline genetics, as well as somatic tumor genomic research, hold great promise in the effort to understand the biology of breast cancer variations between different population subsets.
Collapse
Affiliation(s)
- Melissa B Davis
- Henry Ford Cancer Institute, 2799 West Grand Boulevard, Detroit, MI 48202, USA
| | - Lisa A Newman
- Breast Oncology Program, Department of Surgery, Henry Ford Health System, Henry Ford Cancer Institute, International Center for the Study of Breast Cancer Subtypes, 2799 West Grand Boulevard, Detroit, MI 48202, USA.
| |
Collapse
|
27
|
McKenzie F, Zietsman A, Galukande M, Anele A, Adisa C, Parham G, Pinder L, Cubasch H, Joffe M, Kidaaga F, Lukande R, Offiah AU, Egejuru RO, Shibemba A, Schuz J, Anderson BO, dos Santos Silva I, McCormack V. Drivers of advanced stage at breast cancer diagnosis in the multicountry African breast cancer - disparities in outcomes (ABC-DO) study. Int J Cancer 2018; 142:1568-1579. [PMID: 29197068 PMCID: PMC5838525 DOI: 10.1002/ijc.31187] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 10/26/2017] [Accepted: 10/30/2017] [Indexed: 01/25/2023]
Abstract
Breast cancer (BC) survival rates in sub-Saharan Africa (SSA) are low in part due to advanced stage at diagnosis. As one component of a study of the entire journey of SSA women with BC, we aimed to identify shared and setting-specific drivers of advanced stage BC. Women newly diagnosed in the multicountry African Breast Cancer-Disparities in Outcomes (ABC-DO) study completed a baseline interview and their stage information was extracted from medical records. Ordinal logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) for advanced stage (I, II, III, IV) in relation to individual woman-level, referral and biological factors. A total of 1795 women were included from Nigeria, Uganda, Zambia, and the multiracial populations of Namibia and South Africa, 1091 of whom (61%) were stage III/IV. Stage was lower in women with greater BC knowledge (OR 0.77 (95% CI: 0.70, 0.85) per point on a 6 point scale). More advanced stage was associated with being black (4.00 (2.79, 5.74)), having attended
Collapse
Affiliation(s)
- Fiona McKenzie
- Section of Environment and RadiationInternational Agency for Research on CancerLyonFrance
| | | | | | | | | | | | | | - Herbert Cubasch
- University of the Witwatersrand, Chris Hani Baragwanath Academic HospitalJohannesburgSouth Africa
| | - Maureen Joffe
- University of the Witwatersrand, Chris Hani Baragwanath Academic HospitalJohannesburgSouth Africa
| | | | | | | | | | | | - Joachim Schuz
- Section of Environment and RadiationInternational Agency for Research on CancerLyonFrance
| | | | - Isabel dos Santos Silva
- Department of Non‐Communicable Disease EpidemiologyLondon School of Hygiene & Tropical MedicineLondonUK
| | - Valerie McCormack
- Section of Environment and RadiationInternational Agency for Research on CancerLyonFrance
| |
Collapse
|
28
|
Martei YM, Pace LE, Brock JE, Shulman LN. Breast Cancer in Low- and Middle-Income Countries: Why We Need Pathology Capability to Solve This Challenge. Clin Lab Med 2018; 38:161-173. [PMID: 29412880 PMCID: PMC6277976 DOI: 10.1016/j.cll.2017.10.013] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Breast cancer is the leading cause of cancer mortality among women in developing countries. Timely and accurate histopathological diagnosis of breast cancer is critical to delivering high-quality breast cancer care to patients in low- and middle-income countries (LMIC). The most important prognostic factors in breast cancer along with tumor size and nodal status are tumor grade, estrogen receptor status, as well as HER2 status in countries where specific targeted therapies are available. In addition, detailed and complete cancer registry data are needed to assess a country's disease burden and guide disease prioritization and allocation of resources for breast cancer treatment. Innovations in leapfrog technology and low-cost point-of-care tests for molecular evaluations are needed to provide accurate and timely pathology, with the ultimate goal of improving survival outcomes for patients with breast cancer in LMIC.
Collapse
Affiliation(s)
- Yehoda M Martei
- Division of Hematology-Oncology, Department of Medicine, University of Pennsylvania, Abramson Cancer Center, 3400 Civic Center Boulevard, Philadelphia, PA 19106 USA
| | - Lydia E Pace
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Jane E Brock
- Department of Pathology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Lawrence N Shulman
- Division of Hematology-Oncology, Department of Medicine, University of Pennsylvania, Abramson Cancer Center, 3400 Civic Center Boulevard, Philadelphia, PA 19106 USA.
| |
Collapse
|
29
|
Triple-Negative Breast Cancer, Stem Cells, and African Ancestry. THE AMERICAN JOURNAL OF PATHOLOGY 2018; 188:271-279. [DOI: 10.1016/j.ajpath.2017.06.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 06/10/2017] [Accepted: 06/26/2017] [Indexed: 02/07/2023]
|
30
|
Sengal AT, Haj-Mukhtar NS, Elhaj AM, Bedri S, Kantelhardt EJ, Mohamedani AA. Immunohistochemistry defined subtypes of breast cancer in 678 Sudanese and Eritrean women; hospitals based case series. BMC Cancer 2017; 17:804. [PMID: 29191181 PMCID: PMC5710067 DOI: 10.1186/s12885-017-3805-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 11/21/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Breast cancer is the most common malignancy accounting for 25% of all cancers in females. In Africa, breast cancer prevalence and mortality are steadily increasing. Knowledge of hormone receptors and human epidermal growth factor receptor-2 (HER-2) expressions are vital for breast cancer management plans and decision making. There is wide regional variation in the proportion of these biomarkers, especially in African countries. Hormone receptors positivity in indigenous African and African American women is considered to be low and triple negative breast cancer is a dominant phenotype. There is paucity of data regarding hormone receptors (ER and PR) and HER2 expressions in North-eastern Africa (Eritrea and Sudan). The purpose of this study was to evaluate the expression of ER, PR and HER2 in Eritrean and Sudanese case series and correlate these biomarkers with the clinicopathological profile. METHOD Clinicopathologic data of patients were collected from clinical records. Immunohistochemistry biomarkers (ER, PR, and HER2) were assessed in consecutive female patients who had been diagnosed with invasive breast cancer from 2011 to 2015 in Gezira University Pathology Laboratory, the Sudan and National Health laboratory, Asmara, Eritrea. RESULTS There were 678 cases involved in this study. The mean age was 48.8 years with ±0.53 standard error of the mean. Two-thirds of the case were ≤50 years. Invasive ductal carcinoma, no special type was the most dominant histologic type (86%) in both study groups. The majority of cases (70%) had tumour stage pT2 and pT3 and about 50% had lymph node involvement. Less than 5% of the cases had well-differentiated tumours. The ER, PR and HER2 positive rates were 45%, 32%, and 29%, respectively. The proportion of luminal-A like, luminal-B like, HER2 enriched and TNBC were 37%, 13%, 16% and 34%, respectively. Fisher extract analysis showed age (p = .015), tumour size (p = .041), and histologic grade (p = .000) were significantly associated with intrinsic subtypes. Furthermore, Logistic regression analysis stratified by origin, age, tumour size, lymph-node metastasis and grade indicated that younger women age (≤50 years) and grade III tumours were more likely to be diagnosed with ER negative breast cancer. CONCLUSION Most of Sudanese and Eritrean women were diagnosed at younger age and with unfavourable prognostic clinicopathologic prognostic markers. TNBC is more frequent in this cohort study; patients with grade III tumours and young age are more likely to be hormone receptors negative. Therefore, routine determination of hormone receptors is warranted for appropriate targeted therapy.
Collapse
Affiliation(s)
- Asmerom Tesfamariam Sengal
- Pathology Department, Faculty of Medicine, University of Gezira, Wad-Medani, Gezira Sudan
- Orotta School of Medicine and Dentistry, Asmara, Eritrea
| | | | | | - Shahinaz Bedri
- Weill Cornell of Medicine- Qatar, Pathology and Laboratory Medicine, Department of Medical Education, Doha, Qatar
| | - Eva Johanna Kantelhardt
- Department of Gynaecology, Institute of Medical Epidemiology, Biostatistics and Informatcs, Martin-Luther University, (Saale) Halle-Wittenberg, Germany
| | - Ahmed A. Mohamedani
- Pathology Department, Faculty of Medicine, University of Gezira, Wad-Medani, Gezira Sudan
| |
Collapse
|
31
|
Ethnicity and breast cancer characteristics in Kenya. Breast Cancer Res Treat 2017; 167:425-437. [PMID: 28951987 DOI: 10.1007/s10549-017-4511-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 09/13/2017] [Indexed: 12/31/2022]
Abstract
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 diagnosed between March 2012 and May 2015 at 11 hospitals throughout Kenya. Sociodemographic, 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 tumor characteristics or molecular subtypes by ethnicity, although the Nilote tumors 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 tumor characteristics or molecular subtypes, but significant differences in sociodemographic 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.
Collapse
|
32
|
Newman LA, Stark A, Chitale D, Pepe M, Longton G, Worsham MJ, Nathanson SD, Miller P, Bensenhaver JM, Proctor E, Swain M, Patriotis C, Engstrom PF. Association Between Benign Breast Disease in African American and White American Women and Subsequent Triple-Negative Breast Cancer. JAMA Oncol 2017; 3:1102-1106. [PMID: 28006062 DOI: 10.1001/jamaoncol.2016.5598] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Importance Compared with white American (WA) women, African American (AA) women have a 2-fold higher incidence of breast cancers that are negative for estrogen receptor, progesterone receptor, and ERBB2 (triple-negative breast cancer [TNBC]). Triple-negative breast cancer, compared with non-TNBC, likely arises from different pathogenetic pathways, and benign breast disease (BBD) predicts future non-TNBC. Objective To determine whether AA identity remains associated with TNBC for women with a prior diagnosis of BBD. Design, Setting, and Participants This study is a retrospective analysis of data of a cohort of 2588 AA and 3566 WA women aged between 40 and 70 years with a biopsy-proven BBD diagnosis. The data-obtained from the Pathology Information System of Henry Ford Health System (HFHS), an integrated multihospital and multispecialty health care system headquartered in Detroit, Michigan-include specimens of biopsies performed between January 1, 1994, and December 31, 2005. Data analysis was performed from November 1, 2015, to June 15, 2016. Main Outcomes and Measures Subsequent breast cancer was stratified on the basis of combinations of hormone receptor and ERBB2 expression. Results Case management, follow-up, and outcomes received or obtained by our cohort of 2588 AA and 3566 WA patients were similar, demonstrating that HFHS delivered care equitably. Subsequent breast cancers developed in 103 (4.1%) of AA patients (mean follow-up interval of 6.8 years) and 143 (4.0%) of WA patients (mean follow-up interval of 6.1 years). More than three-quarters of subsequent breast cancers in each subset were ductal carcinoma in situ or stage I. The 10-year probability estimate for developing TNBC was 0.56% (95% CI, 0.32%-1.0%) for AA patients and 0.25% (95% CI, 0.12%-0.53%) for WA patients. Among the 66 AA patients who developed subsequent invasive breast cancer, 16 (24.2%) developed TNBC compared with 7 (7.4%) of the 94 WA patients who developed subsequent invasive breast cancers and had complete biomarker data (P = .01). Conclusions and Relevance This study is the largest analysis to date of TNBC in the context of racial/ethnic identity and BBD as risk factors. The study found that AA identity persisted as a significant risk factor for TNBC. This finding suggests that AA identity is associated with inherent susceptibility for TNBC pathogenetic pathways.
Collapse
Affiliation(s)
- Lisa A Newman
- Breast Oncology Program, Department of Surgery, International Center for the Study of Breast Cancer Subtypes, Henry Ford Health System, Detroit, Michigan
| | - Azadeh Stark
- Breast Oncology Program, Department of Surgery, International Center for the Study of Breast Cancer Subtypes, Henry Ford Health System, Detroit, Michigan.,Breast Oncology Program, Department of Pathology, Henry Ford Health System, Detroit, Michigan
| | - Dhanajay Chitale
- Breast Oncology Program, Department of Pathology, Henry Ford Health System, Detroit, Michigan
| | - Margaret Pepe
- Department of Biostatistics and Biomathematics, Fred Hutchinson Comprehensive Cancer Center, Seattle, Washington
| | - Gary Longton
- Department of Biostatistics and Biomathematics, Fred Hutchinson Comprehensive Cancer Center, Seattle, Washington
| | - Maria J Worsham
- Breast Oncology Program, Department of Otolaryngology, Henry Ford Health System, Detroit, Michigan
| | - S David Nathanson
- Breast Oncology Program, Department of Surgery, International Center for the Study of Breast Cancer Subtypes, Henry Ford Health System, Detroit, Michigan
| | - Patricia Miller
- Breast Oncology Program, Department of Radiology, Henry Ford Health System, Detroit, Michigan
| | - Jessica M Bensenhaver
- Breast Oncology Program, Department of Surgery, International Center for the Study of Breast Cancer Subtypes, Henry Ford Health System, Detroit, Michigan
| | - Erica Proctor
- Breast Oncology Program, Department of Surgery, International Center for the Study of Breast Cancer Subtypes, Henry Ford Health System, Detroit, Michigan
| | - Monique Swain
- Breast Oncology Program, Department of Surgery, International Center for the Study of Breast Cancer Subtypes, Henry Ford Health System, Detroit, Michigan
| | - Christos Patriotis
- Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland
| | | |
Collapse
|
33
|
Lukong KE, Ogunbolude Y, Kamdem JP. Breast cancer in Africa: prevalence, treatment options, herbal medicines, and socioeconomic determinants. Breast Cancer Res Treat 2017; 166:351-365. [PMID: 28776284 DOI: 10.1007/s10549-017-4408-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 07/17/2017] [Indexed: 12/11/2022]
Abstract
Breast cancer is the leading cause of cancer-related deaths in women worldwide. GLOBOCAN estimated about 1.7 million new cases of breast cancer diagnoses worldwide and about 522,000 deaths in 2012. The burden of breast cancer mortality lies in the developing low-income and middle-income countries, where about 70% of such deaths occur. The incidence of breast cancer is also rising in low-income and middle-income countries in Africa as trend towards urbanization, and adoption of Western lifestyles increases. In general, the triple-negative breast cancer (TNBC) subtype tends to be frequent in women of African ancestry. What are the factors contributing to this prevalence? Are there genetic predispositions to TNBC in African women? This review addresses these questions and provides an update on the incidence, survival, and mortality of breast cancer in Africans, with a focus on sub-Saharan Africans. We have also addressed factors that could account for ethical disparities in incidence and mortality. Further, we have highlighted challenges associated with access to essential drug and to healthcare treatment in some African countries and outlined alternative/herbal treatment methods that are increasingly implemented in Africa and other developing nations.
Collapse
Affiliation(s)
- Kiven Erique Lukong
- Department of Biochemistry, College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada.
| | - Yetunde Ogunbolude
- Department of Biochemistry, College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | - Jean Paul Kamdem
- Department of Biological Sciences, Regional University of Cariri, Campus Pimenta, Crato, Ceará, CEP: 63105-000, Brazil
| |
Collapse
|
34
|
Nartey Y, Hill PC, Amo-Antwi K, Nyarko KM, Yarney J, Cox B. Cervical Cancer in the Greater Accra and Ashanti Regions of Ghana. J Glob Oncol 2016; 3:782-790. [PMID: 29244993 PMCID: PMC5735962 DOI: 10.1200/jgo.2016.005744] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Purpose Cervical cancer is a common cancer among women worldwide. An estimated 528,000 new cases and 266,000 deaths occurred in 2012. More than 85% of invasive cervical cancer cases occur in low- and middle-income countries. Cervical cancer ranks as the most common cancer among women in Ghana. We conducted a retrospective study to assess the descriptive epidemiology of cervical cancer in Ghana. We describe cervical cancer incidence and mortality rates for the regions served by two large hospitals in Ghana. Patients and Methods Information for women diagnosed with invasive cervical cancer between 2010 and 2013 was collected from the Komfo Anokye and Korle Bu Teaching Hospitals through review of medical, computer, and pathology records at the oncology units and the obstetrics and gynecology departments. Telephone interviews were also conducted with patients and relatives. Data were analyzed using summary statistics. Results A total of 1,725 women with cervical cancer were included in the study. Their ages ranged from 11 to 100 years (mean, 56.9 years). The histology of the primary tumor was the basis of diagnosis in 77.5% of women and a clinical diagnosis was made in 22.5% of women. For the 1,336 women for whom tumor grade was available, 34.3% were moderately differentiated tumors. Late stage at presentation was common. The incidence and mortality rates of cervical cancer increased with age up until the 75 to 79-year age group and began to decrease at older ages. The Greater Accra region had higher overall incidence and mortality rates than the Ashanti region. Conclusion Our study suggests that improvements in the application of preventive strategies could considerably reduce the burden of cervical cancer in Ghana and other low- and middle-income countries. The study provides important information to inform policy on cancer prevention and control in Ghana.
Collapse
Affiliation(s)
- Yvonne Nartey
- Yvonne Nartey, Philip C. Hill, and Brian Cox, University of Otago, Dunedin, New Zealand; Kwabena Amo-Antwi, Komfo Anokye Teaching Hospital, Kumasi; Kofi M. Nyarko, Ghana Health Service; and Joel Yarney, Korle Bu Teaching Hospital, Accra, Ghana
| | - Philip C Hill
- Yvonne Nartey, Philip C. Hill, and Brian Cox, University of Otago, Dunedin, New Zealand; Kwabena Amo-Antwi, Komfo Anokye Teaching Hospital, Kumasi; Kofi M. Nyarko, Ghana Health Service; and Joel Yarney, Korle Bu Teaching Hospital, Accra, Ghana
| | - Kwabena Amo-Antwi
- Yvonne Nartey, Philip C. Hill, and Brian Cox, University of Otago, Dunedin, New Zealand; Kwabena Amo-Antwi, Komfo Anokye Teaching Hospital, Kumasi; Kofi M. Nyarko, Ghana Health Service; and Joel Yarney, Korle Bu Teaching Hospital, Accra, Ghana
| | - Kofi M Nyarko
- Yvonne Nartey, Philip C. Hill, and Brian Cox, University of Otago, Dunedin, New Zealand; Kwabena Amo-Antwi, Komfo Anokye Teaching Hospital, Kumasi; Kofi M. Nyarko, Ghana Health Service; and Joel Yarney, Korle Bu Teaching Hospital, Accra, Ghana
| | - Joel Yarney
- Yvonne Nartey, Philip C. Hill, and Brian Cox, University of Otago, Dunedin, New Zealand; Kwabena Amo-Antwi, Komfo Anokye Teaching Hospital, Kumasi; Kofi M. Nyarko, Ghana Health Service; and Joel Yarney, Korle Bu Teaching Hospital, Accra, Ghana
| | - Brian Cox
- Yvonne Nartey, Philip C. Hill, and Brian Cox, University of Otago, Dunedin, New Zealand; Kwabena Amo-Antwi, Komfo Anokye Teaching Hospital, Kumasi; Kofi M. Nyarko, Ghana Health Service; and Joel Yarney, Korle Bu Teaching Hospital, Accra, Ghana
| |
Collapse
|
35
|
McKenzie F, Zietsman A, Galukande M, Anele A, Adisa C, Cubasch H, Parham G, Anderson BO, Abedi-Ardekani B, Schuz J, dos Santos Silva I, McCormack V. African Breast Cancer-Disparities in Outcomes (ABC-DO): protocol of a multicountry mobile health prospective study of breast cancer survival in sub-Saharan Africa. BMJ Open 2016; 6:e011390. [PMID: 27554102 PMCID: PMC5013398 DOI: 10.1136/bmjopen-2016-011390] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 04/07/2016] [Accepted: 05/26/2016] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Sub-Saharan African (SSA) women with breast cancer (BC) have low survival rates from this potentially treatable disease. An understanding of context-specific societal, health-systems and woman-level barriers to BC early detection, diagnosis and treatment are needed. METHODS The African Breast Cancer-Disparities in Outcomes (ABC-DO) is a prospective hospital-based study of overall survival, impact on quality of life (QOL) and delays along the journey to diagnosis and treatment of BC in SSA. ABC-DO is currently recruiting in Namibia, Nigeria, South Africa, Uganda and Zambia. Women aged 18 years or older who present at participating secondary and tertiary hospitals with a new clinical or histocytological diagnosis of primary BC are invited to participate. For consented women, tumour characteristics, specimen and treatment data are obtained. Over a 2-year enrolment period, we aim to recruit 2000 women who, in the first instance, will be followed for between 1 and 3 years. A face-to-face baseline interview obtains information on socioeconomic, cultural and demographic factors, QOL, health and BC attitudes/knowledge, and timing of all prediagnostic contacts with caregivers in orthodox health, traditional and spiritual systems. Responses are immediately captured on mobile devices that are fed into a tailored mobile health (mHealth) study management system. This system implements the study protocol, by prompting study researchers to phone women on her mobile phone every 3 months and, failing to reach her, prompts contact with her next-of-kin. At follow-up calls, women provide updated information on QOL, care received and disease impacts on family and working life; date of death is asked of her next-of-kin when relevant. ETHICS AND DISSEMINATION The study was approved by ethics committees of all involved institutions. All participants provide written informed consent. The findings from the study will be published in peer-reviewed scientific journals, presented to funders and relevant local organisations and at scientific conferences.
Collapse
Affiliation(s)
- Fiona McKenzie
- Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France
| | | | | | | | - Charles Adisa
- Abia State University Teaching Hospital, Aba, Nigeria
| | - Herbert Cubasch
- Department of Surgery, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | | | | | | | - Joachim Schuz
- Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France
| | - Isabel dos Santos Silva
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Valerie McCormack
- Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France
| |
Collapse
|
36
|
Jiagge E, Jibril AS, Chitale D, Bensenhaver JM, Awuah B, Hoenerhoff M, Adjei E, Bekele M, Abebe E, Nathanson SD, Gyan K, Salem B, Oppong J, Aitpillah F, Kyei I, Bonsu EO, Proctor E, Merajver SD, Wicha M, Stark A, Newman LA. Comparative Analysis of Breast Cancer Phenotypes in African American, White American, and West Versus East African patients: Correlation Between African Ancestry and Triple-Negative Breast Cancer. Ann Surg Oncol 2016; 23:3843-3849. [PMID: 27469125 DOI: 10.1245/s10434-016-5420-z] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Triple-negative breast cancer (TNBC) is more common among African American (AA) and western sub-Saharan African breast cancer (BC) patients compared with White/Caucasian Americans (WA) and Europeans. Little is known about TNBC in east Africa. METHODS Invasive BC diagnosed 1998-2014 were evaluated: WA and AA patients from the Henry Ford Health System in Detroit, Michigan; Ghanaian/west Africans from the Komfo Anokye Teaching Hospital in Kumasi, Ghana; and Ethiopian/east Africans from the St. Paul's Hospital Millennium Medical College in Addis Ababa, Ethiopia. Histopathology and immunohistochemistry for estrogen receptor (ER), progesterone receptor (PR), and HER2/neu expression was performed in Michigan on formalin-fixed, paraffin-embedded samples from all cases. RESULTS A total of 234 Ghanaian (mean age 49 years), 94 Ethiopian (mean age 43 years), 272 AA (mean age 60 years), and 321 WA (mean age 62 years; p = 0.001) patients were compared. ER-negative and TNBC were more common among Ghanaian and AA compared with WA and Ethiopian cases (frequency ER-negativity 71.1 and 37.1 % vs. 19.8 and 28.6 % respectively, p < 0.0001; frequency TNBC 53.2 and 29.8 % vs. 15.5 and 15.0 %, respectively, p < 0.0001). Among patients younger than 50 years, prevalence of TNBC remained highest among Ghanaians (50.8 %) and AA (34.3 %) compared with WA and Ethiopians (approximately 16 % in each; p = 0.0002). CONCLUSIONS This study confirms an association between TNBC and West African ancestry; TNBC frequency among AA patients is intermediate between WA and Ghanaian/West Africans consistent with genetic admixture following the west Africa-based trans-Atlantic slave trade. TNBC frequency was low among Ethiopians/East Africans; this may reflect less shared ancestry between AA and Ethiopians.
Collapse
Affiliation(s)
- Evelyn Jiagge
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA.,Department of Oncology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Aisha Souleiman Jibril
- Department of Pathology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | - Jessica M Bensenhaver
- Department of Surgery, Henry Ford Health System, Detroit, MI, USA.,International Center for the Study of Breast Cancer Subtypes, Henry Ford Health System, Detroit, MI, USA
| | - Baffour Awuah
- Department of Oncology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Mark Hoenerhoff
- In Vivo Animal Core, Unit for Laboratory Animal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Ernest Adjei
- Department of Oncology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Mahteme Bekele
- Department of Surgery, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Engida Abebe
- Department of Surgery, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - S David Nathanson
- Department of Surgery, Henry Ford Health System, Detroit, MI, USA.,International Center for the Study of Breast Cancer Subtypes, Henry Ford Health System, Detroit, MI, USA
| | - Kofi Gyan
- International Center for the Study of Breast Cancer Subtypes, Henry Ford Health System, Detroit, MI, USA
| | - Barbara Salem
- International Center for the Study of Breast Cancer Subtypes, Henry Ford Health System, Detroit, MI, USA
| | - Joseph Oppong
- Department of Oncology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Francis Aitpillah
- Department of Oncology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Ishmael Kyei
- Department of Oncology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Ernest Osei Bonsu
- Department of Oncology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Erica Proctor
- Department of Surgery, Henry Ford Health System, Detroit, MI, USA.,International Center for the Study of Breast Cancer Subtypes, Henry Ford Health System, Detroit, MI, USA
| | - Sofia D Merajver
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA
| | - Max Wicha
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA
| | - Azadeh Stark
- Department of Pathology, Henry Ford Health System, Detroit, MI, USA
| | - Lisa A Newman
- Department of Surgery, Henry Ford Health System, Detroit, MI, USA. .,International Center for the Study of Breast Cancer Subtypes, Henry Ford Health System, Detroit, MI, USA.
| |
Collapse
|
37
|
Jiagge E, Oppong JK, Bensenhaver J, Aitpillah F, Gyan K, Kyei I, Osei-Bonsu E, Adjei E, Ohene-Yeboah M, Toy K, Jackson KE, Akpaloo M, Acheampong D, Antwi B, Agyeman FO, Alhassan Z, Fondjo LA, Owusu-Afriyie O, Brewer RN, Gyamfuah A, Salem B, Johnson T, Wicha M, Merajver S, Kleer C, Pang J, Amankwaa-Frempong E, Stark A, Abantanga F, Newman L, Awuah B. Breast Cancer and African Ancestry: Lessons Learned at the 10-Year Anniversary of the Ghana-Michigan Research Partnership and International Breast Registry. J Glob Oncol 2016; 2:302-310. [PMID: 28717716 PMCID: PMC5493263 DOI: 10.1200/jgo.2015.002881] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Women with African ancestry in western, sub-Saharan Africa and in the United States represent a population subset facing an increased risk of being diagnosed with biologically aggressive phenotypes of breast cancer that are negative for the estrogen receptor, the progesterone receptor, and the HER2/neu marker. These tumors are commonly referred to as triple-negative breast cancer. Disparities in breast cancer incidence and outcome related to racial or ethnic identity motivated the establishment of the International Breast Registry, on the basis of partnerships between the Komfo Anokye Teaching Hospital in Kumasi, Ghana, the University of Michigan Comprehensive Cancer Center in Ann Arbor, Michigan, and the Henry Ford Health System in Detroit, Michigan. This research collaborative has featured educational training programs as well as scientific investigations related to the comparative biology of breast cancer in Ghanaian African, African American, and white/European American patients. Currently, the International Breast Registry has expanded to include African American patients throughout the United States by partnering with the Sisters Network (a national African American breast cancer survivors' organization) and additional sites in Ghana (representing West Africa) as well as Ethiopia (representing East Africa). Its activities are now coordinated through the Henry Ford Health System International Center for the Study of Breast Cancer Subtypes. Herein, we review the history and results of this international program at its 10-year anniversary.
Collapse
Affiliation(s)
- Evelyn Jiagge
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Joseph Kwaku Oppong
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Jessica Bensenhaver
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Francis Aitpillah
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Kofi Gyan
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Ishmael Kyei
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Ernest Osei-Bonsu
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Ernest Adjei
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Michael Ohene-Yeboah
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Kathy Toy
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Karen Eubanks Jackson
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Marian Akpaloo
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Dorcas Acheampong
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Beatrice Antwi
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Faustina Obeng Agyeman
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Zainab Alhassan
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Linda Ahenkorah Fondjo
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Osei Owusu-Afriyie
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Robert Newman Brewer
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Amma Gyamfuah
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Barbara Salem
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Timothy Johnson
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Max Wicha
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Sofia Merajver
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Celina Kleer
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Judy Pang
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Emmanuel Amankwaa-Frempong
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Azadeh Stark
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Francis Abantanga
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Lisa Newman
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Baffour Awuah
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| |
Collapse
|