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Ballé JK, Vetter M, Kenea TW, Eber-Schulz P, Reibold C, Ziegenhorn HV, Stückrath K, Wickenhauser C, Addissie A, Santos P, Kantelhardt EJ, Getachew S, Bauer M. PAM50 breast cancer subtypes and survival of patients in rural Ethiopia without adjuvant treatment: a prospective observational study. BMC Cancer 2024; 24:1127. [PMID: 39256703 PMCID: PMC11385137 DOI: 10.1186/s12885-024-12867-6] [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: 05/16/2024] [Accepted: 08/27/2024] [Indexed: 09/12/2024] Open
Abstract
PURPOSE Survival rates of breast cancer (BC) patients are particularly low in rural regions in sub-Saharan Africa (SSA) which is due to limited access to therapy. In recent years, gene expression profiling (GEP) of BC showed a strong prognostic value in patients with local tumour surgery and (neo)adjuvant treatment. The aim of this study was to evaluate the impact of intrinsic subtypes on survival of patients in rural Ethiopia without any (neo)adjuvant therapy. METHODS In total, 113 female patients from Aira Hospital with histologically proven BC and treated only with surgery were included in this study. All samples were analysed by immunohistochemistry (IHC) for estrogen receptor, progesterone receptor, HER2 and Ki67, as well as RNA-expression analysis for PAM50 subtyping. RESULTS A positive hormone receptor status was found in 69.0% of the tumours and intrinsic subtyping demonstrated Luminal B to be the most common subtype (34.5%). Follow-up data was available for 79 of 113 patients. Two-year overall survival (OS) was 57.3% and a considerably worse OS was observed in patients with Basal-like BC compared to Luminal A BC. Moreover, advanced tumours showed an increased risk of mortality. CONCLUSION The OS was very low in the patient cohort that received no (neo)adjuvant treatment. Immunohistochemistry and GEP confirmed endocrine-sensitive tumours in more than half of the patients, with a large proportion of Luminal B, HER2-enriched and Basal-like tumours so that adjuvant chemotherapy should be recommended.
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Affiliation(s)
- Judith Katharina Ballé
- Global Health Working Group, Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Martina Vetter
- Department of Gynaecology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | | | - Pia Eber-Schulz
- Global Health Working Group, Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Christian Reibold
- Global Health Working Group, Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Hannes-Viktor Ziegenhorn
- Global Health Working Group, Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Department of Anesthesiology and Critical Care Medicine, Carl Gustav Carus University Hospital, Dresden, Germany
| | - Kathrin Stückrath
- Department of Gynaecology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Claudia Wickenhauser
- Institute of Pathology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Adamu Addissie
- Global Health Working Group, Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Pablo Santos
- Global Health Working Group, Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Eva Johanna Kantelhardt
- Global Health Working Group, Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Department of Gynaecology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Sefonias Getachew
- Global Health Working Group, Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Marcus Bauer
- Global Health Working Group, Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
- Institute of Pathology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
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Bekele K, Nugusu F, Beressa G, Hollis T, Ferreres A, Duguma D, Guta B, Gutnik L, Lemesse B, Gezahegn H. Proportion of early-stage breast cancer at diagnosis in Ethiopia: a systematic review and meta-analysis. BMC Cancer 2024; 24:1017. [PMID: 39152421 PMCID: PMC11328426 DOI: 10.1186/s12885-024-12768-8] [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: 02/06/2024] [Accepted: 08/06/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUND Breast cancer is the most common cancer-affecting women globally, with disproportionally high mortality rates in lower-income countries, including Ethiopia. The stage at diagnosis is a well-defined predictive system that determines the likelihood of breast cancer mortality. Early-stage breast cancer at diagnosis is associated with better treatment outcomes as compared with late stage. Although there are numerous primary studies on women with breast cancer with different proportions of early-stage breast cancer, there is currently no summary data on what proportion of breast cancer was diagnosed at early-stage in Ethiopia. This study focused on a pooled proportion of early-stage breast cancer at diagnosis in Ethiopia. METHODS By using key terms, Medline through Pub-Med, Google Scholar, Science Direct, HINARI and Medley were searched about breast cancer in Ethiopia, and a total of 288 articles were retrieved. After screening the articles and quality of each article was assessed using Newcastle-Ottawa Scale. Finally, 41 articles were used for the final pooled proportion. A random effects model was used to estimate the pooled prevalence and heterogeneity of included studies that were then assessed by using prediction interval. RESULTS Pooled proportion of early-stage breast cancer at diagnosis in Ethiopian hospitals was found to be 36% with a 95% confidence interval ranging from 31 to 41% and a 95% prediction interval ranging from 28 to 45%. CONCLUSION Most breast cancer patients (64%) in Ethiopia are diagnosed at a late-stage. This contributes to the high mortality rates of breast cancer among women in Ethiopia. Therefore, in line with recommendations by the World Health Organization, we recommend that there should be an emphasis in Ethiopia to focus on early detection of breast cancer.
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Affiliation(s)
- Kebebe Bekele
- School of Medicine, Department of Surgery, Madda Walabu University, Bale-Goba, Ethiopia.
| | - Fikadu Nugusu
- Department of Public Health, Madda Walabu University, Health Sciences, Bale-Goba, Ethiopia
| | - Girma Beressa
- School of Health Sciences, Department of Public Health, Madda Walabu University, Bale-Goba, Ethiopia
| | - Taylor Hollis
- University of Alabama at Birmingham, UAB Department of Surgery, Tuscaloosa, AL, United States
| | - Alberto Ferreres
- University of Buenos Aires, Education and Research Clinical Hospital "Jose de San Martin", Buenos Aires, Argentina
| | | | | | - Lily Gutnik
- Department of Surgery, University of Alabama at Birmingham, Heersink School of Medicine, Tuscaloosa, AL, United States
| | - Bekena Lemesse
- Adama General Hospital and Medical College, Adama, Ethiopia
| | - Habtamu Gezahegn
- School of Medicine, Department of Medical Physiology, Madda Walabu University, Bale-Goba, Ethiopia
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Geremew H, Golla EB, Simegn MB, Abate A, Ali MA, Kumbi H, Wondie SG, Mengstie MA, Tilahun WM. Late-stage diagnosis: The driving force behind high breast cancer mortality in Ethiopia: A systematic review and meta-analysis. PLoS One 2024; 19:e0307283. [PMID: 39028722 PMCID: PMC11259299 DOI: 10.1371/journal.pone.0307283] [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: 01/31/2024] [Accepted: 07/03/2024] [Indexed: 07/21/2024] Open
Abstract
INTRODUCTION Breast cancer continues to be the most common malignancy and the leading cause of cancer-related deaths in Ethiopia. The poor prognosis and high mortality rate of breast cancer patients in the country are largely caused by late-stage diagnosis. Hence, understanding the epidemiology of late-stage diagnosis is essential to address this important problem. However, previous reports in Ethiopia indicated inconsistent findings. Therefore, this literature review was conducted to generate dependable evidence by summarizing the prevalence and determinants of late-stage diagnosis among breast cancer patients in Ethiopia. METHODS Pertinent articles were retrieved by systematically searching on major electronic databases and gray literature. Data were extracted into an Excel spreadsheet and analyzed using the STATA 17 statistical software. The pooled estimates were summarized using the random effect meta-analysis model. Heterogeneity and small study effect were evaluated using the I2 statistics and Egger's regression test in conjunction with the funnel plot, respectively. Meta-regression, sub-group analysis, and sensitivity analysis were also employed. Protocol registration number: CRD42024496237. RESULTS The pooled prevalence of late-stage diagnosis after combining reports of 24 studies with 8,677 participants was 65.85 (95% CI: 58.38, 73.32). Residence (adjusted OR: 1.92; 95% CI: 1.45, 2.53), patient delay at their first presentation (adjusted OR: 2.65; 95% CI: 1.56, 4.49), traditional medicine use (adjusted OR: 2.54; 95% CI: 1.89, 3.41), and breast self-examination practice (adjusted OR: 0.28; 95% CI: 0.09, 0.88) were significant determinants of late-stage diagnosis. CONCLUSION Two-thirds of breast cancer patients in Ethiopia were diagnosed at an advanced stage. Residence, delay in the first presentation, traditional medicine use, and breast self-examination practice were significantly associated with late-stage diagnosis. Public education about breast cancer and its early detection techniques is crucial to reduce mortality and improve the survival of patients. Besides, improving access to cancer screening services is useful to tackle the disease at its curable stages.
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Affiliation(s)
- Habtamu Geremew
- College of Health Science, Oda Bultum University, Chiro, Ethiopia
| | | | - Mulat Belay Simegn
- Department of Public Health, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Alegntaw Abate
- Department of Medical Laboratory Science, College of Health Science, Oda Bultum University, Chiro, Ethiopia
| | - Mohammed Ahmed Ali
- Department of Midwifery, College of Health Science, Oda Bultum University, Chiro, Ethiopia
| | - Hawi Kumbi
- Department of Laboratory, Adama Hospital Medical College, Adama, Ethiopia
| | - Smegnew Gichew Wondie
- Department of Human Nutrition, College of Medicine and Health Science, Mizan Tepi University, Mizan Aman, Ethiopia
| | - Misganaw Asmamaw Mengstie
- Department of Biochemistry, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Werkneh Melkie Tilahun
- Department of Public Health, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
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Setiawan L, Graef K, Schmolze D, Alem A, Taylor L. Building pathology capacity in sub-Saharan Africa to improve breast cancer diagnosis and treatment: training laboratory technicians in high-quality manual immunohistochemistry. BMC Cancer 2024; 24:32. [PMID: 38172837 PMCID: PMC10763384 DOI: 10.1186/s12885-023-11756-8] [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: 10/10/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND To address the need for a skilled workforce in breast cancer (BC) pathology in sub-Saharan Africa (SSA), we implemented an education program to train laboratory technicians in manual immunohistochemistry (IHC). METHODS A quality improvement education project was developed. Interactive webinars were held every six months with didactics and presentations from African experts with experience in IHC. We conducted knowledge assessments and surveys on current practice, equipment, and human resources. A digital mentorship platform (DMP) was created for discussions, sharing SOPs, and networking. For one year (2022-2023), we followed developments in pathology capacity, practice changes, and educational needs. A paired t-test was used to calculate the significance of changes in knowledge immediately after the webinar and comfort level with topics 35 days after the webinar. RESULTS Two hundred and sixty six participants from 10 SSA countries attended the first webinar, a series of six lectures on IHC theory, methods, and practice. Ninety-five participants from nine SSA countries provided a baseline assessment of pathology capacity and feedback. Mean knowledge increased by 17.4% immediately after the webinar (from 41.8% pre-webinar to 59.2% post, p = < 0.0001). Self-reported comfort level in topics 35 days after the webinar increased by 11.3%, but this was not statistically significant (mean 3.36 pre- to 3.74 post, p = 0.1). Over six months, recordings were accessed 412 times. After six months, the second webinar had 93 participants from eight SSA countries. Membership in the DMP increased from 64 to 172; recordings were viewed 412 times in six months; and 113 participants from nine SSA countries completed surveys. Among 74 respondents who perform IHC, 43.5% reported moderate or significant positive practice changes such as improved antigen retrieval techniques and optimization of preanalytical variables. Over half (52.7%, n = 39) reported the quality of slides had moderately or significantly improved. After one year, a third webinar had 98 participants from eight SSA countries. Thirty-eight completed surveys, DMP membership increased to 199, and 1 reported launching IHC in a lab in Nigeria. CONCLUSIONS Our program 1) reached hundreds of participants and provided a baseline assessment of pathology capacity across nine SSA countries; 2) created a novel mechanism to build pathology capacity and assess progress with this cohort; and 3) improved practices and the preparation of slides for over half performing manual IHC. After one year, interest was sustained. Tracking impact on diagnosis and treatment of BC in the region is needed long-term.
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Affiliation(s)
| | - Katy Graef
- BIO Ventures for Global Health, Seattle, WA, USA
| | - Dan Schmolze
- Department of Pathology, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Alemwosen Alem
- Pathology Department, Hawassa University College of Health Science, Hawassa, Ethiopia
| | - Lesley Taylor
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
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Belachew EB, Desta AF, Gebremariam TY, Deneke DB, Ashenafi S, Yeshi MM, Fenta BD, Alem AT, Alemu A, Abafogi AK, Desta T, Chanyalew M, Beshah D, Taylor L, Bauer M, Tsehay D, Girma S, Melka DS, Tessema TS, Kantelhardt EJ, Howe R. Immunohistochemistry-derived subtypes of breast cancer distribution in four regions of Ethiopia. Front Endocrinol (Lausanne) 2023; 14:1250189. [PMID: 38027092 PMCID: PMC10666628 DOI: 10.3389/fendo.2023.1250189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose Different biological characteristics, therapeutic responses, and disease-specific outcomes are associated with different molecular subtypes of breast cancer (BC). Although there have been different studies on BC in the Ethiopian capital city of Addis Ababa, there have been few studies in other parts of the nation, and none have evaluated biological characteristics in other locations in the context of the extensive ethnic and genetic diversity found in Ethiopia. This study was carried out to evaluate the distribution of immunohistochemistry (IHC) subtypes of BCs throughout four Ethiopian regions. Methods A total of 227 formalin-fixed paraffin-embedded (FFPE) tissue blocks were collected from tertiary hospitals in four Ethiopian regions between 2015 and 2021. The IHC staining was performed for subtyping, ER, PR, HER2, and Ki-67 proliferation markers. Results The mean age at diagnosis was 43.9 years. The percentage of ER and PR-negative tumors were 48.3% and 53.2%, respectively. The IHC subtypes showed the following distribution: 33.1% triple-negative breast cancer (TNBC), 27.6% luminal B, 25.2% luminal A, and 14.1% HER2 enriched. In multiple logistic regression analysis, grade III and HER2 positivity were associated with larger tumor size, and also originating from Jimma compared to Mekele. Conclusion Patients with ER-negative, PR-negative, and TNBC were found in 48.3%, 53.2%, and 33.1% of cases, respectively, showing that half the patients could potentially benefit from endocrine treatment. A considerably high prevalence of TNBC was reported in our study, demanding additional research that includes genetic predisposition factors. Additionally, aggressive tumors were found in a high percentage of younger age groups, which must be considered when planning personalized treatment strategies.
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Affiliation(s)
- Esmael Besufikad Belachew
- Biology Department, College of Natural and Computational Sciences, Mizan Tepi University, Mizan, Ethiopia
- Department of Microbial, Cellular and Molecular Biology, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Non-Communicable Diseases (NCD) Research Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Adey Feleke Desta
- Department of Microbial, Cellular and Molecular Biology, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tewodros Yalew Gebremariam
- Department of Pathology, School of Medicine, College of Health Sciences, Tikur Anbessa Specialized Hospital and Addis Ababa University, Addis Ababa, Ethiopia
| | - Dinikisira Bekele Deneke
- Department of Pathology, School of Medicine, College of Health Sciences, Tikur Anbessa Specialized Hospital and Addis Ababa University, Addis Ababa, Ethiopia
| | - Senait Ashenafi
- Department of Pathology, School of Medicine, College of Health Sciences, Tikur Anbessa Specialized Hospital and Addis Ababa University, Addis Ababa, Ethiopia
| | - Melisachew Mulatu Yeshi
- Department of Pathology, School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | | | | | - Addisu Alemu
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Abdo Kedir Abafogi
- Pathology Department, Jimma University Specialized Hospital, Jimma, Ethiopia
| | - Tigist Desta
- Non-Communicable Diseases (NCD) Research Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Menberework Chanyalew
- Non-Communicable Diseases (NCD) Research Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Daniel Beshah
- Department of Diagnostic Laboratory, Tikur Anbessa Specialized Hospital, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Lesley Taylor
- City of Hope National Medical Center, Duarte, CA, United States
| | - Marcus Bauer
- Global Health Working Group, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Institute of Pathology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Dareskedar Tsehay
- Non-Communicable Diseases (NCD) Research Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Selfu Girma
- Non-Communicable Diseases (NCD) Research Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Daniel Seifu Melka
- Department of Biochemistry, Division of Basic Sciences, University of Global Health Equity, Kigali, Rwanda
| | | | - Eva J. Kantelhardt
- Department of Gynecology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Rawleigh Howe
- Non-Communicable Diseases (NCD) Research Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
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Oma D, Teklemariam M, Seifu D, Desalegn Z, Anberbir E, Abebe T, Mequannent S, Tebeje S, Labisso WL. Immunohistochemistry versus PCR Technology for Molecular Subtyping of Breast Cancer: Multicentered Expereinces from Addis Ababa, Ethiopia. J Cancer Prev 2023; 28:64-74. [PMID: 37434799 PMCID: PMC10331035 DOI: 10.15430/jcp.2023.28.2.64] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 07/13/2023] Open
Abstract
The application of immunohistochemistry (IHC) for molecular characterization of breast cancer (BC) is of paramount importance; however, it is not universally standardized, subject to observer variability and quantifying is a challenge. An alternative molecular technology, such as endpoint reverse transcription (RT)-PCR gene expression analysis, may improve observer variability and diagnostic accuracy. This study was intended to compare IHC with the RT-PCR based technique and assess the potential of RT-PCR for molecular subtyping of BC. In this comparative cross-sectional study, 54 BC tissues were collected from three public hospitals in Addis Ababa and shipped to Gynaecology department at Martin-Luther University (Germany) for laboratory analysis. Only 41 samples were qualified for IHC and RT-PCR investigation of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), and Ki-67 protein expression analysis. Kappa statistics was used to assess the concordance between the two techniques. The overall percent agreement between RT-PCR and IHC was 68.3% for ER (positive percent agreement [PPA] 71.1%; negative percent agreement [NPA] 33.3%), 39.0% for PR (PPA 14.3%; NPA 92.3%), and 82.9% for HER2 (PPA 62.5%; NPA 87.9%). Cohen's κ-values of 0.018 (< 0.20), 0.045 (< 0.200), and 0.481 (0.41-0.60) were generated for ER, PR, and HER2, respectively. Concordance for molecular subtypes was only 56.1% (23/41) and 0.20 kappa value. IHC and endpoint RT-PCR techniques have shown to be discordant for 43% samples. Molecular subtyping using endpoint RT-PCR was fairly concordant with IHC. Thus, endpoint RT-PCR may give an objective result, and can be applied for BC subtyping.
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Affiliation(s)
- Dessiet Oma
- Department of Medical Biochemistry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Maria Teklemariam
- Department of Medical Biochemistry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Daniel Seifu
- Department of Biochemistry, University of Global Health Equity, Kigali, Rwanda
| | - Zelalem Desalegn
- Department of Microbiology, Immunology, and Parasitology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Endale Anberbir
- Department of Surgery, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tamrat Abebe
- Department of Microbiology, Immunology, and Parasitology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Solomon Mequannent
- Department of Pharmacology, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Solomon Tebeje
- Department of Medical Biochemistry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Wajana Lako Labisso
- Department of Pathology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Alemu HK, Hammad N, Tola MA, Vanderpuye V. Pregnancy Associated Invasive Apocrine Carcinoma of the Breast: Case Report from Ethiopia. BREAST CANCER (DOVE MEDICAL PRESS) 2023; 15:429-433. [PMID: 37383111 PMCID: PMC10295538 DOI: 10.2147/bctt.s405612] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 06/14/2023] [Indexed: 06/30/2023]
Abstract
We present a case report on a case of invasive apocrine carcinoma of breast during pregnancy at a tertiary referral hospital in Ethiopia. The patient's case in this report signifies the challenging clinical situation that the patient, developing fetus and treating physicians have to go through and the need to improve maternal-fetal medicine and oncologic setup and treatment guidelines in Ethiopia. Our case also illustrates the huge disparity between the management of both breast cancer and its occurrence during pregnancy in low-income countries like Ethiopia and developed nations elsewhere. Our case report shows a rare histological finding. The patient has invasive apocrine carcinoma of the breast. To our knowledge, it is the first case to be reported in the country.
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Affiliation(s)
- Haimanot Kasahun Alemu
- Department of Internal Medicine, Oncology Unit; Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Nazik Hammad
- Department of Medical Oncology, Queen’s University, Kingston, Ontario, Canada
| | - Mesfin Asefa Tola
- Department of Pathology; Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Verna Vanderpuye
- National Centre for Radiotherapy, Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, Ghana
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8
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Bauer M, Vetter M, Stückrath K, Yohannes M, Desalegn Z, Yalew T, Bekuretsion Y, Kenea TW, Joffe M, van den Berg EJ, Nikulu JI, Bakarou K, Manraj SS, Ogunbiyi OJ, Ekanem IO, Igbinoba F, Diomande M, Adebamowo C, Dzamalala CP, Anele AA, Zietsman A, Galukande M, Foerster M, dos-Santos-Silva I, Liu B, Santos P, Jemal A, Abebe T, Wickenhauser C, Seliger B, McCormack V, Kantelhardt EJ. Regional Variation in the Tumor Microenvironment, Immune Escape and Prognostic Factors in Breast Cancer in Sub-Saharan Africa. Cancer Immunol Res 2023; 11:720-731. [PMID: 37058582 PMCID: PMC10552870 DOI: 10.1158/2326-6066.cir-22-0795] [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: 10/07/2022] [Revised: 01/18/2023] [Accepted: 04/10/2023] [Indexed: 04/16/2023]
Abstract
The low overall survival rates of patients with breast cancer in sub-Saharan Africa (SSA) are driven by regionally differing tumor biology, advanced tumor stages at diagnosis, and limited access to therapy. However, it is not known whether regional differences in the composition of the tumor microenvironment (TME) exist and affect patients' prognosis. In this international, multicentre cohort study, 1,237 formalin-fixed, paraffin-embedded breast cancer samples, including samples of the "African Breast Cancer-Disparities in Outcomes (ABC-DO) Study," were analyzed. The immune cell phenotypes, their spatial distribution in the TME, and immune escape mechanisms of breast cancer samples from SSA and Germany (n = 117) were investigated using histomorphology, conventional and multiplex IHC, and RNA expression analysis. The data revealed no regional differences in the number of tumor-infiltrating lymphocytes (TIL) in the 1,237 SSA breast cancer samples, while the distribution of TILs in different breast cancer IHC subtypes showed regional diversity, particularly when compared with German samples. Higher TIL densities were associated with better survival in the SSA cohort (n = 400), but regional differences concerning the predictive value of TILs existed. High numbers of CD163+ macrophages and CD3+CD8+ T cells accompanied by reduced cytotoxicity, altered IL10 and IFNγ levels and downregulation of MHC class I components were predominantly detected in breast cancer samples from Western SSA. Features of nonimmunogenic breast cancer phenotypes were associated with reduced patient survival (n = 131). We therefore conclude that regional diversity in the distribution of breast cancer subtypes, TME composition, and immune escape mechanisms should be considered for therapy decisions in SSA and the design of personalized therapies. See related Spotlight by Bergin et al., p. 705.
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Affiliation(s)
- Marcus Bauer
- Department of Pathology, University Hospital Halle, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Global Health Working Group, Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Martina Vetter
- Department of Gynecology, University Hospital Halle, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Kathrin Stückrath
- Department of Gynecology, University Hospital Halle, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Meron Yohannes
- Department of Medical Laboratory Science, College of Health sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Zelalem Desalegn
- Department of Microbiology, Immunology & Parasitology, School of Medicine, College of Health Sciences, Tikur Anbessa Specialized Hospital, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tewodros Yalew
- Department of Pathology, Tikur Anbessa Specialized University Hospital, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yonas Bekuretsion
- Department of Pathology, Tikur Anbessa Specialized University Hospital, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tariku W. Kenea
- Department of Surgery, Aira General Hospital, Aira, Ethiopia
| | - Maureen Joffe
- Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, South Africa and U Witwatersrand, Faculty of Health Sciences, Strengthening Oncology Services Research Unit
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Eunice J van den Berg
- Department of Anatomical Pathology, University of the Witwatersrand, National Health Laboratory Service, Johannesburg, South Africa
| | - Julien I. Nikulu
- Ligue congolaise contre le cancer, l’Unité Pilote du GFAOP, Lubumbashi, Democratic Republic of the Congo
| | - Kamate Bakarou
- Service d’anatomie, Cytologie Pathologique au C.H.U. du point G BP:333, Bamako, Mali
| | - Shyam S. Manraj
- Central Health Laboratory, Victoria Hospital, Candos, Mauritius
| | - Olufemi J. Ogunbiyi
- Department of Pathology, University College Hospital, Ibadan, Oyo state, Nigeria
| | - Ima-Obong Ekanem
- Department of Pathology, Calabar Cancer Registry, University of Calabar Teaching Hospital, Calabar, Nigeria
| | | | - Mohenou Diomande
- Service d’anatomie et cytologie pathologiques, Abidjan, Côte d’Ivoire
| | - Clement Adebamowo
- Department of Epidemiology and Public Health, and the Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore
| | | | | | - Annelle Zietsman
- AB May Cancer Centre, Windhoek Central Hospital, Windhoek, Namibia
| | - Moses Galukande
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Milena Foerster
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, Lyon, France
| | - Isabel dos-Santos-Silva
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine (LSHTM)
| | - Biying Liu
- African Cancer Registry Network, Oxford, United Kingdom
| | - Pablo Santos
- Global Health Working Group, Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Ahmedin Jemal
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Tamrat Abebe
- Department of Medical Laboratory Science, College of Health sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Claudia Wickenhauser
- Department of Pathology, University Hospital Halle, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Barbara Seliger
- Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Institute of Translational Immunology, Medical School ‘Theodor Fontane, Brandenburg an der Havel, Germany
- Fraunhofer Institute for Immunology, Leipzig, Germany
| | - Valerie McCormack
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, Lyon, France
| | - Eva J. Kantelhardt
- Global Health Working Group, Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
- Department of Gynecology, University Hospital Halle, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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9
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Hassen F, Enquselassie F, Ali A, Addissie A, Taye G, Assefa M, Tsegaye A. Adherence to Chemotherapy among Women with Breast Cancer Treated at Tikur Anbessa Specialized and Teaching Hospital, Addis Ababa, Ethiopia. Asian Pac J Cancer Prev 2022; 23:3035-3041. [PMID: 36172666 PMCID: PMC9810294 DOI: 10.31557/apjcp.2022.23.9.3035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Adherence is important for women with breast cancer because it is a primary determinant for effectiveness of treatment and optimum clinical benefit. Though Breast cancer is the leading cancer in Ethiopia,adherance to chemotherapy is not investigated in Ethiopian women. OBJECTIVE This study aimed to assess adherence to chemotherapy among women with breast cancer treated at Tikur Anbessa specialized and Teaching Hospital. METHODS Cross-sectional study was conducted among 164 breast cancer patients with chemotherapy. After eligible participants were identified, data were collected using face-to-face interviews, card reviews and telephone interviews. Adherence was calculated as the number of doses taken divided by number of recommended or expected doses. Pearson chi-square test was used to evaluate predictors of adherence. RESULTS Among a total of 164 breast cancer patients, majority, 119, (72.6%) of them were urban residents. The mean age of study participants was 41.99 + 10.9 years. The majority 149, (90.9%) of patients were married. More than half 94, (57.3%) of the women were literate. In this study, 137 out of 164 (83.5%) women were adherent to their chemotherapy. Of the 27 non adherent participants. he reason for non-adherence to chemotherapy was unknown for 7, (25.9%) of women. Among different identified reasons for non-adherent, sever illness prevents patients to receive chemotherapy. Based on Pearson chi square test, distance from referral center and treatment regimen were significantly associated with non-adherence rate. CONCLUSION The present study the results showed that the majority 137, (83.5%) of patients were in good adherence to their chemotherapy. The most identified factor of non-adherence was inability to come for their therapy as a result of severity of illness. Therefore, expansion of cancer diagnosis and treatment centers should be encouraged in order to maximize patient's access and adherence to chemotherapy.
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Affiliation(s)
- Fatuma Hassen
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopi.
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Fikre Enquselassie
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Ahmed Ali
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Adamu Addissie
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Girma Taye
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Mathewos Assefa
- Department of Oncology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Aster Tsegaye
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
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10
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Nthontho KC, Ndlovu AK, Sharma K, Kasvosve I, Hertz DL, Paganotti GM. Pharmacogenetics of Breast Cancer Treatments: A Sub-Saharan Africa Perspective. Pharmgenomics Pers Med 2022; 15:613-652. [PMID: 35761855 PMCID: PMC9233488 DOI: 10.2147/pgpm.s308531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/31/2022] [Indexed: 11/30/2022] Open
Abstract
Breast cancer is the most frequent cause of cancer death in low- and middle-income countries, in particular among sub-Saharan African women, where response to available anticancer treatment therapy is often limited by the recurrent breast tumours and metastasis, ultimately resulting in decreased overall survival rate. This can also be attributed to African genomes that contain more variation than those from other parts of the world. The purpose of this review is to summarize published evidence on pharmacogenetic and pharmacokinetic aspects related to specific available treatments and the known genetic variabilities associated with metabolism and/or transport of breast cancer drugs, and treatment outcomes when possible. The emphasis is on the African genetic variation and focuses on the genes with the highest strength of evidence, with a close look on CYP2A6, CYP2B6, CYP2C8, CYP2C9, CYP2C19, CYP2D6, CYP3A4/5, CYP19A1, UGT1A4, UGT2B7, UGT2B15, SLC22A16, SLC38A7, FcγR, DPYD, ABCB1, and SULT1A1, which are the genes known to play major roles in the metabolism and/or elimination of the respective anti-breast cancer drugs given to the patients. The genetic variability of their metabolism could be associated with different metabolic phenotypes that may cause reduced patients' adherence because of toxicity or sub-therapeutic doses. Finally, this knowledge enhances possible personalized treatment approaches, with the possibility of improving survival outcomes in patients with breast cancer.
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Affiliation(s)
- Keneuoe Cecilia Nthontho
- School of Allied Health Professions, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
| | - Andrew Khulekani Ndlovu
- School of Allied Health Professions, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
| | | | - Ishmael Kasvosve
- School of Allied Health Professions, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
| | - Daniel Louis Hertz
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Giacomo Maria Paganotti
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
- Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Biomedical Sciences, Faculty of Medicine, University of Botswana, Gaborone, Botswana
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11
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Intrinsic subtypes in Ethiopian breast cancer patient. Breast Cancer Res Treat 2022; 196:495-504. [PMID: 36282363 PMCID: PMC9633534 DOI: 10.1007/s10549-022-06769-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/06/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE The recent development of multi-gene assays for gene expression profiling has contributed significantly to the understanding of the clinically and biologically heterogeneous breast cancer (BC) disease. PAM50 is one of these assays used to stratify BC patients and individualize treatment. The present study was conducted to characterize PAM50-based intrinsic subtypes among Ethiopian BC patients. PATIENTS AND METHODS Formalin-fixed paraffin-embedded tissues were collected from 334 BC patients who attended five different Ethiopian health facilities. All samples were assessed using the PAM50 algorithm for intrinsic subtyping. RESULTS The tumor samples were classified into PAM50 intrinsic subtypes as follows: 104 samples (31.1%) were luminal A, 91 samples (27.2%) were luminal B, 62 samples (18.6%) were HER2-enriched and 77 samples (23.1%) were basal-like. The intrinsic subtypes were found to be associated with clinical and histopathological parameters such as steroid hormone receptor status, HER2 status, Ki-67 proliferation index and tumor differentiation, but not with age, tumor size or histological type. An immunohistochemistry-based classification of tumors (IHC groups) was found to correlate with intrinsic subtypes. CONCLUSION The distribution of the intrinsic subtypes confirms previous immunohistochemistry-based studies from Ethiopia showing potentially endocrine-sensitive tumors in more than half of the patients. Health workers in primary or secondary level health care facilities can be trained to offer endocrine therapy to improve breast cancer care. Additionally, the findings indicate that PAM50-based classification offers a robust method for the molecular classification of tumors in the Ethiopian context.
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12
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Getachew S, Addissie A, Seife E, Wakuma T, Unverzagt S, Jemal A, Taylor L, Wienke A, Kantelhardt EJ. OUP accepted manuscript. Oncologist 2022; 27:e650-e660. [PMID: 35524760 PMCID: PMC9355816 DOI: 10.1093/oncolo/oyac081] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/09/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Many women in rural Ethiopia do not receive adjuvant therapy following breast cancer surgery despite the majority being diagnosed with estrogen-receptor-positive breast cancer and tamoxifen being available in the country. We aimed to compare a breast nurse intervention to improve adherence to tamoxifen therapy for breast cancer patients. Methods and Materials The 8 hospitals were randomized to intervention and control sites. Between February 2018 and December 2019, patients with breast cancer were recruited after their initial surgery. The primary outcome of the study was adherence to tamoxifen therapy by evaluating 12-month medication-refill data with medication possession ratio (MPR) and using a simplified medication adherence scale (SMAQ) in a subjective assessment. Results A total of 162 patients were recruited (87 intervention and 75 control). Trained nurses delivered education and provided literacy material, gave additional empathetic counselling, phone call reminders, and monitoring of medication refill at the intervention hospitals. Adherence according to MPR at 12 months was high in both the intervention (90%) and control sites (79.3%) (P = .302). The SMAQ revealed that adherence at intervention sites was 70% compared with 44.8% in the control sites (P = .036) at 12 months. Persistence to therapy was found to be 91.2% in the intervention and 77.8% in the control sites during the one-year period (P = .010). Conclusion Breast nurses can improve cost-effective endocrine therapy adherence at peripheral hospitals in low-resource settings. We recommend such task sharing to overcome the shortage of oncologists and distances to central cancer centers.
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Affiliation(s)
- Sefonias Getachew
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Ethiopia
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University (Saale), Halle, Germany
| | - Adamu Addissie
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Ethiopia
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University (Saale), Halle, Germany
| | - Edom Seife
- Radiotherapy Center, Tikur Anbessa Hospital, Addis Ababa University, Ethiopia
| | - Tariku Wakuma
- Department of Surgery, Aira General Hospital, Ethiopia
| | - Susanne Unverzagt
- Institute of General Practice and Family Medicine, Center of Health Sciences, Martin-Luther-UniversityHalle (Saale), Germany
| | | | - Lesley Taylor
- City of Hope National Medical Center, Duarte, CaliforniaUSA
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University (Saale), Halle, Germany
| | - Eva J Kantelhardt
- Corresponding author: Eva J. Kantelhardt, Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University, Magdeburgerstrasse 8; 06097 Halle, Germany. Tel: +493455571847
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13
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Reibold CF, Tariku W, Eber-Schulz P, Getachew S, Addisie A, Unverzagt S, Wienke A, Hauptmann S, Wickenhauser C, Vetter M, Jemal A, Thomssen C, Kantelhardt EJ. Adherence to Newly Implemented Tamoxifen Therapy for Breast Cancer Patients in Rural Western Ethiopia. Breast Care (Basel) 2021; 16:484-490. [PMID: 34720808 PMCID: PMC8543345 DOI: 10.1159/000512840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/15/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Endocrine therapy for breast cancer (BC) patients is highly underutilized in rural Ethiopia and other African countries. OBJECTIVE This study aims to assess the feasibility of and adherence to tamoxifen therapy in rural Ethiopia. METHODS We ascertained the hormone receptor (HR) status in 101 women diagnosed with BC from January 2010 to December 2015 and who had surgery in Aira Hospital, in rural Ethiopia. From 2013, tamoxifen was offered to patients with HR-positive (HR+) tumors. Prescription refill records and a structured questionnaire were used to assess receipt of and adherence to tamoxifen. RESULTS Of the 101 BC patients tested for HR status during the study period, 66 (65%) patients were HR+ and were eligible for tamoxifen treatment. However, 15 of the HR+ patients died before tamoxifen became available in 2013. Of the remaining 51 HR+ patients, 26 (51%) initiated tamoxifen but only 9 of them (35%) adhered to therapy (medication possession rate ≥80%, median observation 16.2 months). After 1 year, 52% of the patients were still adherent, and 9 patients had discontinued therapy. The reasons for non-initiation of tamoxifen included patient factors (n = 5), including financial hardship or lack of transportation, and health care provider factors (n = 12). CONCLUSIONS Endocrine therapy for BC patients seems feasible in rural Western Ethiopia, although non-adherence due to financial hardship and a less developed health care infrastructure remains a major challenge. We postulate that the implementation of breast nurses could reduce patient and health system barriers and improve initiation of and adherence to endocrine treatment.
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Affiliation(s)
| | - Wakuma Tariku
- Ethiopian Evangelical Church of Mekane Yesus EECMY Aira Hospital, Aira, Ethiopia
| | - Pia Eber-Schulz
- Department of Gynecology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Sefonias Getachew
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Adamu Addisie
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Susanne Unverzagt
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Steffen Hauptmann
- Department of Pathology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Claudia Wickenhauser
- Department of Pathology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Martina Vetter
- Department of Gynecology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | | | - Christoph Thomssen
- Department of Gynecology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
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14
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Schwartz AD, Adusei A, Tsegaye S, Moskaluk CA, Schneider SS, Platt MO, Seifu D, Peyton SR, Babbitt CC. Genetic Mutations Associated with Hormone-Positive Breast Cancer in a Small Cohort of Ethiopian Women. Ann Biomed Eng 2021; 49:1900-1908. [PMID: 34142276 DOI: 10.1007/s10439-021-02800-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 05/24/2021] [Indexed: 12/23/2022]
Abstract
In Ethiopia, a breast cancer diagnosis is associated with a prognosis significantly worse than that of Europe and the US. Further, patients presenting with breast cancer in Ethiopia are far younger, on average, and patients are typically diagnosed at very late stages, relative to breast cancer patients of European descent. Emerging data suggest that a large proportion of Ethiopian patients have hormone-positive (ER+) breast cancer. This is surprising given (1) that patients have late-stage breast cancer at the time of diagnosis, (2) that African Americans with breast cancer frequently have triple negative breast cancer (TNBC), and (3) these patients typically receive chemotherapy, not hormone-targeting drugs. To further examine the similarity of Ethiopian breast tumors to those of African Americans or of those of European descent, we sequenced matched tumor and normal adjacent tissue from Ethiopian patients from a small pilot collection. We identified mutations in 615 genes across all three patients, unique to the tumor tissue. Across this analysis, we found far more mutations shared between Ethiopian patient tissue and that from white patients (103) than we did comparing to African Americans (3). Several mutations were found in extracellular matrix encoding genes with known roles in tumor cell growth and metastasis. We suggest future mechanistic studies on this disease focus on these genes first, toward finding new treatment strategies for breast cancer patients in Ethiopia.
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Affiliation(s)
- Alyssa D Schwartz
- Department of Chemical Engineering, University of Massachusetts Amherst, Amherst, MA, USA
| | - Afua Adusei
- Molecular and Cell Biology Graduate Program, University of Massachusetts Amherst, Amherst, MA, USA
| | - Solomon Tsegaye
- Department of Biochemistry, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Sallie S Schneider
- Molecular and Cell Biology Graduate Program, University of Massachusetts Amherst, Amherst, MA, USA.,Pioneer Valley Life Sciences Institute, Springfield, MA, USA
| | - Manu O Platt
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, 950 Atlantic Drive, Suite 3015, Atlanta, GA, 30332, USA
| | - Daniel Seifu
- Department of Biochemistry, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.,Department of Biochemistry, Division of Basic Sciences, University of Global Health Equity, Kigali, Rwanda
| | - Shelly R Peyton
- Department of Chemical Engineering, University of Massachusetts Amherst, Amherst, MA, USA. .,Molecular and Cell Biology Graduate Program, University of Massachusetts Amherst, Amherst, MA, USA. .,Institute for Applied Life Sciences, University of Massachusetts Amherst, Amherst, MA, USA.
| | - Courtney C Babbitt
- Molecular and Cell Biology Graduate Program, University of Massachusetts Amherst, Amherst, MA, USA. .,Department of Biology, University of Massachusetts Amherst, Amherst, MA, USA. .,Institute for Applied Life Sciences, University of Massachusetts Amherst, Amherst, MA, USA.
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15
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Saleh M, Chandrashekar DS, Shahin S, Agarwal S, Kim HG, Behring M, Shaikh AJ, Moloo Z, Eltoum IEA, Yates C, Varambally S, Manne U. Comparative analysis of triple-negative breast cancer transcriptomics of Kenyan, African American and Caucasian Women. Transl Oncol 2021; 14:101086. [PMID: 33839593 PMCID: PMC8058567 DOI: 10.1016/j.tranon.2021.101086] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 03/04/2021] [Accepted: 03/23/2021] [Indexed: 12/17/2022] Open
Abstract
The current study determined the molecular fingerprints of TNBCs of women from kenya (KE) and compared them with those of African–American (AA) and Caucasian (CA) women. RNA sequencing analysis highlights the role of molecular alterations in TNBCs and the potential benefit of targeting pathways in this disease for the KE population as compared to AAs and CAs. The dysregulated genes and signaling pathways could contributes to the aggressive phenotypes of TNBCs of KE women.
Purpose : Triple-negative breast cancer (TNBC) patients of various ethnic groups often have discrete clinical presentations and outcomes. Women of African descent have a disproportionately higher chance of developing TNBCs. The aim of the current study was to establish the transcriptome of TNBCs from Kenyan (KE) women of Bantu origin and compare it to those TNBCs of African-Americans (AA) and Caucasians (CA) for identifying KE TNBC-specific molecular determinants of cancer progression and potential biomarkers of clinical outcomes. Patients and Methods : Pathology-confirmed TNBC tissues from Kenyan women of Bantu origin (n = 15) and age and stage range matched AA (n = 19) and CA (n = 23) TNBCs of patients from Alabama were included in this study. RNA was isolated from paraffin-embedded tissues, and expression was analyzed by RNA sequencing. Results : At clinical presentation, young KE TNBC patients have tumors of higher stages. Differential expression analysis identified 160 up-regulated and 178 down-regulated genes in KE TNBCs compared to AA and CA TNBCs. Validation analyses of the TCGA breast cancer data identified 45 KE TNBC-specific genes that are involved in the apoptosis (ACTC1, ERCC6 and CD14), cell proliferation (UHRF2, KDM4C, UHMK1, KCNH5, KRT18, CSF1R and S100A13), and Wnt signaling (BCL9L) pathways. Conclusions : In this study, we identified biomarkers that are specific for KE TNBC patients of Bantu origin. Further study with a larger sample size of matched tumors could confirm our findings. If biologically confirmed, these molecular determinants could have clinical and biological implications and serve as targets for development of personalized therapeutics for KE TNBC patients.
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Affiliation(s)
- Mansoor Saleh
- Department of Medicine, University of Alabama at Birmingham, Birmingham 35233, AL, United States; Department of Hematology-Oncology, the Aga Khan University, Nairobi, Kenya; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham 35233, AL, United States
| | | | - Sayed Shahin
- Department of Pathology, the Aga Khan University, Nairobi, Kenya
| | - Sumit Agarwal
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Hyung-Gyoon Kim
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Michael Behring
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, United States
| | | | - Zahir Moloo
- Department of Pathology, the Aga Khan University, Nairobi, Kenya
| | - Isam-Eldin A Eltoum
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Clayton Yates
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, United States; Department of Biology & Center for Cancer Research, Tuskegee University, Tuskegee, AL, United States
| | - Sooryanarayana Varambally
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham 35233, AL, United States; Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Upender Manne
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham 35233, AL, United States; Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, United States.
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16
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Popli P, Gutterman EM, Omene C, Ganesan S, Mills D, Marlink R. Receptor-Defined Breast Cancer in Five East African Countries and Its Implications for Treatment: Systematic Review and Meta-Analysis. JCO Glob Oncol 2021; 7:289-301. [PMID: 33591798 PMCID: PMC8081496 DOI: 10.1200/go.20.00398] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER2) are determinants of treatment and mortality for patients with breast cancer (BC). In East Africa, the estimated 5-year survival (37.7%) is far lower than the US average (90%). This meta-analysis investigates BC receptor subtypes within five East African countries to ascertain cross-country patterns and prioritize treatment needs. METHODS From a PubMed search, January 1, 1998-June 30, 2019, for all English-only BC articles for Ethiopia, Kenya, Rwanda, Tanzania, and Uganda, eligible studies had receptor distributions for female BC samples ≥ 30 patients. Outcomes were proportions of ER+, PR+, and HER2-positive (HER2+), and/or molecular subtypes. Data included study characteristics and mean or median patient age. Using metaprop, Stata 16, we estimated pooled proportions (ES) with 95% CIs and assessed heterogeneity. RESULTS Among 36 BC studies with receptor data, 21 met criteria. Weighted mean age was 47.5 years and median, 48. Overall ES were as follows: 55% for ER-positive (ER+) (95% CI, 47 to 62), 23% for HER2+ (95% CI, 20 to 26), and 27% for triple-negative BC (TNBC) (95% CI, 23 to 32). CONCLUSION We found differences between countries, for example, lower distribution of TNBC in Ethiopia (21%) compared with Uganda (35%). ER+, the dominant BC subtype overall at 55%, emphasizes the need to prioritize endocrine therapy. Overall proportions of HER2+ BC (with or without ER+ or PR+), 23%, approached proportions of TNBC, 27%, yet HER2 testing and treatment were infrequent. Testing and reporting of receptor subtypes would promote delivery of more effective treatment reducing the mortality disparity.
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Affiliation(s)
- Pallvi Popli
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | - Coral Omene
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Shridar Ganesan
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | - Richard Marlink
- Rutgers Global Health Institute, and Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
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17
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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.
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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.
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18
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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.
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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
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19
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Sung H, DeSantis CE, Fedewa SA, Kantelhardt EJ, Jemal A. Breast cancer subtypes among Eastern‐African–born black women and other black women in the United States. Cancer 2019; 125:3401-3411. [DOI: 10.1002/cncr.32293] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 05/08/2019] [Accepted: 05/09/2019] [Indexed: 01/19/2023]
Affiliation(s)
- Hyuna Sung
- Surveillance and Health Services Research American Cancer Society Atlanta Georgia
| | - Carol E. DeSantis
- Surveillance and Health Services Research American Cancer Society Atlanta Georgia
| | - Stacey A. Fedewa
- Surveillance and Health Services Research American Cancer Society Atlanta Georgia
| | - Eva J. Kantelhardt
- Department of Gynecology, Institute of Medical Epidemiology, Biometrics and Informatics Martin‐Luther University Halle Germany
| | - Ahmedin Jemal
- Surveillance and Health Services Research American Cancer Society Atlanta Georgia
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20
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Deressa BT, Cihoric N, Badra EV, Tsikkinis A, Rauch D. Breast cancer care in northern Ethiopia - cross-sectional analysis. BMC Cancer 2019; 19:393. [PMID: 31023270 PMCID: PMC6485046 DOI: 10.1186/s12885-019-5612-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 04/12/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND In Ethiopia, the incidence of new cases of breast cancer is currently increasing resulting to high rates of morbidity and mortality. Breast cancer is by far the most common cancer accounting for more than one out of three cancer cases in women and one out of every five in the general population. The study was conducted in University of Gondar Hospital cancer center, located in the North-West Ethiopia; to evaluate the clino-pathologic characteristics of breast cancer and care provided for patients. METHODS All biopsy proven breast cancer patients treated between 2016 and 2017, were identified and information regarding histology, stage, therapeutic procedure and follow up was retrospectively collected from their individual medical records and descriptive analysis was done. RESULTS Among 82 patients treated, 67 (82%) were women and 15 (18%) were men. The median age at the time of diagnosis was 45 years (25-82 years). Operation was performed for 56 (68%) patients. The predominant histology was ductal carcinoma in 61 patients (74%), followed by breast carcinoma of No Special Type (NST) in 17 (21%). The late presentation of the patients and the advanced stage at the time of presentation was observed in most of the patients. Chemotherapy was administered in 79 (96%) patients. Radiotherapy was not available in the hospital. CONCLUSION Breast cancer incidence is rising and becoming a major public health problem in Northern Ethiopia. Breast cancer care in northern-Ethiopia is limited in terms of both pathology, imaging and the offered treatment modalities, which need to be improved.
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Affiliation(s)
- Biniyam Tefera Deressa
- University of Gondar, Gondar, Ethiopia. .,Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Nikola Cihoric
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Eugenia Vlaskou Badra
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alexandros Tsikkinis
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daniel Rauch
- Regional Hospital Thun, Thun, Switzerland.,Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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21
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Gebremariam A, Addissie A, Worku A, Hirpa S, Assefa M, Pace LE, Kantelhardt EJ, Jemal A. Breast and cervical cancer patients' experience in Addis Ababa city, Ethiopia: a follow-up study protocol. BMJ Open 2019; 9:e027034. [PMID: 30967409 PMCID: PMC6500298 DOI: 10.1136/bmjopen-2018-027034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Cancer is an emerging public health problem in Ethiopia, with breast and cervical cancers accounting for over half of all newly diagnosed cancers in women. The majority of women with breast and cervical cancer are diagnosed at late stage of the disease and most patients do not receive care consistent with global standards. However, little is known about the health-seeking behaviours, barriers to early detection and treatment, patient-reported outcomes, financial burden and survival of women with breast and cervical cancer in the country. Therefore, this study aims to document the experience of women with breast and cervical cancer from recognition of symptoms to diagnosis, treatment and survivorship/mortality in Addis Ababa city, Ethiopia. METHODS AND ANALYSIS A prospective follow-up study using mixed methods (both quantitative and qualitative) will be employed. All women newly diagnosed with breast and cervical cancer from 1 January, 2017 to 30 June 2018 in Addis Ababa will be included in the study. Interviewer-administered questionnaires will be used to collect information about medical consultations after recognition of symptoms, health-seeking behaviours, treatment received, barriers to early detection and treatment, and survivorship care. In-depth interview will be conducted on purposefully selected women with breast and cervical cancer. The primary outcomes of the study are time intervals (patient and diagnostic waiting times), stage at diagnosis and survival. Multivariable analysis will be employed to determine the contributions of independent variables on the outcomes of interest. HRs with 95% CIs will be calculated for time-to-event outcomes. Qualitative data will be analysed using thematic analysis. ETHICS AND DISSEMINATION This protocol is ethically approved by Institutional Review Board of Addis Ababa University. Verbal informed consent will be obtained from study participants. Results will be disseminated in international peer-reviewed journals and presented in relevant conferences.
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Affiliation(s)
- Alem Gebremariam
- Public Health, College of Medicine and Health Sciences, Adigrat University, Adigrat, Tigray, Ethiopia
- Preventive Medicine, Addis Ababa University School of Public Health, Addis Ababa, Ethiopia
| | - Adamu Addissie
- Preventive Medicine, Addis Ababa University School of Public Health, Addis Ababa, Ethiopia
| | - Alemayehu Worku
- Preventive Medicine, Addis Ababa University School of Public Health, Addis Ababa, Ethiopia
| | - Selamawit Hirpa
- Preventive Medicine, Addis Ababa University School of Public Health, Addis Ababa, Ethiopia
| | - Mathewos Assefa
- Oncology, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia
| | - Lydia E Pace
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Eva Johanna Kantelhardt
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University, Halle, Germany
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia, USA
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22
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Sengal AT, Haj Mukhtar NS, Vetter M, Elhaj AM, Bedri S, Hauptmann S, Thomssen C, Mohamedani AA, Wickenhauser C, Kantelhardt EJ. Comparison of Receptor-Defined Breast Cancer Subtypes Between German and Sudanese Women: A Facility-Based Cohort Study. J Glob Oncol 2018; 4:1-12. [PMID: 30241184 PMCID: PMC6180747 DOI: 10.1200/jgo.2017.010082] [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: 12/20/2022] Open
Abstract
PURPOSE The objective of this study was to compare tumor characteristics, biomarkers, and surrogate subtypes of breast cancer between Sudanese and German women. METHODS Tumor characteristics and immunohistochemistry markers (estrogen receptor [ER], progesterone receptor [PR], and human epidermal growth factor receptor 2 [HER2]) were collected from the routine assessment of consecutive patients with invasive breast cancer diagnosed from 2010 to 2015 (Gezira University Pathology Laboratory, Gezira, Sudan) and from 1999 to 2013 (Breast Centre, Martin-Luther-University, Halle, Germany). RESULTS A total of 2,492 patients (German [n = 1,932] and Sudanese [n = 560]) were included. Age at diagnosis ranged from 20 to 94 years. Sudanese women were, on average, 10 years younger than German women, with a mean (± standard deviation) age of 48.8 (13.5) and 58.6 (12.4) years, respectively. The Sudanese women had a higher grade, larger tumor, and more lymph node positivity compared with German women. ER-, PR-, and HER2-negative proportions were 55%, 61.8%, and 71.3%, respectively, for Sudanese women versus 22.7%, 32.3%, and 82.5%, respectively, for German women. The triple-negative subtype was more prevalent in Sudanese women (34.5%) than in German women (14.2%). The strongest factor associated with ER-negative disease was grade III (odds ratio, 19.6; 95% CI 11.6 to 33.4; P < .001). Sudanese patients were at higher risk for ER-negative breast cancer, with an odds ratio of 2.01 ( P = .001; adjusted for age, size, nodal status, histologic type, and grade). Stratified by grade, the influence of origin was observed in grade I and grade II tumors, but not in grade III tumors. CONCLUSION Sudanese women had more aggressive tumor characteristics and unfavorable prognostic biomarkers. After adjustment, Sudanese origin was still associated with hormone receptor-negative disease, especially in grade I and II tumors. These findings suggest differences in tumor biology among these ethnic groups.
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Affiliation(s)
- Asmerom Tesfamariam Sengal
- Asmerom Tesfamariam Sengal, Nada Suliman Haj
Mukhtar, Ahmed Mohammed Elhaj, and Ahmed Abdalla
Mohamedani, University of Gezira, Gezira, Sudan; Asmerom
Tesfamariam Sengal, Orotta School of Medicine and Dentistry, Asmara,
Eritrea; Martina Vetter, Christoph Thomssen,
Claudia Wickenhauser, and Eva Johanna Kantelhardt,
Martin-Luther-University Halle-Wittenberg, Halle, Germany; Shahinaz
Bedri, Weill Cornell Medicine-Qatar, Doha, Qatar; and Steffen
Hauptmann, Maastricht University Medical Centre, Maastricht, the
Netherlands
| | - Nada Suliman Haj Mukhtar
- Asmerom Tesfamariam Sengal, Nada Suliman Haj
Mukhtar, Ahmed Mohammed Elhaj, and Ahmed Abdalla
Mohamedani, University of Gezira, Gezira, Sudan; Asmerom
Tesfamariam Sengal, Orotta School of Medicine and Dentistry, Asmara,
Eritrea; Martina Vetter, Christoph Thomssen,
Claudia Wickenhauser, and Eva Johanna Kantelhardt,
Martin-Luther-University Halle-Wittenberg, Halle, Germany; Shahinaz
Bedri, Weill Cornell Medicine-Qatar, Doha, Qatar; and Steffen
Hauptmann, Maastricht University Medical Centre, Maastricht, the
Netherlands
| | - Martina Vetter
- Asmerom Tesfamariam Sengal, Nada Suliman Haj
Mukhtar, Ahmed Mohammed Elhaj, and Ahmed Abdalla
Mohamedani, University of Gezira, Gezira, Sudan; Asmerom
Tesfamariam Sengal, Orotta School of Medicine and Dentistry, Asmara,
Eritrea; Martina Vetter, Christoph Thomssen,
Claudia Wickenhauser, and Eva Johanna Kantelhardt,
Martin-Luther-University Halle-Wittenberg, Halle, Germany; Shahinaz
Bedri, Weill Cornell Medicine-Qatar, Doha, Qatar; and Steffen
Hauptmann, Maastricht University Medical Centre, Maastricht, the
Netherlands
| | - Ahmed Mohammed Elhaj
- Asmerom Tesfamariam Sengal, Nada Suliman Haj
Mukhtar, Ahmed Mohammed Elhaj, and Ahmed Abdalla
Mohamedani, University of Gezira, Gezira, Sudan; Asmerom
Tesfamariam Sengal, Orotta School of Medicine and Dentistry, Asmara,
Eritrea; Martina Vetter, Christoph Thomssen,
Claudia Wickenhauser, and Eva Johanna Kantelhardt,
Martin-Luther-University Halle-Wittenberg, Halle, Germany; Shahinaz
Bedri, Weill Cornell Medicine-Qatar, Doha, Qatar; and Steffen
Hauptmann, Maastricht University Medical Centre, Maastricht, the
Netherlands
| | - Shahinaz Bedri
- Asmerom Tesfamariam Sengal, Nada Suliman Haj
Mukhtar, Ahmed Mohammed Elhaj, and Ahmed Abdalla
Mohamedani, University of Gezira, Gezira, Sudan; Asmerom
Tesfamariam Sengal, Orotta School of Medicine and Dentistry, Asmara,
Eritrea; Martina Vetter, Christoph Thomssen,
Claudia Wickenhauser, and Eva Johanna Kantelhardt,
Martin-Luther-University Halle-Wittenberg, Halle, Germany; Shahinaz
Bedri, Weill Cornell Medicine-Qatar, Doha, Qatar; and Steffen
Hauptmann, Maastricht University Medical Centre, Maastricht, the
Netherlands
| | - Steffen Hauptmann
- Asmerom Tesfamariam Sengal, Nada Suliman Haj
Mukhtar, Ahmed Mohammed Elhaj, and Ahmed Abdalla
Mohamedani, University of Gezira, Gezira, Sudan; Asmerom
Tesfamariam Sengal, Orotta School of Medicine and Dentistry, Asmara,
Eritrea; Martina Vetter, Christoph Thomssen,
Claudia Wickenhauser, and Eva Johanna Kantelhardt,
Martin-Luther-University Halle-Wittenberg, Halle, Germany; Shahinaz
Bedri, Weill Cornell Medicine-Qatar, Doha, Qatar; and Steffen
Hauptmann, Maastricht University Medical Centre, Maastricht, the
Netherlands
| | - Christoph Thomssen
- Asmerom Tesfamariam Sengal, Nada Suliman Haj
Mukhtar, Ahmed Mohammed Elhaj, and Ahmed Abdalla
Mohamedani, University of Gezira, Gezira, Sudan; Asmerom
Tesfamariam Sengal, Orotta School of Medicine and Dentistry, Asmara,
Eritrea; Martina Vetter, Christoph Thomssen,
Claudia Wickenhauser, and Eva Johanna Kantelhardt,
Martin-Luther-University Halle-Wittenberg, Halle, Germany; Shahinaz
Bedri, Weill Cornell Medicine-Qatar, Doha, Qatar; and Steffen
Hauptmann, Maastricht University Medical Centre, Maastricht, the
Netherlands
| | - Ahmed Abdalla Mohamedani
- Asmerom Tesfamariam Sengal, Nada Suliman Haj
Mukhtar, Ahmed Mohammed Elhaj, and Ahmed Abdalla
Mohamedani, University of Gezira, Gezira, Sudan; Asmerom
Tesfamariam Sengal, Orotta School of Medicine and Dentistry, Asmara,
Eritrea; Martina Vetter, Christoph Thomssen,
Claudia Wickenhauser, and Eva Johanna Kantelhardt,
Martin-Luther-University Halle-Wittenberg, Halle, Germany; Shahinaz
Bedri, Weill Cornell Medicine-Qatar, Doha, Qatar; and Steffen
Hauptmann, Maastricht University Medical Centre, Maastricht, the
Netherlands
| | - Claudia Wickenhauser
- Asmerom Tesfamariam Sengal, Nada Suliman Haj
Mukhtar, Ahmed Mohammed Elhaj, and Ahmed Abdalla
Mohamedani, University of Gezira, Gezira, Sudan; Asmerom
Tesfamariam Sengal, Orotta School of Medicine and Dentistry, Asmara,
Eritrea; Martina Vetter, Christoph Thomssen,
Claudia Wickenhauser, and Eva Johanna Kantelhardt,
Martin-Luther-University Halle-Wittenberg, Halle, Germany; Shahinaz
Bedri, Weill Cornell Medicine-Qatar, Doha, Qatar; and Steffen
Hauptmann, Maastricht University Medical Centre, Maastricht, the
Netherlands
| | - Eva Johanna Kantelhardt
- Asmerom Tesfamariam Sengal, Nada Suliman Haj
Mukhtar, Ahmed Mohammed Elhaj, and Ahmed Abdalla
Mohamedani, University of Gezira, Gezira, Sudan; Asmerom
Tesfamariam Sengal, Orotta School of Medicine and Dentistry, Asmara,
Eritrea; Martina Vetter, Christoph Thomssen,
Claudia Wickenhauser, and Eva Johanna Kantelhardt,
Martin-Luther-University Halle-Wittenberg, Halle, Germany; Shahinaz
Bedri, Weill Cornell Medicine-Qatar, Doha, Qatar; and Steffen
Hauptmann, Maastricht University Medical Centre, Maastricht, the
Netherlands
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23
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Weiner CM, Mathewos A, Addissie A, Ayele W, Aynalem A, Wondemagegnehu T, Wienke A, Jemal A, Zerche P, Thomssen C, Seidler A, Kantelhardt EJ. Characteristics and follow-up of metastatic breast cancer in Ethiopia: A cohort study of 573 women. Breast 2018; 42:23-30. [PMID: 30149234 DOI: 10.1016/j.breast.2018.08.095] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 07/27/2018] [Accepted: 08/06/2018] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES There is little information on characteristics, treatment and outcome of metastatic breast cancer (mBC) patients in low-income countries. This study aims to describe mBC in the setting of Ethiopia. MATERIALS AND METHODS A retrospective cohort study was conducted among all female mBC patients from the only oncologic hospital in Addis Ababa 01/2006 to 12/2010. Time between first metastasis and known death or loss to follow-up for more than six months as surrogate for death were used for Cox proportional hazards model. RESULTS A total of 573 patients were included; 188 (32.8%) women with de novo mBC (dnmBC) and 385 women with recurrent mBC (rmBC). The average age at time of first metastasis was 43.7 (standard deviation 11.9) years with an average survival probability of twelve months. Negative hormone receptor status, only present in 29% (Hazard ratio HR = 2.28 [95% confidence interval CI 1.56-3.32] p < 0.001), and grade 3 (HR = 1.72 [95% CI 1.15-2.55] p = 0.008) had significant influence on survival. Patients with initial bone metastasis (HR = 0.63 [95% CI 0.48-0.83] p = 0.001) had best chances of survival compared to more common initial visceral metastasis. About 35% of the patients received chemotherapy and 30.5% were on endocrine therapy. CONCLUSION The lower survival for mBC in Addis Ababa compared to that from Western countries is presumably due to the later presentation at the hospital and lack of standard therapy. An unexpected high proportion of patients with hormone receptor positive mBC encourage consequent utilization of endocrine therapy to improve the quality of palliative care in this cohort.
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Affiliation(s)
| | - Assefa Mathewos
- Radiotherapy Centre, Addis Ababa University, Addis Ababa, Ethiopia
| | - Adamu Addissie
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Wondimu Ayele
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abraha Aynalem
- Radiotherapy Centre, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle, Saale, Germany
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, USA
| | - Peter Zerche
- Department of Surgery, Hospital Martha-Maria Halle-Dölau, Halle, Saale, Germany
| | - Christoph Thomssen
- Department of Gynaecology, Martin-Luther-University Halle-Wittenberg, Halle, Saale, Germany
| | - Andreas Seidler
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine Carl Gustav Carus, Dresden, Germany
| | - Eva Johanna Kantelhardt
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle, Saale, Germany; Department of Gynaecology, Martin-Luther-University Halle-Wittenberg, Halle, Saale, Germany
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24
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Lemos MP, Taylor TE, McGoldrick SM, Molyneux ME, Menon M, Kussick S, Mkhize NN, Martinson NA, Stritmatter A, Randolph-Habecker J. Pathology-Based Research in Africa. Clin Lab Med 2018; 38:67-90. [PMID: 29412886 PMCID: PMC5894888 DOI: 10.1016/j.cll.2017.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The process of conducting pathology research in Africa can be challenging. But the rewards in terms of knowledge gained, quality of collaborations, and impact on communities affected by infectious disease and cancer are great. This report reviews 3 different research efforts: fatal malaria in Malawi, mucosal immunity to HIV in South Africa, and cancer research in Uganda. What unifies them is the use of pathology-based approaches to answer vital questions, such as physiology, pathogenesis, predictors of clinical course, and diagnostic testing schemes.
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Affiliation(s)
- Maria P Lemos
- Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N, E4-203, Seattle, WA 98101, USA
| | - Terrie E Taylor
- College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA; Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi
| | - Suzanne M McGoldrick
- Seattle Genetics, Seattle Children's Hospital, Fred Hutchinson Cancer Research Center, 21823 30th Dr SE, Bothell, WA 98021, USA
| | - Malcolm E Molyneux
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L35QA, UK
| | - Manoj Menon
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue, M1-B140, Seattle, WA 98109, USA; Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue, M1-B140, Seattle, WA 98109, USA; Department of Medicine, University of Washington, 1100 Fairview Avenue, M1-B140, Seattle, WA 98109, USA
| | - Steve Kussick
- PhenoPath Laboratories, 551 North 34th Street #100, Seattle, WA 98103, USA
| | - Nonhlanhla N Mkhize
- Centre for HIV and STIs, National Institute for Communicable Diseases (NICD), National Health Laboratory Service (NHLS), Johannesburg, South Africa; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Neil A Martinson
- Perinatal HIV Research Unit (PHRU), MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa; Johns Hopkins University, Center for Tuberculosis Research, Baltimore, MD, USA
| | - Andrea Stritmatter
- Pacific Northwest University of Health Sciences, 200 University Parkway, Room BHH 423, Yakima, WA 98901, USA
| | - Julie Randolph-Habecker
- Pacific Northwest University of Health Sciences, 200 University Parkway, Room BHH 423, Yakima, WA 98901, USA.
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25
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Eber-Schulz P, Tariku W, Reibold C, Addissie A, Wickenhauser C, Fathke C, Hauptmann S, Jemal A, Thomssen C, Kantelhardt EJ. Survival of breast cancer patients in rural Ethiopia. Breast Cancer Res Treat 2018; 170:111-118. [PMID: 29479644 DOI: 10.1007/s10549-018-4724-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 02/16/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE To describe the histopathological characteristics and survival of female breast cancer (BC) patients in a rural setting with limited access to adjuvant treatment. METHODS A prospective study of 107 histologically confirmed BC patients treated with surgery from 2010 to 2016 from rural parts of western Ethiopia. Referral pathology was performed, and active follow-up was conducted. Adjusted cox regression analysis (hazard ratio [HR]) was performed. RESULTS The median age at diagnosis was 45 (16-83) years; 57% of the patients presented with cT3/4 tumors, 71% with clinically positive lymph nodes, 21% with HER2-overexpression (Dako3+) and 68% with grade 3 tumors. Estrogen and/or progesterone receptor expressions were present in 66% and triple-negative disease in 25%. The estimated 1- and 2-year overall survival probability rates were 78 and 53%, respectively. The 2-year survival for patients with clinically positive lymph nodes was 44% compared to 73% for patients with lymph node-negative disease (HR 2.44; 95% confidence interval [95% CI] 1.19-5.02). The corresponding 2-year survival for patients with cT4 tumors was 25% versus 68% for patients with cT1-2 tumors (cT1-3 vs. cT4 HR 3.86; 95% CI 1.82-13.63). The 2-year survival for patients with hormone receptor-negative disease was 40% compared to 59% for patients with hormone receptor-positive disease (HR 1.92; 95% CI 1.06-3.47). CONCLUSION The majority of breast cancer patients treated with surgery in rural parts of western Ethiopia are diagnosed at advanced stage and have hormone receptor-positive disease. Nearly half of the patients die within 2 years. These findings underscore the need for provision of adjuvant hormonal therapy and for the establishment of pathology service including hormone receptor testing.
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Affiliation(s)
- Pia Eber-Schulz
- Department of Gynecology, Martin-Luther-University, Halle, Germany
| | - Wakuma Tariku
- Ethiopian Evangelical Church of Mekane Yesus EECMY Aira Hospital, Aira, Ethiopia
| | | | - Adamu Addissie
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Christine Fathke
- Department of Pathology, Martin-Luther-University, Halle, Germany
| | | | | | | | - Eva Johanna Kantelhardt
- Department of Gynecology, Martin-Luther-University, Halle, Germany. .,Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University, Saale, Halle, Germany.
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26
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Hadgu E, Seifu D, Tigneh W, Bokretsion Y, Bekele A, Abebe M, Sollie T, Merajver SD, Karlsson C, Karlsson MG. Breast cancer in Ethiopia: evidence for geographic difference in the distribution of molecular subtypes in Africa. BMC WOMENS HEALTH 2018; 18:40. [PMID: 29444670 PMCID: PMC5813361 DOI: 10.1186/s12905-018-0531-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 02/07/2018] [Indexed: 01/03/2023]
Abstract
Background Breast cancer is a heterogeneous disease with several morphological and molecular subtypes. Widely accepted molecular classification system uses assessment of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2) and proliferation marker Ki67. Few studies have been conducted on the incidence and molecular types of breast cancer in Sub-Saharan Africa. Previous studies mainly from Western and Central Africa, showed breast cancer to occur at younger ages and to present with aggressive features, such as high-grade, advanced stage and triple-negative phenotype (negative for ER, PR and HER2). Limited data from East Africa including Ethiopia however shows hormone receptor negative tumors to account for a lower proportion of all breast cancers than has been reported from elsewhere in Africa. Methods In this study from Tikur Anbessa Specialized Hospital, 114 breast cancer patients diagnosed between 2012 and 2015 were enrolled. ER, PR, Ki67 and HER2 receptor status were assessed using immunohistochemistry from tissue microarrays. FISH was used for assessment of gene amplification in all equivocal tumor samples and for confirmation in HER2-enriched cases. Results The distribution of molecular subtypes was: Luminal A: 40%; Luminal B: 26%; HER2-enriched: 10%; TNBC: 23%. ER were positive in 65% of all tumors and 43% the cases were positive for PR. There was statistically significant difference in median age at diagnosis between the molecular subtypes (P < 0.05). There was a bimodal distribution of molecular subtypes in different age ranges with Luminal B subtype being more common at younger ages (median = 36) and Luminal A subtype more prevalent at older ages (median = 42). There were no statistically significant differences in tumor grade, histology, and stage between the molecular subtypes of breast cancer. Conclusion The present study detected Luminal A breast cancer to be the most common subtype and reveals a relatively low rate of hormone receptor negative and TNBC. Our findings and results from other East African studies suggest geographic variability in the distribution of the molecular subtypes of breast cancer in Africa and hence have important clinical and policy implications for breast cancer control and treatment in Ethiopia.
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Affiliation(s)
- Endale Hadgu
- Department of Biochemistry, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Daniel Seifu
- Department of Biochemistry, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Wondemagegnhu Tigneh
- Department of Oncology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yonas Bokretsion
- Department of Pathology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abebe Bekele
- Department of Surgery, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Markos Abebe
- Armauer Hansen research Institute (AHRI), Addis Ababa, Ethiopia
| | - Thomas Sollie
- Dept of Laboratory Medicine, Faculty of Medicine and Health, Orebro University, Orebro, Sweden
| | - Sofia D Merajver
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA
| | | | - Mats G Karlsson
- Dept of Laboratory Medicine, Faculty of Medicine and Health, Orebro University, Orebro, Sweden
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27
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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.
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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
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28
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Miguel F, Lopes LV, Ferreira E, Ribas E, Pelaez AF, Leal C, Amaro T, Lopes P, Santos CM, Lopes C, Santos LL. Breast cancer in Angola, molecular subtypes: a first glance. Ecancermedicalscience 2017; 11:763. [PMID: 28900476 PMCID: PMC5574661 DOI: 10.3332/ecancer.2017.763] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Indexed: 12/27/2022] Open
Abstract
Purpose The aim of this study was to investigate the breast cancer (BC) molecular subtypes according to its surrogate immunohistochemistry (IHC) markers. We conducted a preliminary study, to correlate the clinical pathological profiles and molecular subtypes of breast cancer in Luanda, Angola. Methods From January 2011 to 30 December 2014, 140 consecutive cases of microscopically confirmed invasive breast carcinoma were classified regarding histology and IHC (ER, PR, HER2, and Ki-67). Surrogate molecular subtypes were classified according to ESMO recommendations. Results All patients were female; the median age was 47 years (24–84 years). Invasive carcinoma NST was the most common type (91.4%) and grade 2 was prevalent (70.7%). Most tumours were locally advanced (stage III – 65% and stage IV – 3.6%). In 140 studied cases, 74 (52.8%) malignancies were hormone receptor positive; 25.7% were luminal A like, 19.3% luminal B and HER2 negative like, 7.9% luminal B and HER2-positive like, 15.7% HER2 positive, and 31.4% were triple negative. Conclusion Women’s BC in Luanda-Angola is diagnosed at a young age and at an advanced stage. The two predominant molecular subtypes are HR positive and triple negative. The percentage of HER2-positive BC cases was high. Determining the molecular subtype using surrogate IHC markers has important treatment and prognostic implications for Angolan women with BC. There is an urgent need to study a prospective BC series in order to confirm the present results.
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Affiliation(s)
- Fernando Miguel
- Angolan Institute of Cancer Control, Rua Amílcar Cabral, Luanda, Angola.,These authors contributed equally to this work
| | - Lygia Vieira Lopes
- Sagrada Esperança Clinic, Av Murtala Mohammed, Luanda, Angola.,These authors contributed equally to this work
| | - Eduardo Ferreira
- Eduardo Ferreira Pathology Laboratory, Rua de Camões, 218-5º andar, Porto 4000-000, Portugal.,These authors contributed equally to this work
| | - Emília Ribas
- Sagrada Esperança Clinic, Av Murtala Mohammed, Luanda, Angola
| | | | - Conceição Leal
- Pathology Service, Portuguese Institute of Oncology, Rua António Bernardino de Almeida, Porto 4200-072, Portugal
| | - Teresina Amaro
- Experimental Pathology and Therapeutics Group, Portuguese Institute of Oncology, Rua António Bernardino de Almeida, Porto 4200-072, Portugal
| | - Paula Lopes
- Eduardo Ferreira Pathology Laboratory, Rua de Camões, 218-5º andar, Porto 4000-000, Portugal
| | - Cristina Mendes Santos
- Sagrada Esperança Clinic, Av Murtala Mohammed, Luanda, Angola.,ONCOCIR - Education and Care in Oncology - Lusophone Africa, Rua de Quires 168-10J, Moreira da Maia 4470- 643, Portugal
| | - Carlos Lopes
- Experimental Pathology and Therapeutics Group, Portuguese Institute of Oncology, Rua António Bernardino de Almeida, Porto 4200-072, Portugal
| | - Lúcio Lara Santos
- Experimental Pathology and Therapeutics Group, Portuguese Institute of Oncology, Rua António Bernardino de Almeida, Porto 4200-072, Portugal.,ONCOCIR - Education and Care in Oncology - Lusophone Africa, Rua de Quires 168-10J, Moreira da Maia 4470- 643, Portugal.,Surgical Oncology Department, Portuguese Institute of Oncology, Rua António Bernardino de Almeida, Porto 4200-072, Portugal.,These authors contributed equally to this work
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29
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Elidrissi Errahhali M, Elidrissi Errahhali M, Ouarzane M, El Harroudi T, Afqir S, Bellaoui M. First report on molecular breast cancer subtypes and their clinico-pathological characteristics in Eastern Morocco: series of 2260 cases. BMC WOMENS HEALTH 2017; 17:3. [PMID: 28068979 PMCID: PMC5223366 DOI: 10.1186/s12905-016-0361-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 12/29/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Breast cancer is the most frequent malignancy among women in Eastern Morocco. In this paper, we provide the first report on molecular breast cancer subtypes in this region. This is the largest population-based study on breast cancer among Moroccan women. METHODS We analyzed 2260 breast cancer cases diagnosed at the Hassan II Regional Oncology Center between October 2005 and December 2012. Clinico-pathological and therapeutic features were studied. Molecular subtypes were determined and their associations with the clinico-pathological characteristics of the tumors were examined. RESULTS The mean age at diagnosis was 48.7 years ±11.4. Invasive ductal carcinoma was the predominant histological type (77.1%), followed by lobular invasive carcinoma (15.3%). The mean size of breast tumors was 3.5 cm ± 1.96, and 84% of our patients are diagnosed with tumors of more than 2 cm. Histological grade II tumors were the most frequent (70.4%), followed by advanced histological grade (18%). Lymph node positive tumors were observed in 64.8% of cases and 29.3% of patients had distant metastasis. Most tumors were hormone receptor-positive (73%) and 28.6% were HER2 positive. 86.1% of patients with hormone receptor-positive breast cancer were given hormone therapy, while 68.9% of patients with HER2+ breast cancer received targeted therapy with Herceptin. Luminal A was the commonest molecular subtype, followed by Luminal B, Triple Negative and HER2. The highest prevalence of premenopausal patients was observed in Triple Negative subtype (72.2%), followed by HER2 (64.1%), Luminal B (62.2%), and Luminal A (55.1%). Luminal B subtype had a poorer prognosis than Luminal A. Compared with Triple Negative, HER2 subtype tend to spread more aggressively and is associated with poorer prognosis. CONCLUSIONS Unlike Western countries, breast cancer occurs at an earlier age and is diagnosed at a more advanced stage in Eastern Morocco. In this region, hormone receptor-positive tumors are predominant and so the majority of breast cancer patients should benefit from hormone therapy. HER2 subtype presents an aggressive tendency, suggesting the importance of anti-HER2 therapy. This study will contribute in developing appropriate screening and cancer management strategies in Eastern Morocco.
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Affiliation(s)
- Manal Elidrissi Errahhali
- Medical Biology Unit, Faculty of Medicine and Pharmacy of Oujda, University Mohammed the First, Oujda, Morocco
| | - Mounia Elidrissi Errahhali
- Medical Biology Unit, Faculty of Medicine and Pharmacy of Oujda, University Mohammed the First, Oujda, Morocco
| | - Meryem Ouarzane
- Medical Biology Unit, Faculty of Medicine and Pharmacy of Oujda, University Mohammed the First, Oujda, Morocco
| | | | - Said Afqir
- Medical Biology Unit, Faculty of Medicine and Pharmacy of Oujda, University Mohammed the First, Oujda, Morocco.,Hassan II Regional Oncology Center, Oujda, Morocco
| | - Mohammed Bellaoui
- Medical Biology Unit, Faculty of Medicine and Pharmacy of Oujda, University Mohammed the First, Oujda, Morocco.
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30
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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.
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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.
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Sawe RT, Kerper M, Badve S, Li J, Sandoval-Cooper M, Xie J, Shi Z, Patel K, Chumba D, Ofulla A, Prosperi J, Taylor K, Stack MS, Mining S, Littlepage LE. Aggressive breast cancer in western Kenya has early onset, high proliferation, and immune cell infiltration. BMC Cancer 2016; 16:204. [PMID: 26964534 PMCID: PMC4787041 DOI: 10.1186/s12885-016-2204-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 02/17/2016] [Indexed: 12/11/2022] Open
Abstract
Background Breast cancer incidence and mortality vary significantly among different nations and racial groups. African nations have the highest breast cancer mortality rates in the world, even though the incidence rates are below those of many nations. Differences in disease progression suggest that aggressive breast tumors may harbor a unique molecular signature to promote disease progression. However, few studies have investigated the pathology and clinical markers expressed in breast tissue from regional African patient populations. Methods We collected 68 malignant and 89 non-cancerous samples from Kenyan breast tissue. To characterize the tumors from these patients, we constructed tissue microarrays (TMAs) from these tissues. Sections from these TMAs were stained and analyzed using immunohistochemistry to detect clinical breast cancer markers, including estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor 2 receptor (HER2) status, Ki67, and immune cell markers. Results Thirty-three percent of the tumors were triple negative (ER-, PR-, HER2-), 59 % were ER+, and almost all tumors analyzed were HER2-. Seven percent of the breast cancer patients were male, and 30 % were <40 years old at diagnosis. Cancer tissue had increased immune cell infiltration with recruitment of CD163+ (M2 macrophage), CD25+ (regulatory T lymphocyte), and CD4+ (T helper) cells compared to non-cancer tissue. Conclusions We identified clinical biomarkers that may assist in identifying therapy strategies for breast cancer patients in western Kenya. Estrogen receptor status in particular should lead initial treatment strategies in these breast cancer patients. Increased CD25 expression suggests a need for additional treatment strategies designed to overcome immune suppression by CD25+ cells in order to promote the antitumor activity of CD8+ cytotoxic T cells. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2204-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rispah T Sawe
- University of Notre Dame, Notre Dame, IN, USA.,Harper Cancer Research Institute, University of Notre Dame, 1234 N Notre Dame Avenue, South Bend, IN, USA.,Moi University, Eldoret, Kenya.,Maseno University, Maseno, Kenya
| | - Maggie Kerper
- University of Notre Dame, Notre Dame, IN, USA.,Harper Cancer Research Institute, University of Notre Dame, 1234 N Notre Dame Avenue, South Bend, IN, USA
| | - Sunil Badve
- Harper Cancer Research Institute, University of Notre Dame, 1234 N Notre Dame Avenue, South Bend, IN, USA.,Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jun Li
- University of Notre Dame, Notre Dame, IN, USA.,Harper Cancer Research Institute, University of Notre Dame, 1234 N Notre Dame Avenue, South Bend, IN, USA
| | - Mayra Sandoval-Cooper
- University of Notre Dame, Notre Dame, IN, USA.,Harper Cancer Research Institute, University of Notre Dame, 1234 N Notre Dame Avenue, South Bend, IN, USA
| | - Jingmeng Xie
- University of Notre Dame, Notre Dame, IN, USA.,Harper Cancer Research Institute, University of Notre Dame, 1234 N Notre Dame Avenue, South Bend, IN, USA.,Eck Institute for Global Health, Notre Dame, IN, USA
| | - Zonggao Shi
- Harper Cancer Research Institute, University of Notre Dame, 1234 N Notre Dame Avenue, South Bend, IN, USA
| | | | | | | | - Jenifer Prosperi
- University of Notre Dame, Notre Dame, IN, USA.,Harper Cancer Research Institute, University of Notre Dame, 1234 N Notre Dame Avenue, South Bend, IN, USA.,Indiana University School of Medicine, Indianapolis, IN, USA.,Indiana University School of Medicine-South Bend, South Bend, IN, USA
| | - Katherine Taylor
- University of Notre Dame, Notre Dame, IN, USA.,Eck Institute for Global Health, Notre Dame, IN, USA
| | - M Sharon Stack
- University of Notre Dame, Notre Dame, IN, USA.,Harper Cancer Research Institute, University of Notre Dame, 1234 N Notre Dame Avenue, South Bend, IN, USA.,Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Laurie E Littlepage
- University of Notre Dame, Notre Dame, IN, USA. .,Harper Cancer Research Institute, University of Notre Dame, 1234 N Notre Dame Avenue, South Bend, IN, USA. .,Indiana University School of Medicine, Indianapolis, IN, USA.
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A national framework for breast cancer control: A report on Rwanda’s inaugural symposium on the management of breast cancer. J Cancer Policy 2015. [DOI: 10.1016/j.jcpo.2015.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Klassen AC, Pankiewicz A, Hsieh S, Ward A, Curriero FC. The association of area-level social class and tobacco use with adverse breast cancer characteristics among white and black women: evidence from Maryland, 1992-2003. Int J Health Geogr 2015; 14:13. [PMID: 25880216 PMCID: PMC4413983 DOI: 10.1186/s12942-015-0007-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 02/25/2015] [Indexed: 11/05/2022] Open
Abstract
Background In breast cancer, worse disease characteristics are associated with fewer social resources and black race. However, it is unknown whether social gradients have similar impact across race, and whether behaviors, including tobacco use, may explain a portion of the social gradient. Methods We modeled relationships between area-level social class, tobacco spending and tumor characteristics, using 50,062 white and black cases diagnosed from 1992–2003 in Maryland, a racially and economically diverse state on the east coast of the United States. Multi-level models estimated the effect of area-level social class and tobacco consumption on tumor grade, size, and stage at diagnosis. Results Adjusting for race, age and year of diagnosis, higher social class was associated with lower risk for tumors with histological grade 3 or 4 (O.R. 0.96, 95% C.I. 0.94,0.99), those diagnosed at SEER stage 2 or later (O.R. 0.89, 95% C.I. 0.86, 0.91), and tumor size >2 cm (O.R. 0.87, 95% C.I. 0.84, 0.90). Higher tobacco spending was associated with higher risk for higher grade (O.R. 1.01, 1.00, 1.03) and larger tumors (O.R. 1.03, 95% C.I. 1.01, 1.06), but was not statistically significantly related to later stage (O.R. 1.00, 95% C.I. 0.98, 1.02). Social class was less protective for black women, but tobacco effects were not race-specific. Conclusions Results suggest that in one U.S. geographic area, there is a differential protection from social class for black and white women, supporting use of intersectionality theory in breast cancer disparities investigations. Area-level tobacco consumption may capture cases’ direct use and second hand smoke exposure, but also may identify neighborhoods with excess cancer-related behavioral or environmental exposures, beyond those measured by social class. Given the growing global burden of both tobacco addiction and aggressive breast cancer, similar investigations across diverse geographic areas are warranted.
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Affiliation(s)
- Ann C Klassen
- Department of Community Health and Prevention, Drexel University School of Public Health, 3215 Market Street, 4th Floor, Philadelphia, PA, 19104, USA. .,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Aaron Pankiewicz
- Department of Community Health and Prevention, Drexel University School of Public Health, 3215 Market Street, 4th Floor, Philadelphia, PA, 19104, USA.
| | - Stephanie Hsieh
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Abigail Ward
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Frank C Curriero
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. .,Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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