Does the breast cancer age at diagnosis differ by ethnicity? A study on immigrants to Sweden

Prognostic factors and overall survival of breast cancer in Benin: a hospital-based study

BACKGROUND

In Benin, a country in West Africa, breast cancer is the leading cancer in women, both in terms of incidence and mortality. However, evidence on the mortality of breast cancer and its associated factors is lacking in this country. Our aim was to describe and analyze the clinical, histopathological, and prognostic aspects of breast cancer in Benin.

METHODS

A descriptive and analytical study was carried out at the CNHU-HKM and the CHU-MEL, two major tertiary referral hospitals for breast cancer management located in Cotonou, the capital city of Benin. All breast cancer medical records with histological evidence and immunohistochemistry studies were retrospectively collected between January 1, 2014, and September 30, 2020, in these two tertiary referral hospitals and analyzed in the current study.

RESULTS

Finally, 319 medical records were included. The mean age at diagnosis was 48.74 years. The tumors were most frequently classified as T4 (47.6%) with lymph node involvement N2 (34.5%), and metastases were clinically noted in 21.9% of cases. Stage was reported in the medical records of 284 patients. Tumors were diagnosed at very late AJCC stages: stage III (47.5%) and stage IV (24.7%). Grades SBR 2 (49.2%) and SBR 3 (32.6%) were the most frequent grades. Triple-negative breast cancer (31.3%) was the most common molecular type. The overall 5-year survival was 48.49%. In multivariable analysis, the poor prognostic factors were lymph node invasion (HR = 2.63; p = 0.026; CI: [1.12, 6.17]), the presence of metastasis (HR = 3.64; p < 0.001); CI: [2.36, 5.62] and the immunohistochemical profile (HR = 1.29; p < 0.001; CI: [1.13, 1.48]).

CONCLUSIONS

Breast cancer in Beninese is predominant in young adults and is often diagnosed at a late stage. The survival of breast cancer patients in Benin can be improved by enhancing early diagnosis and multidisciplinary management.

Cancer in Migrants: A Population-Based Study in Italy

BACKGROUND

Migrants are a vulnerable and neglected population. We aimed at investigating cancer proportionate rates in migrants in Sicily, Southern Italy.

METHODS

We extracted data on new cancer cases diagnosed between 2004 and 2019 from the Eastern Sicily cancer registry. We compared the adjusted proportionate morbidity ratio (PMR) for the most common cancer types among migrants and non-migrants. We fitted multivariate logistic regression models comparing one cancer to all other cancers to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for migration status. The analysis was stratified by region of origin.

RESULTS

Overall, 4726 new cancer cases occurred in migrants between 2004 and 2019, 63.5% of those among women and 224,211 in non-migrants, including 54.5% among men, with odds for migrants/non-migrants of 2.1%. Migrants had an increased proportion of cervical (PMR = 2.68, 95% CI = 2.29-3.10) and lung cancer (PMR = 1.20, 95% CI = 1.07-1.33). The highest OR in migrants was observed for cervical cancer (OR = 3.54, 95% CI = 2.99-4.20). Colorectal cancer was decreased among migrants (OR = 0.86, 95% CI = 0.77-0.96).

CONCLUSIONS

Migrants to Sicily have higher odds of cervical cancer and a decreased risk of colorectal cancer compared to non-migrants. Increased odds were also detected for lung cancer, in particular in women. Different cancer patterns could be observed based on the region of origin. HPV-related cancers need targeted attention in migrants living in Sicily.

Incidence of Epstein-Barr Virus Among Women With Breast Cancer Using Monoclonal Antibodies for Latent Membrane Protein 1 (LMP1)

BACKGROUND/AIM

Breast cancer is a common type of cancer in Sudan. Numerous studies propose viral oncogenesis as an etiological factor for breast cancer. The aim of the study was to analyze the presence of the Epstein-Barr virus (EBV) using monoclonal antibodies against latent membrane protein 1 (LAMP1) and determine the correlation between the presence of EBV and clinicopathological characteristics.

PATIENTS AND METHODS

This study used immunohistochemistry to analyze the presence of EBV in 202 samples from Sudanese women diagnosed with breast cancer. Clinicopathological data were collected from patient records from the Radiation and Isotopes Centre in Khartoum State, Republic of Sudan.

RESULTS

This study included 202 patients 168 (83.2%), 16 (7.9%), and 18 (8.9%), diagnosed with invasive ductal carcinoma, invasive lobular carcinoma, and papillary carcinoma, respectively. Axillary lymph node metastasis was present in 57 (28.2%) of cases, while 11 patients (5.4%) tested positive for EBV. The mean age of patients was 48.14±14.4 years. EBV infection was more frequently detected in invasive ductal carcinoma cases, and EBV positivity was not associated with cancer type, grade, progesterone levels, and HER2 expression. On the other hand, a statistically significant association was found between EBV presence and lymph node involvement, estrogen receptor status, and age group.

CONCLUSION

EBV may not play a vital role in the pathogenesis of breast carcinoma in Sudanese women.

First Prospective Cross-Sectional Study on the Impact of Immigration Background and Education in Early Detection of Breast Cancer

Background

Although immigrant health is an important issue in national health policy, there is a serious shortage of data in many countries. Most studies lack information on educational status, which is a major limitation. This prospective cross-sectional study analyzed a real-world breast cancer population on the influence of immigration background and educational status on participation in breast cancer early detection programs in the federal state of Lower Saxony, Germany.

Methods

Data collection was conducted from 2012 to 2016 in six certified breast cancer centers using a standardized questionnaire for patients' interview and tumor-specific data from the patients' medical records.

Results

2,145/3,047 primary breast cancer cases were analyzed. 17.5% of our patients had a history of immigration, including n = 202 first-generation immigrants and n = 168 second-generation immigrants. Most of them were citizens of EU27 member states. No significant difference was seen in age, tumor stage, histology, grading, Ki-67, Her2/neu-status, and hormone receptor status compared to the native cohort. 100% participation rate in the breast cancer early detection programs were seen in patients with no school graduation. With regards to the national mammography screening program, participation decreased significantly with educational status (p = 0.0003).

Conclusions

No tumor biological differences were seen between immigrants and German natives. In first-generation immigrants, early detection programs were well accepted despite sociocultural and language differences. Participation rate decreased significantly with higher education levels irrespective of country of origin. Immigration background does not have a negative effect on the participation in breast cancer screening. This mainly relates to immigrants from EU27 member states.

Premenopausal Breast Cancer Risk Factors and Associations with Molecular Subtypes: A Case-Control Study

Background

Breast cancer (BC) is the most prevalent cancer in women and the leading cause of women's cancer-related deaths and morbidity worldwide. In Rwanda, BC incidence is increasing with an unacceptably high mortality rate in premenopausal women.

Objectives

The purpose was to identify modifiable BC risk factors and assess associations between common breast cancer risks factors and molecular subtypes in premenopausal women in Rwanda.

Methods

This was a case-control study. Premenopausal women with histological confirmation of BC and frequency-matched for age controls were recruited. A preestablished questionnaire was administered to both cases and controls for sociodemographics, BC probable risk factors, and clinical and pathological characteristics. BC was classified into luminal A, luminal B, HER2-type, basal-like (triple negative), and unclassified molecular subtypes by immunohistochemistry (IHC). Odds ratio (OR) and 95% confidence interval (CI) were estimated using multivariate logistic regression analysis.

Results

340 participants were recruited into the study (170 cases vs. 170 controls). The median age was 39 years. The majority of cases presented at advanced stages of the disease (51.2% in stages III and IV) and had invasive ductal carcinoma (98.2%). 60.6% had subtypes of poor prognosis (HER2 enriched 14.7%, triple negative 12.9%, and unclassified 32.9%). Alcohol intake (AOR = 3.73, 95%CI 2.19 - 6.32, p < 0.001), obesity/overweight in adolescence or early adulthood (AOR = 10.86, 95%CI 4.82 - 24.4, p < 0.001), history of primary infertility (AOR = 33.8, 95%CI 3.5 - 321.5, p = 0.002), nulliparity (AOR = 3.75, 95%CI 1.61 - 8.75, p = 0.002), and a history of benign breast disease (AOR = 6.06, 95%CI 1.19 - 30.73, p = 0.03) were associated with the occurrence of premenopausal breast cancer. There was no significant difference between risk factor stratification per molecular subtype.

Conclusion

Several reproductive, environmental, and lifestyle risk factors have been identified to be associated with premenopausal BC. Among them, alcohol intake and obesity/overweight during adolescence/early adulthood can be modified. Interventions targeting alcohol consumption and obesity/overweight in adolescents and young adults may decrease the incidence of premenopausal breast cancer.

Population Based Survival Analysis of Females Diagnosed with Breast Cancer and Its Related Factors in Kerman Province from 2001 to 2015, Using Parametric Log-Logistic Models

Background: Breast cancer is the most common cancer among women worldwide and 14.2% of deaths in Iranian women were due to breast cancer. Objectives: The present study aimed at investigating the survival of females with breast cancer diagnosed over 14 years and its related factors in Kerman Province. Methods: This is a longitudinal study. Information about 2851 females diagnosed with breast cancer was inquired from the Cancer Registry of Kerman University of Medical Sciences from March 2001 to March 2015. Data analysis was performed by Stata 14 and SPSS 22. Results: Totally, 8511 women diagnosed with breast cancer were enrolled in this study. The median survival time among patients with grade 3 at diagnosis was 0.51 of patients with grade 1 (P = 0.016). The median survival time among patients with stage 4 at diagnosis was 0.11 of patients with stages 0 and 1 (P < 0.001). The median survival time among post-menopause patients at diagnosis was 0.65 of pre-menopause patients (P = 0.014). The median survival time among patients with secondary metastasis was 0.22 of patients without it (P < 0.001) and the median survival time among patients with hormonotherapy was 1.52 of patients without this treatment (P = 0.013). Conclusions: Early diagnosis can improve the survival of patients with breast cancer. Periodic checkups especially in menopause ages are recommended. Hormone therapy has been successful in increasing patients’ survival.

Young breast cancer and the influence of ethnicity in Sandakan: A 3-year retrospective cross-sectional study

INTRODUCTION

Breast cancer (BC) is the most common cancer in Malaysia, with incidence increasing with age. There have been demonstrated differences in age of presentation and tumour biology when comparing ethnicities. Twenty percent of Caucasian women present before 50 years old, but almost 50% of Southeast Asian (SEA) women present before 50. However, BC in Indigenous sub-groups has not yet been studied. Sandakan is a city in Sabah with a large Indigenous population. Current nationwide screening guidelines are based on the U.S. Preventive Task Force 2009 Guidelines, which may not represent our population. We aim to examine the age of incidence for our local population, for local screening recommendations.

METHOD

Retrospective cross-sectional study, including all consecutive cases of epithelial invasive tumours, from January 2016 to December 2018. Other histological types were excluded. Univariate and multivariate analyses were performed.

RESULT

A total of 115 breast tumours were identified. Ten tumours were excluded (five ductal carcinoma in situ, four phyllodes, and one sarcoma), leaving a study population of 105 patients. Median age of presentation was 53 years (min 30; max 97). A total of 41.9% presented before the age of 50. Patients of Indigenous ethnic origins were 11 years younger at presentation than non-Indigenous women. Tumour grade was more likely to be higher among Indigenous women.

CONCLUSION

Median age of presentation of BC in Sandakan matches regional data; however, patients of Indigenous ethnic groups present even earlier. Screening guidelines should consider the growing evidence of young BC in SEA.

Trends in breast cancer incidence in Ho Chi Minh City 1996-2015: A registry-based study

The burden of breast cancer in Vietnam has not been documented. This study sought to estimate the incidence of breast cancer in Ho Chi Minh City, the largest economic center of Vietnam, from 1996 to 2015. This was a population-based study using the Ho Chi Minh City Cancer Registry as a source of data (coverage period: 1996-2015). The Registry adopted the International Classification of Diseases for Oncology, 3rd Edition for the classification of primary sites and morphology, and guidelines from the International Agency for Research on Cancer and the International Association of Cancer Registries. Using the population statistics from census data of Ho Chi Minh City, the point incidence of breast cancer for 5-year period was estimated. Based on the national population, we calculated the age-standardized rate (ASR) of breast cancer between 1996 and 2015. Overall 14,222 new cases of breast cancer (13,948 women, or 98%) had been registered during the 1996-2015 period; among whom, just over half (52%) were in the 2nd stage and 26% in the 3rd and 4th stages. In women, the median age at diagnosis was 50 years and there was a slight increase over time. The ASR of breast cancer during the 2011-2015 period was 107.4 cases per 100,000 women, representing an increase of 70% compared to the rate during the 1996-2000 period. In men, there was also a significant increase in the ASR: from 1.13 during the 1996-2001 period to 2.32 per 100,000 men during the 2011-2015 period. These very first data from Vietnam suggest that although the incidence of breast cancer in Vietnam remains relatively low, it has increased over time.

Determinants of breast cancer in Saudi women from Makkah region: a case-control study (breast cancer risk factors among Saudi women)

BACKGROUND

There are various factors that play a major role in influencing the overall health conditions of women diagnosed with breast cancer. The population of women in Makkah region are diverse, therefore it is significant to highlight the possible determinants of breast cancer in this population. This is a case-control study that assessed determinants of breast cancer including socioeconomic factors, health-related characteristics, menstrual histories and breastfeeding among postmenopausal women in Makkah region in Saudi Arabia.

METHODS

A total of 432 female participants (214 cases and 218 controls) were recruited for this study. A validated questionnaire was completed by trained dietitians at King Abdullah Medical City Hospital in the Makkah region of Saudi Arabia.

RESULTS

Results displayed that determinants of breast cancer were associated significantly (P < 0.05) with unemployment, large family size, lack of knowledge and awareness about breast cancer, obesity, sedentary lifestyle, smoking, starting menarche at an early age, as well as hormonal and non-hormonal contraceptive use. There was no effect of diabetes, hypertension, hyperlipidemia, and duration of breastfeeding on the incidence of breast cancer.

CONCLUSION

In summary, the results of this study accentuate the possible effect of socioeconomic factors, health-related characteristics and menstrual history on the incidence of breast cancer in postmenopausal women in the Makkah region. Education programs should be applied to increase breast cancer awareness and possibly decrease its incidence.

Breast cancer by migrant background in Belgium: Lower risk, but worse survival in women of non-European origin

Foreign and native populations differ in terms of breast cancer outcomes. Studies rarely distinguish between premenopausal and postmenopausal breast cancer, although the risk profile is different; nor between migrants of the first and second generation (FG and SG), which is crucial to examine genetic and environmental influences on breast cancer. This research fills these gaps by investigating patterns in breast cancer incidence and survival in different migrant groups by menopausal and migrant generational status, taking various risk factors into account. To this end, individually linked data from the 2001 census, the Belgian Cancer Registry and the Crossroads Bank for Social Security are used. Age-standardised incidence rates and incidence rate ratios are calculated by migrant background group, stratified according to ages 30-50 (premenopausal) and 50-70 (postmenopausal). Incidence rate ratios are examined with and without taking reproductive factors and socioeconomic position (SEP) into account. Relative survival percentages and relative excess risks of dying among premenopausal and postmenopausal patients are computed with and without controlling for the stage at diagnosis and SEP. Premenopausal breast cancer is further examined by migrant generational status. Breast cancer incidence is lower among non-European migrants compared to Belgians. Keeping SEP and known risk factors constant reduces much, but not all of the observed discrepancies. A risk convergence between SG migrants and Belgians for the development of premenopausal breast cancer is observed. Premenopausal breast cancer survival is worse among Moroccan patients due to a higher stage at diagnosis. This disadvantage is concentrated in the FG.

Multicenter cross-sectional screening of the BRCA gene for Chinese high hereditary risk breast cancer populations

Due to lack of systematic reviews, BRCA, DNA Repair Associated (BRCA) mutations in the Chinese population are not completely understood. The following study investigates the prevalence and type of BRCA mutations in Chinese patients with high hereditary risk of breast cancer (BC). Patients Drwere recruited from 14 cities between October 2015 and February 2016, and were selected based on family and personal medical history. BRCA mutations were analyzed by collecting blood samples from all participants. 437 BC patients were included. A total of seventy-six (17.4%) mutation carriers were identified with no geographic difference. The mutation rate in the early-onset BC patients was lower compared to family history of breast/ovarian cancer (OC), bilateral BC, male BC, BC&OC or meeting ≥2 criteria (9.2 vs. 21.7, 24.0, 22.2, 16.7 and 24.3%, respectively, P=0.007). A total of 61 mutation sites were identified (BRCA1 32, BRCA2 29) including 47.5% novel sites and extra 10 variants of uncertain significance. A total of five sites were repeated in more than one unrelated patient. A total of 11 sites were associated with hereditary breast and ovarian cancer syndrome, two of which were confirmed by family pedigrees. Compared with BRCA^- patients, patients with BRCA1 mutation tended to be triple-negative BC (P<0.001), whereas patients with BRCA2 mutation were more likely to be hormone receptor positive BC (P=0.02). The present study provides a general BRCA mutation profile in the Chinese population. The prevalence of BRCA mutation in BC patients with high hereditary risk is lower compared with Western populations. Chinese mutation type is different with Western people, without obvious founder mutation.

Rising global burden of breast cancer: the case of sub-Saharan Africa (with emphasis on Nigeria) and implications for regional development: a review

BACKGROUND

Despite mortality from breast cancer in Africa being higher than in high income countries, breast cancer has not been extensively studied in the region. The aim of this paper was to highlight the rising burden of breast cancer with an emphasis on sub-Saharan Africa as well as trends, characteristics, controversies and their implications for regional development.

METHODOLOGY

A review of published studies and documents was conducted in Medline, Scopus, Pubmed and Google using combinations of key words-breast neoplasm, breast cancer, cancer, incidence, mortality, Africa, Nigeria. Graphical and frequency analyses were carried out on some of the incidence and mortality figures retrieved from published papers and the GLOBOCAN website.

FINDINGS

Globally, about 25% and 15% of all new cancer cases and cancer deaths respectively among females were due to breast cancer. Africa currently had the highest age-standardized breast cancer mortality rate globally, with the highest incidence rates being recorded within the sub-Saharan African sub-region. Incidence trends such as inherently aggressive tumour and younger age profile had been subject to controversies. Certain factors such as westernized diet, urbanization and possibly increasing awareness had been implicated, though their specific contributions were yet to be fully established.

CONCLUSION

Unless urgent action is taken, breast cancer will compound sub-Saharan Africa's disease burden, increase poverty and gender inequality as well as reverse the current global gains against maternal and neonatal mortality.

Cancer risk in different generations of Middle Eastern immigrants to California, 1988-2013

The objective of this study is to compare cancer risk among different generations of Middle Eastern immigrants (ME) and non-Hispanic whites (NHW) in California between 1988 and 2013. We used data from the California Cancer Registry to identify invasive primary incident cancer cases in three population groups: (i) first-generation ME immigrants, (ii) second- or subsequent-generations ME immigrants, and (iii) NHW. Proportional incidence ratio (PIR) was used to compare cancer risk of the 15 selected most common cancers in the 3 population groups taking into consideration time since immigration for first-generation ME immigrants. First generation ME immigrants were more likely to be at increased risk of stomach (PIR= 3.13) and hepatobiliary (PIR = 2.27) cancers in females and thyroid (PIR = 2.19) and stomach (PIR = 2.13) cancers in males in comparison with NHW. Second- or subsequent-generations ME immigrants were at increased risk of thyroid cancer (PIR = 1.43 in females and 2.00 in males) in comparison with NHW, and malignant melanoma cancer (PIR = 4.53 in females and 4.61 in males) in comparison with first-generation ME immigrants. The risk levels of breast, thyroid and bladder cancers in ME first generation were significantly higher compared to NHW regardless of time spent in the United States suggesting the role of genetic predisposition, and/or cultural characteristics associated with these cancers. The results suggest that differences in cancer risk between ME first-generation immigrants and NHW change in second or subsequent generations, approaching the risk level of NHW and indicating the impact of acculturation in this immigrant population.

Demographic survey of four thousand patients with 10 common cancers in North Eastern Iran over the past three decades

BACKGROUND

Cancer is a major cause of mortality in developing countries and correct and valid information about the epidemiology of this disease is the first step in the planning of health care in each region. The aim of this study was to determine the relative frequency, mean age and sex ratio of the most 10 common non-skin cancers in the world and Iran, among patients referred to an oncology clinic.

MATERIALS AND METHODS

This descriptive study was conducted in Mashhad, north east of Iran. The data obtained from the records of patients referred to the private oncology center between the years of 1985-2012." According to the latest report of GLOBOCAN study commonest malignancies included were lung, breast, colorectal, prostate, stomach, liver, cervix, esophageal, bladder cancers and Non-Hodgkin lymphoma.

RESULTS

A total of 4,606 cases were analyzed. The mean age was 55.5±13.8years (male: 59.5±13.9, female: 52.6±12.9). Overall, breast cancer (1,264 cases, relative frequency of 27.4%) was the most prevalent cancer; however the mean ages of diagnosis were not significantly different between 5-year time period divisions (p=0.290). The most common cancer in men was esophageal cancer (26.3%).The lowest mean age was related to women diagnosed with breast cancer (48.5±11.8) and men with non-Hodgkins lymphoma (48.4±17.8). There were statistically significant differences between the mean age of men and women with gastric (p=0.003) and esophageal cancers (p<0.001). Male to female sex ratios in our study for bladder, lung and stomach cancers were 6.57, 2.60 and 2.50 respectively.

CONCLUSIONS

The results showed that breast cancer tends to be found in younger female patients and bladder cancer appears more often in men. Screening in target population in addition to early diagnosis may reduce death and disability.

Epidemiologic and Clinical Profiles of Breast Diseases in Niger

This study aimed at characterizing epidemiologic and clinical profiles of breast diseases in Niger during the period of 2010–2013 at the National Hospital of Niamey. Medical records were abstracted for demographic, reproductive, clinical, and treatment information. A process map of patient navigation and barriers to seeking medical care was developed after interviewing 26 local health professionals who encounter and/or manage breast diseases. We identified 245 breast cancers and 122 other breast diseases. Mean age of breast cancer patients was 45.4 (±13.26 years) and that of breast diseases was 31(±12.5 years) with 1/3 of cancers under age 44. Infection-related diseases represented 24% of non-cancers. Male breast diseases represented 4.75% of diseases and 2.05% of cancers. Only 37.1% of cancers had histopathologic confirmation and 90% of cancer patients presented at advanced stages and mastectomy was performed for 66% of breast cancers. Patient and system barriers to care were common in diagnosing and treating breast diseases. Women in Niger have double burden of infectious breast diseases and emerging breast cancer. Younger age and late diagnosis are common features. Reducing barriers to access to care, down-staging of cancer, implementation of clinical guidelines for managing advanced cases are important needs for reducing breast cancer morbidity and mortality in Niger.

Cytomorphology of palpable breast lesions: Diagnostic utility of FNAC in a developing country

BACKGROUND

Breast lesions including breast cancer represent a major public health issue in Sudan. Fine-needle aspiration cytology (FNAC) is an established, simple, highly accurate, minimally invasive, and cost-effective method of diagnosing most breast lesions. The aim of this study is to document the most common breast conditions diagnosed by means of FNAC over a two-year period in Atbara, a city in north Sudan.

METHODS

A retrospective, descriptive, cross-sectional, laboratory-based study in which records of all palpable breast lesions diagnosed by FNAC in the years 2012 and 2013 were reviewed and analyzed.

RESULTS

The total number of cases studied was 232; most subjects, 222 (95.7%), were females. The age range was 15-90 years (mean 38.2). Painless lump was the most common 190 (81.9%) clinical presentation. The left breast was affected more often than the right breast, 56.0% vs. 40.5%. Benign conditions were 167 (72%). Malignant neoplasms were 65 (28.0%). The most important associations with malignancy were female sex, age above 35 years, multiparity, painless lump at upper outer quadrant of left breast, lump size above 2 cm and the presence of an enlarged ipsilateral axillary lymph node at presentation.

CONCLUSION

In the northern part of Sudan, the prevalence of malignant breast lesions diagnosed by FNAC is more than one fourth of all cases presenting with palpable breast lumps. FNAC is a technique that is ideal for use in resource-limited health settings.

Imaging surveillance programs for women at high breast cancer risk in Europe: Are women from ethnic minority groups adequately included? (Review)

Women from ethnic minority groups, including immigrants and refugees are reported to have low breast cancer (BC) screening rates. Active, culturally-sensitive outreach is vital for increasing participation of these women in BC screening programs. Women at high BC risk and who belong to an ethnic minority group are of special concern. Such women could benefit from ongoing trials aimed at optimizing screening strategies for early BC detection among those at increased BC risk. Considering the marked disparities in BC survival in Europe and its enormous and dynamic ethnic diversity, these issues are extremely timely for Europe. We systematically reviewed the literature concerning European surveillance studies that had imaging in the protocol and that targeted women at high BC risk. The aim of the present review was thereby to assess the likelihood that women at high BC risk from minority ethnic groups were adequately included in these surveillance programs. Twenty-seven research groups in Europe reported on their imaging surveillance programs for women at increased BC risk. The benefit of strategies such as inclusion of magnetic resonance imaging and/or more intensive screening was clearly documented for the participating women at increased BC risk. However, none of the reports indicated that sufficient outreach was performed to ensure that women at increased BC risk from minority ethnic groups were adequately included in these surveillance programs. On the basis of this systematic review, we conclude that the specific screening needs of ethnic minority women at increased BC risk have not yet been met in Europe. Active, culturally-sensitive outreach is needed to identify minority women at increased BC risk and to facilitate their inclusion in on-going surveillance programs. It is anticipated that these efforts would be most effective if coordinated with the development of European-wide, population-based approaches to BC screening.

Breast Cancer Challenges and Screening in China: Lessons From Current Registry Data and Population Screening Studies

BACKGROUND

As one of its responses to the increasing global burden of breast cancer (BC), China has deployed a national registration and BC screening campaign. The present report describes these programs and the initial results of these national BC control strategies, highlighting the challenges to be considered.

MATERIALS AND METHODS

The primary BC incidence and prevalence data were obtained from the Chinese National Central Cancer Registry. MapInfo software was used to map the geographic distribution and variation. The time trends were estimated by the annual percentage of change from 2003 to 2009. The description of the screening plans and preliminary results were provided by the Ministry of Health.

RESULTS

Chinese cancer registries were primarily developed and activated in the East and Coastal regions of China, with only 12.5% of the registries located in West China. Geographic variation was noted, with the incidence of BC higher in North China than in South China and in urban areas compared with rural areas. Of great interest, these registries reported that the overall BC incidence has been increasing in China, with an earlier age of onset compared with Western countries and a peak incidence rate at age 50. In response to this increasing incidence and early age of onset, BC screening programs assessed 1.46 million women aged 35-59 years, using clinical breast examinations and ultrasound as primary screening tools between 2009 and 2011. The diagnostic rate for this screening program was only 48.0/10(5) with 440 cases of early stage BC. Early stage BC was detected in nearly 70% of screened patients. Subsequently, a second-generation screening program was conducted that included older women aged 35-64 years and an additional 6 million women were screened.

CONCLUSION

The cancer registration system in China has been uneven, with a greater focus on East rather than West China. The data from these registries demonstrate regional variation, an increasing BC incidence, and an early age of onset. The 2009 to 2011 BC screening program targeting women aged 35-59 years had a low detection rate that resulted in a second-generation screening program that extended the cohort size and ages screened to 35-64 years.

IMPLICATIONS FOR PRACTICE

Cancer registration has been active in China for decades; however, a national survey of registries has not been routinely reported. This study used MapInfo to describe the reported data and found asymmetric registration activities, geographic variations in breast cancer (BC) burdens, and an increasing incidence with a peak at age 50. The initial Chinese BC screening programs focused on a relatively young population of women aged 35-59 years and had a low detection rate, but 69.7% of patients had early stage BC. Older women were included in the second-generation screening programs, and an additional 6 million women were screened. Consideration of regional variations and age is necessary to optimize the efficiency and utility of BC screening in China, with the ultimate goal to reduce BC mortality.

Cancer in immigrants as a pointer to the causes of cancer

The early cancer studies on immigrants, which started to appear some 50 years ago, showed that the incidence in cancers changes to the level of the new host country in one or two generations. These findings were fundamental to the understanding of the environmental etiology of human cancer. Many immigrant groups originate from countries with no cancer registration, and, hence, the immigrant studies may provide estimates on the indigenous cancer rates. The Swedish Family-Cancer Database has been an important source of data for immigrant studies on various diseases. The Database covers the Swedish population of the past 100 years, and it records the country of birth for each subject. A total of 1.79 million individuals were foreign born, Finns and other Scandinavians being the largest immigrant groups. Over the course of years, some 30 publications have appeared relating to cancer in immigrants. In the present article, we will review more recent immigrant studies, mainly among Swedish immigrants, on all cancers and emphasize the differences between ethnic groups. In the second part, we discuss the problem of reliable registration of cancer and compare cancer incidence among non-European immigrants with cancer incidence in countries of origin, as these have now active cancer registries. We discuss the experiences in cancer registration in Morocco and Egypt. We show the usefulness and limitations in predicting cancer incidence in the countries of origin.

Hispano-Americans in Europe: what do we know about their health status and determinants? A scoping review

Background

Policy makers and health practitioners are in need of guidance to respond to the growing geographic mobility of Hispano-American migrants in Europe. Drawing from contributions from epidemiology, social sciences, demography, psychology, psychiatry and economy, this scoping review provides an up-to-date and comprehensive synthesis of studies addressing the health status and determinants of this population. We describe major research gaps and suggest specific avenues of further inquiry.

Methods

We identified systematically papers that addressed the concepts “health” and “Hispano Americans” indexed in five data bases from Jan 1990 to May 2014 with no language restrictions. We screened the 4,464 citations retrieved against exclusion criteria and classified 193 selected references in 12 thematic folders with the aid of the reference management software ENDNOTE X6. After reviewing the full text of all papers we extracted relevant data systematically into a table template to facilitate the synthesising process.

Results

Most studies focused on a particular disease, leaving unexplored the interlinkages between different health conditions and how these relate to legislative, health services, environmental, occupational, and other health determinants. We elucidated some consistent results but there were many heterogeneous findings and several popular beliefs were not fully supported by empirical evidence. Few studies adopted a trans-national perspective and many consisted of cross-sectional descriptions that considered “Hispano-Americans” as a homogeneous category, limiting our analysis. Our results are also constrained by the availability and varying quality of studies reviewed.

Conclusions

Burgeoning research has produced some consistent findings but there are huge gaps in knowledge. To prevent unhelpful generalisations we need a more holistic and nuanced understanding of how mobility, ethnicity, income, gender, legislative status, employment status, working conditions, neighbourhood characteristics and social status intersect with demographic variables and policy contexts to influence the health of the diverse Hispano-American populations present in Europe.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-1799-x) contains supplementary material, which is available to authorized users.

Female breast cancer incidence among Asian and Western populations: more similar than expected

BACKGROUND

Previous reports suggested that female breast cancer is associated with earlier ages at onset among Asian than Western populations. However, most studies utilized cross-sectional analyses that may be confounded by calendar-period and/or birth cohort effects. We, therefore, considered a longitudinal (forward-looking) approach adjusted for calendar-period changes and conditioned upon birth cohort.

METHODS

Invasive female breast cancer data (1988-2009) were obtained from cancer registries in China, Hong Kong, South Korea, Taiwan, Singapore, and the United States. Age-period-cohort models were used to extrapolate longitudinal age-specific incidence rates for the 1920, 1944, and 1970 birth cohorts.

RESULTS

Cross-sectional age-specific incidence rates rose continuously until age 80 years among US white women, but plateaued or decreased after age 50 years among Asian women. In contrast, longitudinal age-specific rates were proportional (similar) among all Asian countries and the United States with incidence rates rising continuously until age 80 years. The extrapolated estimates for the most recent cohorts in some Asian countries actually showed later ages at onset than in the United States. Additionally, over successive birth cohorts, the incidence rate ratios (IRRs) for the longitudinal curves converged (narrowed) between Asian and US white women.

CONCLUSIONS

Similar longitudinal age-specific incidence rates along with converging IRRs indicate that the age effects for invasive breast cancer are more similar among Asian and Western populations than might be expected from a solely cross-sectional analysis. Indeed, the Asian breast cancer rates in recent generations are even surpassing the historically high rates in the United States, highlighting an urgent need for efficient prevention and treatment strategies among Asian populations.

Improving breast cancer detection using ultrasonography in asymptomatic women with non-fatty breast density

BACKGROUND

Mammography (MX) is a reliable modality for detection of breast cancer in asymptomatic women. Use of additional whole breast ultrasonography (US) for breast cancer screening is widely recognized, in particular in women with dense breast parenchyma.

PURPOSE

To determine the subgroup of women, according to breast density and age, who receive most benefit from US following MX for detection of breast cancer in an asymptomatic condition.

MATERIAL AND METHODS

The study was conducted in asymptomatic women who had non-fatty breast parenchyma using MX and US during January 2006 and December 2007. Mammographic breast density was classified as recommended by ACR BI-RADS lexicon. Non-fatty breast referred to D2, D3, and D4. US was performed by the same radiologists who interpreted MX with a handheld machine during the same visit. Data on demographics, cancer detection rate (CDR), and incremental cancer detection rate (ICDR) were analyzed using 95% confident interval (CI).

RESULTS

Of 14,483 breast cancer screenings in women who had non-fatty breast density, 115 cancers were documented. The mean age of cancer patients was 49.6 years. Of 115 cancers, 105 were evidenced on images (31 with MX alone, 19 with US alone, and 55 with both MX and US). Overall CDR was 7.9 per 1000 examination (95% CI, 6.5-9.5). CDR for MX only (MX-CDR) was 6.5 per 1000 examinations (95% CI, 5.2-7.9). Additional US could significantly improve CDR (P < 0.001; 95% CI, 0.9-2.2); US-ICDR was 1.4 per 1000 examinations. According to age group, the group of 40-59 years had statistically significant improvement of ICDR (P < 0.001). The ICDR was highest in D4 breast density (D4) (US-ICDR = 2.5 per 1000 examinations).

CONCLUSION

Use of US adjunct to MX for detection of breast cancer in asymptomatic non-fatty, average-risk women for detection of breast cancer is a promising diagnostic procedure. A significant benefit was documented, in particular, in women aged 40-59 years old, and in women with D4 breast density.

Baseline staging tests based on molecular subtype is necessary for newly diagnosed breast cancer

Background

Bone scanning (BS), liver ultrasonography (LUS), and chest radiography (CXR) are commonly recommended for baseline staging in patients with newly diagnosed breast cancer. The purpose of this study is to demonstrate whether these tests are indicated for specific patient subpopulation based on clinical staging and molecular subtype.

Methods

A retrospective study on 5406 patients with newly diagnosed breast cancer was conducted to identify differences in occurrence of metastasis based on clinical staging and molecular subtypes. All patients had been evaluated by BS, LUS and CXR at diagnosis.

Results

Complete information on clinical staging was available in 5184 patients. For stage I, II, and III, bone metastasis rate was 0%, 0.6% and 2.7%, respectively (P < 0.01); liver metastasis rate was 0%, 0.1%, and 1.0%, respectively (P < 0.01); lung metastasis rate was 0.1%, 0.1%, and 0.7%, respectively (P < 0.01). Complete information on molecular subtype was available in 3411 patients. For Luminal A, Luminal B (HER2^-), Luminal BH (HER2⁺), HER2⁺ overexpression, and Basal-like, bone metastasis rate was 1.4%, 0.7%, 2.5%, 2.7%, and 0.9%, respectively (P < 0.05); liver metastasis rate was 0.1%, 0.1%, 1.0%, 1.1%, and 0.9%, respectively (P < 0.01); lung metastasis rate was 0.20%, 0%, 0%, 0.27%, and 0.9%, respectively (P < 0.05). cT (tumor size), cN (lymph node), PR (progesterone receptor), and HER2 status predicted bone metastasis (P < 0.05). cT, cN, ER (estrogen receptor), PR, and HER2 status predicted liver metastasis (P < 0.05). cT, cN, and PR status predicted lung metastasis (P < 0.05).

Conclusion

These data indicate that based on clinical staging and molecular subtypes, BS, LUS and CXR are necessary for patients with newly diagnosed breast cancer.

Triple-negative breast cancer risk in women is defined by the defect of estrogen signaling: preventive and therapeutic implications

Epidemiologic studies strongly support that triple-negative breast cancers (TNBCs) may be distinct entities as compared with estrogen receptor (ER)+ tumors, suggesting that the etiologic factors, clinical characteristics, and therapeutic possibilities may vary by molecular subtypes. Many investigations propose that reproductive factors and exogenous hormone use differently or even quite inversely affect the risk of TNBCs and ER+ cancers. Controversies concerning the exact role of even the same risk factor in TNBC development justify that the biological mechanisms behind the initiation of both TNBCs and non-TNBCs are completely obscure. To arrive at a comprehensive understanding of the etiology of different breast cancer subtypes, we should also reconsider our traditional concepts and beliefs regarding cancer risk factors. Malignancies are multicausal, but the disturbance of proper estrogen signaling seems to be a crucial risk factor for the development of mammary cancers. The grade of defect in metabolic and hormonal equilibrium is directly associated with TNBC risk for women during their whole life. Inverse impact of menopausal status or parity on the development of ER+ and ER− breast cancers may not be possible; these controversial results derive from the misinterpretation of percentage-based statistical evaluations. Exogenous or parity-associated excessive estrogen supply is suppressive against breast cancer, though the lower the ER expression of tumors, the weaker the anticancer capacity. In women, the most important preventive strategy against breast cancers – included TNBCs – is the strict control and maintenance of hormonal equilibrium from early adolescence through the whole lifetime, particularly during the periods of great hormonal changes.

Ethnic differences in breast cancer risk and survival: a study on immigrants in Sweden

BACKGROUND

There are large geographic differences in breast cancer risk but whether survival differs between low- and high-risk groups is less well-established. As the survival of cancer depends on the level of healthcare and awareness of disease risks, subtle differences in cancer biology cannot be revealed in international comparisons. Instead, comparison of diverse immigrant groups in a country of uniformly accessible healthcare system should enable conclusions to be made about ethnic determinants of cancer risk and survival.

MATERIAL AND METHODS

The Swedish Family-Cancer Database was used to calculate standardized incidence (SIRs) and hazard ratios (HRs) of death from female breast cancer in 12 505 and 137 547 patients diagnosed with breast cancer among immigrants and Swedes, respectively. The ratios were adjusted for age, period, region, parity, and age at first childbirth. Ordinal logistic regression analysis was used to estimate odds ratios (ORs) for the clinical TNM classes. The analyses were stratified by menopausal status and histology. Results. Turks, Southeast Asians, and Chileans had the lowest breast cancer risk (SIR = 0.44; 95% CI 0.37-0.51) and Iraqis the highest risk (1.19; 1.05-1.35), mainly due to premenopausal cancer (1.51; 1.27-1.78). The HRs for all breast cancers were between 0.98 (0.81-1.18) (low-risk Europeans) and 1.24 (0.94-1.63) (lowest-risk non-Europeans), but were not significant. No differences in survival of ductal carcinoma between immigrants and Swedes were found, while low-risk non-Europeans had a HR of 2.88 (1.37-6.08) for lobular carcinoma. Low-risk non-Europeans were diagnosed in a higher T-class (OR = 1.87; 1.21-2.87) than Swedes.

CONCLUSION

We did not find any evidence that ethnic differences in breast cancer risk substantially affect the survival. The observed poor survival of some low-risk immigrants in lobular carcinoma may be related to treatment. The tendency of low-risk immigrants to present with higher T-class compared to Swedes may depend on their lower participation in the mammography screening program.

Breast cancer trends in Israeli Jewish and Arab women, 1996-2007

Breast cancer is the most common malignancy in Israeli Jewish and Arab women. The main objective of this study was to reexamine the trends in breast cancer incidence, mortality, and survival in Israel in 1996 through 2007, as well as the use of mammography. Data were obtained from the Israel National Cancer Registry, the Central Bureau of Statistics, and National Health Surveys. Incidence and mortality rates per 100 000 are age adjusted to the world standard population. Time trends are presented using the joinpoint regression analysis. The relative survival was calculated for the diagnosis years 1996-2003. Data on mammography performance were obtained from the Knowledge, Attitudes and Practices surveys carried out in 2002-2008. From 1996 through 2007, the incidence of in-situ breast cancer increased in both subpopulations whereas the incidence of invasive breast cancer decreased by 3% for Jewish women and increased by 98% for Arab women (P value for 'between-populations' differences <0.001). Reports on having had a mammogram in the last 2 years increased by 16% in Jewish women and by 17% in Arab women in 2002 through 2008 (P=0.880). Breast cancer mortality rates decreased significantly from 24.7 in 1996 to 19.0 in 2007 in Jewish women, but remained stable in Arab women (P=0.041). The 5-year relative survival increased in both subpopulations (P=0.420). The incidence of breast cancer has been stable in Jewish women, but had been increasing rapidly in Arab women throughout 1996-2007. The differences indicate an epidemiologic transition in the Arab minority in Israel. Efforts should focus not only on secondary but also on primary prevention strategies.

Breast cancer screening utilization among Eastern European immigrant women worldwide: a systematic literature review and a focus on psychosocial barriers

OBJECTIVE

Many countries host growing Eastern European immigrant communities whose breast cancer preventive behaviors are largely unknown. Thus, we aimed to synthesize current evidence regarding secondary prevention via breast cancer screening utilized by that population.

METHODS

All observational, general population studies on breast cancer screening with Eastern European immigrant women and without any country, language, or age restrictions were identified. Screening modalities included breast self-examination, clinical breast examination, and mammography.

RESULTS

The selected 30 studies were published between 1996 and 2013 and came from Australia, Canada, Denmark, Germany, Israel, the Netherlands, Spain, Switzerland, the UK, and the USA. The reported prevalence of monthly breast self-examination was 0-48%; for yearly clinical breast examination 27-54%; and for biennial mammography 0-71%. The substantial methodologic heterogeneity prevented a meta-analysis. Nonetheless, irrespective of host country, healthcare access, or educational level, the findings consistently indicated that Eastern European immigrant women underutilize breast cancer screening largely because of insufficient knowledge about early detection and an external locus of control regarding decision making in health matters.

CONCLUSIONS

This is a vulnerable population for whom the implementation of culturally tailored breast cancer screening programs is needed. As with other underscreened immigrant/minority groups, Eastern European women's inadequate engagement in prevention is troublesome as it points to susceptibility not only to cancer but also to other serious conditions for which personal action and responsibility are critical.

Morbidity and mortality in gynecological cancers among first- and second-generation immigrants in Sweden

We studied the effect of new environment on the risk in and mortality of gynecological cancers in first- and second-generation immigrants in Sweden. We used the nationwide Swedish Family-Cancer Database to calculate standardized incidence/mortality ratios (SIRs/SMRs) of cervical, endometrial and ovarian cancers among immigrants in comparison to the native Swedes. Risk of cervical cancer increased among first-generation immigrants with Danish (SIR = 1.64), Norwegian (1.33), former Yugoslavian (1.21) and East European (1.35) origins, whereas this risk decreased among Finns (0.88) and Asians (SIRs varies from 0.11 in Iranians to 0.54 in East Asians). Risk of endometrial (SIRs varies from 0.28 in Africans to 0.86 in Finns) and ovarian (SIRs varies from 0.23 in Chileans to 0.82 in Finns) cancers decreased in first-generation immigrants. The overall gynecological cancer risk for the second-generation immigrants, independent of the birth region, was almost similar to that obtained for the first generations. The birth region-specific SMRs of gynecological cancers in first- and second-generation immigrants co-varied with the SIRs. Risk of gynecological cancers among the first-generation immigrants is similar to that in their original countries, except for cervical cancer among Africans and endometrial cancer among North Americans and East Europeans. Our findings show that risk and mortality of gynecological cancers observed in the first-generation immigrants remain in the second generation. We conclude that the risk and protective factors of gynecological cancers are preserved upon immigration and through generations, suggesting a role for behavioral factors or familial aggregation in the etiology of these diseases.

Localization of Epstein-Barr virus to infiltrating lymphocytes in breast carcinomas and not malignant cells

The pathogenesis of breast cancer is unknown. In recent years, a number of studies have implicated a role for Epstein-Barr virus (EBV) in a subset of cases. However, these findings are controversial and others have failed to find any link between the virus and this malignancy. We hypothesized that technical differences and the different type and ethnic origin of the cases may be the cause of the disparities reported. Using a highly sensitive EBER-in situ hybridization and immunohistochemistry, we examined 219 samples (158 malignant and 61 non-malignant) from 61 Emirati breast cancer cases to determine if EBV was etiologically associated with Emirati cases and if there was any correlation with other established prognostic factors such as age, histological type, lymph node metastasis, estrogen, progesterone and HER2 expression. We found 47.5% of the cases to be EBV positive, but the virus was localized to occasional infiltrating lymphocytes and not in the malignant cells. EBV lymphocytes were more commonly observed in lymph nodes than in breast tissues, but there was no correlation with malignancy or hormone status. The mean age of our patients was 48years and hormone receptor staining revealed 20% of the cases to be triple negative (ER-/PR-/HER2-). We conclude that although EBV can be detected in breast cancer cases, it is not directly associated with the disease. Thus, a PCR-based approach cannot be used to link this ubiquitous virus to the pathogenesis of breast cancer. Furthermore, we do not find any correlation between the presence of EBV in infiltrating lymphocytes and ER, PR, HER2 expression. We believe our findings will help explain some of the controversies relating to the role of EBV in the pathogenesis of breast cancer.