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Merrell KW, Konney TO, Acheamfour O, Lucido J, Aduse-Poku AY, Kumar A, Ansah MB, Amankwa AT, Shumway D, Awittor FK, Badu-Peprah A, Fonkoua LAAK, Hendrickson AEW, Boakye E, Adjei EK, Kyei I, Kemper K, Rank M, Peethambaram PP, Spangenberg K, Sorenson K, Hearrold M, Garda A, Graham R, Lang K, Adom J, Achiaa R, Jakub J, Amo BD, Osei-Bonsu E, Camacho R, Addison ECDK. Participant Evaluation of a Multi-disciplinary Oncology Preceptorship Training Program for Oncology Health Professionals from Kumasi, Ghana. J Cancer Educ 2024:10.1007/s13187-024-02417-w. [PMID: 38506985 DOI: 10.1007/s13187-024-02417-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/26/2024] [Indexed: 03/22/2024]
Abstract
A critical shortage of skilled healthcare workers is a primary cause of disparate global cancer outcomes. We report participant evaluation of a multidisciplinary preceptorship program. In collaboration with the city of Kumasi, Ghana, Mayo Clinic and the City Cancer Challenge hosted a preceptorship program for comprehensive multidisciplinary breast and cervix cancer training. A total of 14 healthcare workers from Kumasi received two weeks of training at Mayo Clinic in November and December 2021. Each participant and preceptor were requested to complete an anonymous post-participation survey. Of the 14 trainee participants, 10 (71%) completed the survey. All respondents found the program "valuable and applicable to their clinical practice." Ninety percent reported they were able to "review effective and critical elements in the development and expansion of the multidisciplinary team" and able to "solve practical clinical cases as a team". General themes of satisfaction included: (1) organization and administration, (2) clinical observations and demonstrations, (3) guidelines development, and (4) recognizing the central importance of cultivating a team-based approach. Of the 40 preceptors, 16 (40%) completed the survey. All respondents reported they felt the training would meaningfully "influence patient care in Ghana", that participation "added value or joy to their clinical practice," and all wished to "participate in future preceptorship programs". After a focused two-week program, trainees reported high satisfaction, usefulness from observing specialized cancer care, and value in closely observing a multidisciplinary oncology team. Preceptors reported the experience added joy and perspective to their clinical practice and wished to participate in future programs.
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Affiliation(s)
- Kenneth W Merrell
- Department of Radiation Oncology, Global Bridges, Mayo Clinic, Rochester, MN, USA.
| | | | | | - Joseph Lucido
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | | | - Amanika Kumar
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Dean Shumway
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - Ernest Boakye
- Ernphil Laboratory and Diagnostic Services, Kumasi, Ghana
| | | | | | | | | | | | | | - Kasie Sorenson
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Miranda Hearrold
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Allison Garda
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Rondell Graham
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Karen Lang
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Joseph Adom
- Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - James Jakub
- General Surgery, Mayo Clinic, Jacksonville, FL, USA
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Olivos N, Banta JE, Spencer-Hwang R, Ansong D, Beane Freeman LE, Clegg-Lamptey JN, Wiafe-Addai B, Edusei L, Adjei E, Titiloye N, Dedey F, Aitpillah F, Oppong J, Vanderpuye V, Osei-Bonsu E, Ahearn TU, Biritwum R, Yarney J, Awuah B, Nyarko K, Garcia-Closas M, Abubakar M, Brinton LA, Figueroa JD, Wiafe S. Mosquito control exposures and breast cancer risk: analysis of 1071 cases and 2096 controls from the Ghana Breast Health Study. Breast Cancer Res 2023; 25:150. [PMID: 38082317 PMCID: PMC10714652 DOI: 10.1186/s13058-023-01737-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 10/30/2023] [Indexed: 12/18/2023] Open
Abstract
Epidemiologic data on insecticide exposures and breast cancer risk are inconclusive and mostly from high-income countries. Using data from 1071 invasive pathologically confirmed breast cancer cases and 2096 controls from the Ghana Breast Health Study conducted from 2013 to 2015, we investigated associations with mosquito control products to reduce the spread of mosquito-borne diseases, such as malaria. These mosquito control products were insecticide-treated nets, mosquito coils, repellent room sprays, and skin creams for personal protection against mosquitos. Multivariable and polytomous logistic regression models were used to estimate odds ratios (ORadj) and 95% confidence intervals (CI) with breast cancer risk-adjusted for potential confounders and known risk factors. Among controls, the reported use of mosquito control products were mosquito coils (65%), followed by insecticide-treated nets (56%), repellent room sprays (53%), and repellent skin creams (15%). Compared to a referent group of participants unexposed to mosquito control products, there was no significant association between breast cancer risk and mosquito coils. There was an association in breast cancer risk with reported use of insecticide-treated nets; however, that association was weak and not statistically significant. Participants who reported using repellent sprays were at elevated risks compared to women who did not use any mosquito control products, even after adjustment for all other mosquito control products (OR = 1.42, 95% CI=1.15-1.75). We had limited power to detect an association with repellent skin creams. Although only a few participants reported using repellent room sprays weekly/daily or < month-monthly, no trends were evident with increased frequency of use of repellent sprays, and there was no statistical evidence of heterogeneity by estrogen receptor (ER) status (p-het > 0.25). Our analysis was limited when determining if an association existed with repellent skin creams; therefore, we cannot conclude an association. We found limited evidence of risk associations with widely used mosquito coils and insecticide-treated nets, which are reassuring given their importance for malaria prevention. Our findings regarding specific breast cancer risk associations, specifically those observed between repellent sprays, require further study.
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Affiliation(s)
- Naomie Olivos
- School of Public Health, Loma Linda University, Loma Linda, CA, USA
| | - Jim E Banta
- School of Public Health, Loma Linda University, Loma Linda, CA, USA
| | | | | | - Laura E Beane Freeman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | | | | | | | | | | | | | | | | | | | | | - Thomas U Ahearn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | | | | | | | | | | | - Mustapha Abubakar
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Louise A Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Jonine D Figueroa
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA.
| | - Seth Wiafe
- School of Public Health, Loma Linda University, Loma Linda, CA, USA.
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Wu Z, Pfeiffer RM, Byrd DA, Wan Y, Ansong D, Clegg-Lamptey JN, Wiafe-Addai B, Edusei L, Adjei E, Titiloye N, Dedey F, Aitpillah F, Oppong J, Vanderpuye V, Osei-Bonsu E, Dagnall CL, Jones K, Hutchinson A, Hicks BD, Ahearn TU, Knight R, Biritwum R, Yarney J, Wiafe S, Awuah B, Nyarko K, Garcia-Closas M, Sinha R, Figueroa JD, Brinton LA, Trabert B, Vogtmann E. Associations of Circulating Estrogens and Estrogen Metabolites with Fecal and Oral Microbiome in Postmenopausal Women in the Ghana Breast Health Study. Microbiol Spectr 2023; 11:e0157223. [PMID: 37341612 PMCID: PMC10433996 DOI: 10.1128/spectrum.01572-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 05/26/2023] [Indexed: 06/22/2023] Open
Abstract
The human fecal and oral microbiome may play a role in the etiology of breast cancer through modulation of endogenous estrogen metabolism. This study aimed to investigate associations of circulating estrogens and estrogen metabolites with the fecal and oral microbiome in postmenopausal African women. A total of 117 women with fecal (N = 110) and oral (N = 114) microbiome data measured by 16S rRNA gene sequencing, and estrogens and estrogen metabolites data measured by liquid chromatography tandem mass spectrometry were included. The outcomes were measures of the microbiome and the independent variables were the estrogens and estrogen metabolites. Estrogens and estrogen metabolites were associated with the fecal microbial Shannon index (global P < 0.01). In particular, higher levels of estrone (β = 0.36, P = 0.03), 2-hydroxyestradiol (β = 0.30, P = 0.02), 4-methoxyestrone (β = 0.51, P = 0.01), and estriol (β = 0.36, P = 0.04) were associated with higher levels of the Shannon index, while 16alpha-hydroxyestrone (β = -0.57, P < 0.01) was inversely associated with the Shannon index as indicated by linear regression. Conjugated 2-methoxyestrone was associated with oral microbial unweighted UniFrac as indicated by MiRKAT (P < 0.01) and PERMANOVA, where conjugated 2-methoxyestrone explained 2.67% of the oral microbial variability, but no other estrogens or estrogen metabolites were associated with any other beta diversity measures. The presence and abundance of multiple fecal and oral genera, such as fecal genera from families Lachnospiraceae and Ruminococcaceae, were associated with several estrogens and estrogen metabolites as indicated by zero-inflated negative binomial regression. Overall, we found several associations of specific estrogens and estrogen metabolites and the fecal and oral microbiome. IMPORTANCE Several epidemiologic studies have found associations of urinary estrogens and estrogen metabolites with the fecal microbiome. However, urinary estrogen concentrations are not strongly correlated with serum estrogens, a known risk factor for breast cancer. To better understand whether the human fecal and oral microbiome were associated with breast cancer risk via the regulation of estrogen metabolism, we conducted this study to investigate the associations of circulating estrogens and estrogen metabolites with the fecal and oral microbiome in postmenopausal African women. We found several associations of parent estrogens and several estrogen metabolites with the microbial communities, and multiple individual associations of estrogens and estrogen metabolites with the presence and abundance of multiple fecal and oral genera, such as fecal genera from families Lachnospiraceae and Ruminococcaceae, which have estrogen metabolizing properties. Future large, longitudinal studies to investigate the dynamic changes of the fecal and oral microbiome and estrogen relationship are needed.
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Affiliation(s)
- Zeni Wu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Ruth M. Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Doratha A. Byrd
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Yunhu Wan
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | | | | | | | | | | | | | | | | | | | | | | | - Casey L. Dagnall
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
- Cancer Genomics Research Laboratory, Frederick National Lab for Cancer Research, Frederick, Maryland, USA
| | - Kristine Jones
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
- Cancer Genomics Research Laboratory, Frederick National Lab for Cancer Research, Frederick, Maryland, USA
| | - Amy Hutchinson
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
- Cancer Genomics Research Laboratory, Frederick National Lab for Cancer Research, Frederick, Maryland, USA
| | - Belynda D. Hicks
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
- Cancer Genomics Research Laboratory, Frederick National Lab for Cancer Research, Frederick, Maryland, USA
| | - Thomas U. Ahearn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Rob Knight
- Department of Pediatrics, University of California San Diego, La Jolla, California, USA
| | | | | | - Seth Wiafe
- School of Public Health, Loma Linda University, Loma Linda, California, USA
| | | | | | - Montserrat Garcia-Closas
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Rashmi Sinha
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Jonine D. Figueroa
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
- Usher Institute and CRUK Edinburgh Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Louise A. Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Britton Trabert
- Department of Obstetrics and Gynecology, University of Utah, and Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah, USA
| | - Emily Vogtmann
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
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Geczik AM, Falk RT, Xu X, Wiafe-Addai B, Yarney J, Awuah B, Biritwum R, Vanderpuye V, Dedey F, Adjei E, Aitpillah F, Osei-Bonsu E, Oppong J, Titiloye N, Edusei L, Nyarko K, Clegg-Lamptey JN, Wiafe S, Ansong D, Ahearn TU, Figueroa J, Garcia-Closas M, Brinton LA, Trabert B. Relation of circulating estrogens with hair relaxer and skin lightener use among postmenopausal women in Ghana. J Expo Sci Environ Epidemiol 2023; 33:301-310. [PMID: 34992224 PMCID: PMC9256865 DOI: 10.1038/s41370-021-00407-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 12/09/2021] [Accepted: 12/16/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Hair relaxers and skin lighteners have been commonly used by African women, with suggestions that they may have hormonal activity. OBJECTIVES To investigate the relationship of hair relaxer and skin lightener use to serum estrogen/estrogen metabolite levels. METHODS We utilized the postmenopausal population-based controls of the Ghana Breast Health Study to estimate adjusted geometric means (GM) and 95% confidence intervals of individual circulating estrogen levels by hair relaxer/skin lightener exposure categories. RESULTS Of the 585 postmenopausal women included in our analysis, 80.2% reported hair relaxer use and 29.4% skin lightener use. Ever hair relaxer use was positively associated with estriol (adjusted GM 95.4 pmol/L vs. never 74.5, p value = 0.02) and 16-epiestriol (20.4 vs. 16.8, p value = 0.05) particularly among users of lye-based hair relaxers. Positive associations between scalp burns and unconjugated estrogens were observed (e.g., unconjugated estrone: 5+ scalp burns 76.9 [59.6-99.2] vs. no burns 64.0 [53.7-76.3], p-trend = 0.03). No association was observed between use of skin lighteners and circulating estrogens. SIGNIFICANCE This study presents evidence that circulating 16-pathway estrogens (i.e., estriol and 16-epiestriol) may be increased in users of lye-based hair relaxer products. Among hair relaxer users, unconjugated estrogen levels were elevated in women with a greater number of scalp burns. IMPACT STATEMENT In this population-based study of hair relaxer and skin lightener use among postmenopausal women in Ghana, altered estrogen metabolism was observed with hair relaxer use, particularly among women using lye-based products or with a greater number of scalp burns. In contrast, skin lightener use was not associated with differences in estrogen metabolism in this population. Continued investigation of the potential biological impact on breast cancer risk of hair relaxer use is warranted.
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Affiliation(s)
- Ashley M Geczik
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Roni T Falk
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Xia Xu
- Protein Characterization Laboratory, Leidos-Frederick, Inc, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Seth Wiafe
- Loma Linda University, School of Public Health, Loma Linda, CA, USA
| | - Daniel Ansong
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Thomas U Ahearn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jonine Figueroa
- The University of Edinburgh, Cancer Research UK Edinburgh Center, Edinburgh, UK
| | - Montserrat Garcia-Closas
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Louise A Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Britton Trabert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
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Geczik AM, Falk RT, Xu X, Wiafe-Addai B, Yarney J, Awuah B, Biritwum R, Vanderpuye V, Dedey F, Adjei E, Aitpillah F, Osei-Bonsu E, Oppong J, Titiloye N, Edusei L, Nyarko K, Clegg-Lamptey JN, Wiafe S, Ansong D, Ahearn TU, Figueroa J, Garcia-Closas M, Brinton LA, Trabert B. Correction to: Relation of circulating estrogens with hair relaxer and skin lightener use among postmenopausal women in Ghana. J Expo Sci Environ Epidemiol 2023; 33:311. [PMID: 35094015 DOI: 10.1038/s41370-022-00415-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Ashley M Geczik
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Roni T Falk
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Xia Xu
- Protein Characterization Laboratory, Leidos-Frederick, Inc, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Seth Wiafe
- Loma Linda University, School of Public Health, Loma Linda, CA, USA
| | - Daniel Ansong
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Thomas U Ahearn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jonine Figueroa
- The University of Edinburgh, Cancer Research UK Edinburgh Center, Edinburgh, UK
| | - Montserrat Garcia-Closas
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Louise A Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Britton Trabert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
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Wu Z, Byrd DA, Wan Y, Ansong D, Clegg-Lamptey JN, Wiafe-Addai B, Edusei L, Adjei E, Titiloye N, Dedey F, Aitpillah F, Oppong J, Vanderpuye V, Osei-Bonsu E, Dagnall CL, Jones K, Hutchinson A, Hicks BD, Ahearn TU, Shi J, Knight R, Biritwum R, Yarney J, Seth Wiafe, Awuah B, Nyarko K, Figueroa JD, Sinha R, Garcia-Closas M, Brinton LA, Vogtmann E. The oral microbiome and breast cancer and nonmalignant breast disease, and its relationship with the fecal microbiome in the Ghana Breast Health Study. Int J Cancer 2022; 151:1248-1260. [PMID: 35657343 PMCID: PMC9420782 DOI: 10.1002/ijc.34145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 12/24/2022]
Abstract
The oral microbiome, like the fecal microbiome, may be related to breast cancer risk. Therefore, we investigated whether the oral microbiome was associated with breast cancer and nonmalignant breast disease, and its relationship with the fecal microbiome in a case-control study in Ghana. A total of 881 women were included (369 breast cancers, 93 nonmalignant cases and 419 population-based controls). The V4 region of the 16S rRNA gene was sequenced from oral and fecal samples. Alpha-diversity (observed amplicon sequence variants [ASVs], Shannon index and Faith's Phylogenetic Diversity) and beta-diversity (Bray-Curtis, Jaccard and weighted and unweighted UniFrac) metrics were computed. MiRKAT and logistic regression models were used to investigate the case-control associations. Oral sample alpha-diversity was inversely associated with breast cancer and nonmalignant breast disease with odds ratios (95% CIs) per every 10 observed ASVs of 0.86 (0.83-0.89) and 0.79 (0.73-0.85), respectively, compared to controls. Beta-diversity was also associated with breast cancer and nonmalignant breast disease compared to controls (P ≤ .001). The relative abundances of Porphyromonas and Fusobacterium were lower for breast cancer cases compared to controls. Alpha-diversity and presence/relative abundance of specific genera from the oral and fecal microbiome were strongly correlated among breast cancer cases, but weakly correlated among controls. Particularly, the relative abundance of oral Porphyromonas was strongly, inversely correlated with fecal Bacteroides among breast cancer cases (r = -.37, P ≤ .001). Many oral microbial metrics were strongly associated with breast cancer and nonmalignant breast disease, and strongly correlated with fecal microbiome among breast cancer cases, but not controls.
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Affiliation(s)
- Zeni Wu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Doratha A Byrd
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL USA
| | - Yunhu Wan
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | | | | | | | | | | | | | | | | | | | | | | | - Casey L. Dagnall
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
- Cancer Genomics Research Laboratory, Frederick National Lab for Cancer Research, Frederick, MD USA
| | - Kristine Jones
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
- Cancer Genomics Research Laboratory, Frederick National Lab for Cancer Research, Frederick, MD USA
| | - Amy Hutchinson
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
- Cancer Genomics Research Laboratory, Frederick National Lab for Cancer Research, Frederick, MD USA
| | - Belynda D. Hicks
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
- Cancer Genomics Research Laboratory, Frederick National Lab for Cancer Research, Frederick, MD USA
| | - Thomas U. Ahearn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Jianxin Shi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Rob Knight
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | | | | | - Seth Wiafe
- School of Public Health, Loma Linda University, Loma Linda, CA, USA
| | | | | | - Jonine D. Figueroa
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
- Usher Institute and CRUK Edinburgh Centre, University of Edinburgh, Edinburgh, UK
| | - Rashmi Sinha
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | | | - Louise A. Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Emily Vogtmann
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
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Scott AA, Polo A, Zubizarreta E, Akoto-Aidoo C, Edusa C, Osei-Bonsu E, Yarney J, Dwobeng B, Milosevic M, Rodin D. Geographic Accessibility and Availability of Radiotherapy in Ghana. JAMA Netw Open 2022; 5:e2226319. [PMID: 35951324 PMCID: PMC9372791 DOI: 10.1001/jamanetworkopen.2022.26319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Radiotherapy is critical for comprehensive cancer care, but there are large gaps in access. Within Ghana, data on radiotherapy availability and on the relationship between distance and access are unknown. OBJECTIVES To estimate the gaps in radiotherapy machine availability in Ghana and to describe the association between distance and access to care. DESIGN, SETTING, AND PARTICIPANTS This is a cross-sectional, population-based study of radiotherapy delivery in Ghana in 2020 and model-based analysis of radiotherapy demand and the radiotherapy utilization rate (RUR) using the Global Task Force on Radiotherapy for Cancer Control investment framework. EXPOSURES Receipt of radiotherapy and the number of radiotherapy courses delivered. MAIN OUTCOMES AND MEASURES Geocoded location of patients receiving external beam radiotherapy (EBRT); median Euclidean distance from the district centroids to the nearest radiotherapy centers; proportion of population living within geographic buffer zones of 100, 150, and 200 km; additional capacity required for optimal utilization; and geographic accessibility after strategic location of a radiotherapy facility in an underserviced region. RESULTS A total of 2883 patients underwent EBRT courses in 2020, with an actual RUR of 11%. Based on an optimal RUR of 48%, 11 524 patients had an indication for radiotherapy, indicating that only 23% of patients received treatment. An investment of 23 additional EBRT machines would be required to meet demand. The median Euclidean distance from the district centroids to the nearest radiotherapy facility was 110.6 km (range, 0.62-513.2 km). The proportion of the total population living within a radius of 100, 150 and 200 km of a radiotherapy facility was 47%, 61% and 70%, respectively. A new radiotherapy facility in the northern regional capital would reduce the median of Euclidean distance by 10% to 99.4 km (range, 0.62-267.7 km) and increase proportion of the total population living within a radius of 100, 150 and 200 km to 53%, 69% and 84%, respectively. The greatest benefit was seen in regions in the northern half of Ghana. CONCLUSIONS AND RELEVANCE In this cross-sectional study of geographic accessibility and availability of radiotherapy, Ghana had major national deficits of radiotherapy capacity, with significant geographic disparities among regions. Well-planned infrastructure scale-up that accounts for the population distribution could improve radiotherapy accessibility.
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Affiliation(s)
- Aba Anoa Scott
- National Centre for Radiotherapy and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, Ghana
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Global Cancer Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Alfredo Polo
- International Atomic Energy Agency, Vienna, Austria
| | | | - Charles Akoto-Aidoo
- National Centre for Radiotherapy and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, Ghana
| | - Clement Edusa
- Oncology Department, Sweden Ghana Medical Centre, Accra, Ghana
| | - Ernest Osei-Bonsu
- National Radiotherapy and Nuclear Medicine Centre, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Joel Yarney
- National Centre for Radiotherapy and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, Ghana
| | - Bismark Dwobeng
- National Radiotherapy and Nuclear Medicine Centre, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Michael Milosevic
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Global Cancer Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Danielle Rodin
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Global Cancer Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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8
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Geczik AM, Falk RT, Xu X, Ansong D, Yarney J, Wiafe-Addai B, Edusei L, Dedey F, Vanderpuye V, Titiloye N, Adjei E, Aitpillah F, Osei-Bonsu E, Oppong J, Biritwum R, Nyarko K, Wiafe S, Awuah B, Clegg-Lamptey JN, Ahearn TU, Figueroa J, Garcia-Closas M, Brinton LA, Trabert B. Measured body size and serum estrogen metabolism in postmenopausal women: the Ghana Breast Health Study. Breast Cancer Res 2022; 24:9. [PMID: 35081987 PMCID: PMC8793253 DOI: 10.1186/s13058-022-01500-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 01/10/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Several anthropometric measures have been associated with hormone-related cancers, and it has been shown that estrogen metabolism in postmenopausal women plays an important role in these relationships. However, little is known about circulating estrogen levels in African women, and the relevance to breast cancer or breast cancer risk factors. To shed further light on the relationship of anthropometric factors and estrogen levels in African women, we examined whether measured body mass index (BMI), waist-to-hip ratio (WHR), height, and self-reported body size were associated with serum estrogens/estrogen metabolites in a cross-sectional analysis among postmenopausal population-based controls of the Ghana Breast Health Study.
Methods
Fifteen estrogens/estrogen metabolites were quantified using liquid chromatography-tandem mass spectrometry in serum samples collected from postmenopausal female controls enrolled in the Ghana Breast Health Study, a population-based case–control study conducted in Accra and Kumasi. Geometric means (GMs) of estrogens/estrogen metabolites were estimated using linear regression, adjusting for potential confounders.
Results
Measured BMI (≥ 30 vs. 18.5–24.9 kg/m2) was positively associated with parent estrogens (multivariable adjusted GM for unconjugated estrone: 78.90 (66.57–93.53) vs. 50.89 (43.47–59.59), p-value < 0.0001; and unconjugated estradiol: 27.83 (21.47–36.07) vs. 13.26 (10.37–16.95), p-value < 0.0001). Independent of unconjugated estradiol, measured BMI was associated with lower levels of 2-pathway metabolites and higher levels of 16-ketoestradriol. Similar patterns of association were found with WHR; however, the associations were not entirely independent of BMI. Height was not associated with postmenopausal estrogens/estrogen metabolite levels in African women.
Conclusions
We observed strong associations between measured BMI and parent estrogens and estrogen metabolite patterns that largely mirrored relations that have previously been associated with higher breast cancer risk in postmenopausal White women. The consistency of the BMI-estrogen metabolism associations in our study with those previously noted among White women suggests that estrogens likely explain part of the BMI-postmenopausal breast cancer risk in both groups. These findings merit evaluation in Black women, including prospective studies.
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9
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Mburu W, Boamah Mensah AB, Virnig B, Amuasi JH, Awuah B, Porta CM, Osei-Bonsu E, Kulasingam S. Pathways to Breast Cancer Diagnosis and Treatment Among Women in Ghana: A Qualitative Study. Womens Health Rep (New Rochelle) 2021; 2:234-244. [PMID: 34318293 PMCID: PMC8310750 DOI: 10.1089/whr.2020.0117] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/02/2021] [Indexed: 12/24/2022]
Abstract
Background: Breast cancer is the leading cause of cancer death among Ghanaian women and most women are identified once they develop symptoms. Women then must navigate a complex health care system to get diagnosed and receive orthodox medicine. We describe Ghanaian women's pathways of care from breast cancer-related symptom detection to treatment receipt. Methods: We conducted a qualitative study using an empirical phenomenological approach. We used a purposive sampling technique to recruit 31 women with breast cancer who were receiving treatment at Komfo Anokye Teaching Hospital in Kumasi, Ghana. They participated in semistructured in-depth interviews between November 2019 and March 2020. All interviews were transcribed verbatim and analyzed using a deductive coding approach. Results: Women navigate approximately nine steps from symptom detection to receiving orthodox breast cancer treatment. The breast cancer care pathway is not linear and women frequently move among different management approaches, including alternative therapy (faith healing and traditional herbal healing). All the women detected the symptoms themselves. Some of the women sought orthodox medicine due to information from the media. Conclusions: Alternative therapy providers play a critical role in the breast cancer diagnosis and care pathways in Ghana underscoring the need to formally integrate them into the health care system. Breast cancer awareness programs through the media and educational programs aimed at alternative therapy providers may reduce the time from symptom detection to receipt of orthodox medicine.
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Affiliation(s)
- Waruiru Mburu
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Beth Virnig
- Division of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota, USA
| | - John H Amuasi
- Department of Global Health, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Baffour Awuah
- Ministry of Health, Accra, Ghana.,Department of Medical Oncology and Radiation, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Carolyn M Porta
- School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ernest Osei-Bonsu
- Department of Medical Oncology and Radiation, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Shalini Kulasingam
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
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10
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Jiagge EM, Ulintz PJ, Wong S, McDermott SP, Fossi SI, Suhan TK, Hoenerhoff MJ, Bensenhaver JM, Salem B, Dziubinski M, Oppong JK, Aitpillah F, Ishmael K, Osei-Bonsu E, Adjei E, Baffour A, Aldrich J, Kurdoglu A, Fernando K, Craig DW, Trent JM, Li J, Chitale D, Newman LA, Carpten JD, Wicha MS, Merajver SD. Multiethnic PDX models predict a possible immune signature associated with TNBC of African ancestry. Breast Cancer Res Treat 2021; 186:391-401. [PMID: 33576900 DOI: 10.1007/s10549-021-06097-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 01/05/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Triple-negative breast cancer (TNBC) is an aggressive subtype most prevalent among women of Western Sub-Saharan African ancestry. It accounts for 15-25% of African American (AA) breast cancers (BC) and up to 80% of Ghanaian breast cancers, thus contributing to outcome disparities in BC for black women. The aggressive biology of TNBC has been shown to be regulated partially by breast cancer stem cells (BCSC) which mediate tumor recurrence and metastasis and are more abundant in African breast tumors. METHODS We studied the biological differences between TNBC in women with African ancestry and those of Caucasian women by comparing the gene expression of the BCSC. From low-passage patient derived xenografts (PDX) from Ghanaian (GH), AA, and Caucasian American (CA) TNBCs, we sorted for and sequenced the stem cell populations and analyzed for differential gene enrichment. RESULTS In our cohort of TNBC tumors, we observed that the ALDH expressing stem cells display distinct ethnic specific gene expression patterns, with the largest difference existing between the GH and AA ALDH+ cells. Furthermore, the tumors from the women of African ancestry [GH/AA] had ALDH stem cell (SC) enrichment for expression of immune related genes and processes. Among the significantly upregulated genes were CD274 (PD-L1), CXCR9, CXCR10 and IFI27, which could serve as potential drug targets. CONCLUSIONS Further exploration of the role of immune regulated genes and biological processes in BCSC may offer insight into developing novel approaches to treating TNBC to help ameliorate survival disparities in women with African ancestry.
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Affiliation(s)
- Evelyn M Jiagge
- Henry Ford Cancer Institute/Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI, 48202, USA. .,Department of Internal Medicine, Michigan Medicine, University of Michigan, 1500 East Medical Center Drive, RCC 7314, Ann Arbor, MI, 48105, USA. .,Rogel Cancer Center, University of Michigan, Ann Arbor, MI, 48105, USA.
| | - Peter J Ulintz
- Department of Internal Medicine, Michigan Medicine, University of Michigan, 1500 East Medical Center Drive, RCC 7314, Ann Arbor, MI, 48105, USA.,Rogel Cancer Center, University of Michigan, Ann Arbor, MI, 48105, USA
| | - Shukmei Wong
- The Translational Genomics Research Institute, Phoenix, AZ, USA
| | - Sean P McDermott
- Department of Internal Medicine, Michigan Medicine, University of Michigan, 1500 East Medical Center Drive, RCC 7314, Ann Arbor, MI, 48105, USA
| | - Sabrina I Fossi
- Henry Ford Cancer Institute/Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI, 48202, USA.,Department of Internal Medicine, Michigan Medicine, University of Michigan, 1500 East Medical Center Drive, RCC 7314, Ann Arbor, MI, 48105, USA
| | - Tahra K Suhan
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, 48105, USA.,Department of Urology, Michigan Medicine, University of Michigan, Ann Arbor, USA
| | - Mark J Hoenerhoff
- Unit for Laboratory Animal Medicine, University of Michigan, Ann Arbor, USA
| | - Jessica M Bensenhaver
- Henry Ford Cancer Institute/Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI, 48202, USA
| | - Barbara Salem
- Michigan Institute for Clinical & Health Research, Ann Arbor, USA
| | | | | | | | | | | | | | | | - Jessica Aldrich
- The Translational Genomics Research Institute, Phoenix, AZ, USA
| | - Ahmet Kurdoglu
- The Translational Genomics Research Institute, Phoenix, AZ, USA
| | - Kurt Fernando
- Henry Ford Cancer Institute/Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI, 48202, USA
| | - David W Craig
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jeff M Trent
- The Translational Genomics Research Institute, Phoenix, AZ, USA
| | - Jun Li
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, 48105, USA
| | - Dhananjay Chitale
- Henry Ford Cancer Institute/Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI, 48202, USA
| | - Lisa A Newman
- New York-Presbyterian/Weill Cornell Medical Center and Weill Cornell Medicine, New York, NY, USA
| | - John D Carpten
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Max S Wicha
- Department of Internal Medicine, Michigan Medicine, University of Michigan, 1500 East Medical Center Drive, RCC 7314, Ann Arbor, MI, 48105, USA.,Rogel Cancer Center, University of Michigan, Ann Arbor, MI, 48105, USA
| | - Sofia D Merajver
- Department of Internal Medicine, Michigan Medicine, University of Michigan, 1500 East Medical Center Drive, RCC 7314, Ann Arbor, MI, 48105, USA. .,Rogel Cancer Center, University of Michigan, Ann Arbor, MI, 48105, USA.
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11
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Amoako YA, Awuah B, Larsen-Reindorf R, Awittor FK, Kyem G, Ofori-Boadu K, Osei-Bonsu E, Laryea DO. Malignant tumours in urban Ghana: evidence from the city of Kumasi. BMC Cancer 2019; 19:267. [PMID: 30909876 PMCID: PMC6434839 DOI: 10.1186/s12885-019-5480-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 03/14/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Data from population-based cancer registries (PBCRs) are a useful resource for estimating the incidence of cancers. PBCR data is useful in the planning and implementation of cancer prevention and control strategies. Ghana's plan for control of non-communicable diseases recognises the need for good quality data to facilitate the attainment of set goals. METHODS We reviewed data from the Kumasi Cancer Registry for the year 2015. Data collected included clinical and demographic information, laboratory reports and source of case information. Data was entered into the Canreg-5 software. Data was initially analysed using Canreg-5 to estimate the incidence and age standardised rates (ASR) for various tumours. Data was also exported to Microsoft Excel for further analysis using Epi Info version 7.1.4. Microsoft Excel was used to generate charts and graphs. Aggregated data for the years 2013 and 2014 were also analysed for trends in cancer incidence and ASR. RESULTS A total of 736 cancer cases were recorded among the residents of Kumasi for the year 2015. Females accounted for 62.4% of all cases. The overall incidence of cancer in Kumasi for 2015 was 46.1 per 100,000. The mean age of all cases was 51.3 years (with a range of 1 to 99 years). The incidence among female residents was estimated at 54.1 per 100,000 compared with 37.1 per 100,000 in males. Among females, breast and cervical cancers recorded the highest incidences of 16.1 per 100,000 and 13.7 per 100,000 respectively. Among males, prostate cancer had the highest incidence of 10.5 per 100,000. Breast, cervical and liver cancers were the commonest in both sexes accounting for 19.7, 14.7 and 11.4% of cases respectively. CONCLUSION There has been significant improvement in data quality and coverage since the inception of our PBCR in 2012. PBCRs are feasible; therefore there is the need for more such registries to improve data on cancers in Ghana. Consistent with other evidence, we found breast cancer as the commonest female cancer in Ghana.
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Affiliation(s)
- Yaw Ampem Amoako
- Department of Medicine, Komfo Anokye Teaching Hospital, P O Box 1934, Kumasi, Ghana.
| | - Baffour Awuah
- Kumasi Cancer Registry, Kumasi, Ghana.,Directorate of Oncology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Rita Larsen-Reindorf
- Directorate of Ear, Nose and Throat, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - Gloria Kyem
- Department of Medicine, Komfo Anokye Teaching Hospital, P O Box 1934, Kumasi, Ghana
| | | | | | - Dennis Odai Laryea
- Kumasi Cancer Registry, Kumasi, Ghana.,Non-Communicable Disease Control Programme, Ghana Health Service, Accra, Ghana
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12
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Brinton LA, Awuah B, Nat Clegg-Lamptey J, Wiafe-Addai B, Ansong D, Nyarko KM, Wiafe S, Yarney J, Biritwum R, Brotzman M, Adjei AA, Adjei E, Aitpillah F, Edusei L, Dedey F, Nyante SJ, Oppong J, Osei-Bonsu E, Titiloye N, Vanderpuye V, Brew Abaidoo E, Arhin B, Boakye I, Frempong M, Ohene Oti N, Okyne V, Figueroa JD. Design considerations for identifying breast cancer risk factors in a population-based study in Africa. Int J Cancer 2017; 140:2667-2677. [PMID: 28295287 DOI: 10.1002/ijc.30688] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 01/30/2017] [Accepted: 02/08/2017] [Indexed: 02/04/2023]
Abstract
Although breast cancer is becoming more prevalent in Africa, few epidemiologic studies have been undertaken and appropriate methodologic approaches remain uncertain. We therefore conducted a population-based case-control study in Accra and Kumasi, Ghana, enrolling 2,202 women with lesions suspicious for breast cancer and 2,161 population controls. Biopsy tissue for cases prior to neoadjuvant therapy (if given), blood, saliva and fecal samples were sought for study subjects. Response rates, risk factor prevalences and odds ratios for established breast cancer risk factors were calculated. A total of 54.5% of the recruited cases were diagnosed with malignancies, 36.0% with benign conditions and 9.5% with indeterminate diagnoses. Response rates to interviews were 99.2% in cases and 91.9% in controls, with the vast majority of interviewed subjects providing saliva (97.9% in cases vs. 98.8% in controls) and blood (91.8% vs. 82.5%) samples; lower proportions (58.1% vs. 46.1%) provided fecal samples. While risk factor prevalences were unique as compared to women in other countries (e.g., less education, higher parity), cancer risk factors resembled patterns identified elsewhere (elevated risks associated with higher levels of education, familial histories of breast cancer, low parity and larger body sizes). Subjects with benign conditions were younger and exhibited higher socioeconomic profiles (e.g., higher education and lower parity) than those with malignancies, suggesting selective referral influences. While further defining breast cancer risk factors in Africa, this study showed that successful population-based interdisciplinary studies of cancer in Africa are possible but require close attention to diagnostic referral biases and standardized and documented approaches for high-quality data collection, including biospecimens.
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Affiliation(s)
- Louise A Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Florence Dedey
- Korle Bu Teaching Hospital, Accra, Ghana.,University of Ghana, Accra, Ghana
| | - Sarah J Nyante
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD.,Currently at the University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | | | | | | | | | | | | | | | | | - Jonine D Figueroa
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD.,Currently at the Usher Institute of Population Health Sciences and Informatics, Edinburgh Cancer Research Centre, Edinburgh, Scotland
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13
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Thomas AS, Kidwell KM, Oppong JK, Adjei EK, Osei-Bonsu E, Boahene A, Jiggae E, Gyan K, Merajver SD. Breast Cancer in Ghana: Demonstrating the Need for Population-Based Cancer Registries in Low- and Middle-Income Countries. J Glob Oncol 2017; 3:765-772. [PMID: 29244986 PMCID: PMC5735963 DOI: 10.1200/jgo.2016.006098] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Purpose Breast cancer, the most common cancer worldwide, is the leading cause of
cancer mortality in Ghanaian women. Previous studies find Ghanaian women are
diagnosed at a younger age and at more advanced stages (III and IV), and
have tumors with characteristics similar to African American women. We
sought to remedy gaps in knowledge about breast cancer survival in Ghana and
its relation to demographic and biologic factors of the tumors at diagnosis
to assist in cancer control and registration planning. Methods Individuals with a breast cancer diagnosis who sought care at Komfo Anokye
Teaching Hospital from 2009 to 2014 were identified via medical records.
Follow-up telephone interviews were held to assess survival. Kaplan-Meier
plots and Cox proportional hazards models assessed survival associated with
clinical and demographic characteristics. Results A total of 223 patients completed follow-up and were analyzed. The median
survival was 3.8 years. Approximately 50% of patients were diagnosed with
grade 3 tumors, which significantly increased the risk of recurrence or
death (hazard ratio [HR] for grade 2 versus 1, 2.98; 95% CI, 1.26 to 7.02;
HR grade 3 v 1, 2.56; 95% CI, 1.08 to 6.07;
P = .04). No other variables were significantly
associated with survival. Conclusion Higher tumor grade was significantly associated with shorter survival,
indicating impact of aggressive biology at diagnosis on higher risk of
cancer spread and recurrence. Contrary to prevailing notions, telephone
numbers were not reliable for follow-up. Collecting additional contact
information will likely contribute to improvements in patient care and
tracking. A region-wide population-based active registry is important to
implement cancer control programs and improve survival in sub-Saharan
Africa.
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Affiliation(s)
- Abigail S Thomas
- Abigail S. Thomas, Kelley M. Kidwell, and Sofia D. Merajver, University of Michigan School of Public Health, and Evelyn Jiggae, University of Michigan School of Medicine Ann Arbor, MI; Joseph K. Oppong, Ernest K. Adjei, Ernest Osei-Bonsu, and Angela Boahene, Komfo Anokye Teaching Hospital, Kumasi, Ghana; and Kofi Gyan, Henry Ford Hospital, Detroit, MI
| | - Kelley M Kidwell
- Abigail S. Thomas, Kelley M. Kidwell, and Sofia D. Merajver, University of Michigan School of Public Health, and Evelyn Jiggae, University of Michigan School of Medicine Ann Arbor, MI; Joseph K. Oppong, Ernest K. Adjei, Ernest Osei-Bonsu, and Angela Boahene, Komfo Anokye Teaching Hospital, Kumasi, Ghana; and Kofi Gyan, Henry Ford Hospital, Detroit, MI
| | - Joseph K Oppong
- Abigail S. Thomas, Kelley M. Kidwell, and Sofia D. Merajver, University of Michigan School of Public Health, and Evelyn Jiggae, University of Michigan School of Medicine Ann Arbor, MI; Joseph K. Oppong, Ernest K. Adjei, Ernest Osei-Bonsu, and Angela Boahene, Komfo Anokye Teaching Hospital, Kumasi, Ghana; and Kofi Gyan, Henry Ford Hospital, Detroit, MI
| | - Ernest K Adjei
- Abigail S. Thomas, Kelley M. Kidwell, and Sofia D. Merajver, University of Michigan School of Public Health, and Evelyn Jiggae, University of Michigan School of Medicine Ann Arbor, MI; Joseph K. Oppong, Ernest K. Adjei, Ernest Osei-Bonsu, and Angela Boahene, Komfo Anokye Teaching Hospital, Kumasi, Ghana; and Kofi Gyan, Henry Ford Hospital, Detroit, MI
| | - Ernest Osei-Bonsu
- Abigail S. Thomas, Kelley M. Kidwell, and Sofia D. Merajver, University of Michigan School of Public Health, and Evelyn Jiggae, University of Michigan School of Medicine Ann Arbor, MI; Joseph K. Oppong, Ernest K. Adjei, Ernest Osei-Bonsu, and Angela Boahene, Komfo Anokye Teaching Hospital, Kumasi, Ghana; and Kofi Gyan, Henry Ford Hospital, Detroit, MI
| | - Angela Boahene
- Abigail S. Thomas, Kelley M. Kidwell, and Sofia D. Merajver, University of Michigan School of Public Health, and Evelyn Jiggae, University of Michigan School of Medicine Ann Arbor, MI; Joseph K. Oppong, Ernest K. Adjei, Ernest Osei-Bonsu, and Angela Boahene, Komfo Anokye Teaching Hospital, Kumasi, Ghana; and Kofi Gyan, Henry Ford Hospital, Detroit, MI
| | - Evelyn Jiggae
- Abigail S. Thomas, Kelley M. Kidwell, and Sofia D. Merajver, University of Michigan School of Public Health, and Evelyn Jiggae, University of Michigan School of Medicine Ann Arbor, MI; Joseph K. Oppong, Ernest K. Adjei, Ernest Osei-Bonsu, and Angela Boahene, Komfo Anokye Teaching Hospital, Kumasi, Ghana; and Kofi Gyan, Henry Ford Hospital, Detroit, MI
| | - Kofi Gyan
- Abigail S. Thomas, Kelley M. Kidwell, and Sofia D. Merajver, University of Michigan School of Public Health, and Evelyn Jiggae, University of Michigan School of Medicine Ann Arbor, MI; Joseph K. Oppong, Ernest K. Adjei, Ernest Osei-Bonsu, and Angela Boahene, Komfo Anokye Teaching Hospital, Kumasi, Ghana; and Kofi Gyan, Henry Ford Hospital, Detroit, MI
| | - Sofia D Merajver
- Abigail S. Thomas, Kelley M. Kidwell, and Sofia D. Merajver, University of Michigan School of Public Health, and Evelyn Jiggae, University of Michigan School of Medicine Ann Arbor, MI; Joseph K. Oppong, Ernest K. Adjei, Ernest Osei-Bonsu, and Angela Boahene, Komfo Anokye Teaching Hospital, Kumasi, Ghana; and Kofi Gyan, Henry Ford Hospital, Detroit, MI
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14
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Jiagge E, Oppong JK, Bensenhaver J, Aitpillah F, Gyan K, Kyei I, Osei-Bonsu E, Adjei E, Ohene-Yeboah M, Toy K, Jackson KE, Akpaloo M, Acheampong D, Antwi B, Agyeman FO, Alhassan Z, Fondjo LA, Owusu-Afriyie O, Brewer RN, Gyamfuah A, Salem B, Johnson T, Wicha M, Merajver S, Kleer C, Pang J, Amankwaa-Frempong E, Stark A, Abantanga F, Newman L, Awuah B. Breast Cancer and African Ancestry: Lessons Learned at the 10-Year Anniversary of the Ghana-Michigan Research Partnership and International Breast Registry. J Glob Oncol 2016; 2:302-310. [PMID: 28717716 PMCID: PMC5493263 DOI: 10.1200/jgo.2015.002881] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Women with African ancestry in western, sub-Saharan Africa and in the United States represent a population subset facing an increased risk of being diagnosed with biologically aggressive phenotypes of breast cancer that are negative for the estrogen receptor, the progesterone receptor, and the HER2/neu marker. These tumors are commonly referred to as triple-negative breast cancer. Disparities in breast cancer incidence and outcome related to racial or ethnic identity motivated the establishment of the International Breast Registry, on the basis of partnerships between the Komfo Anokye Teaching Hospital in Kumasi, Ghana, the University of Michigan Comprehensive Cancer Center in Ann Arbor, Michigan, and the Henry Ford Health System in Detroit, Michigan. This research collaborative has featured educational training programs as well as scientific investigations related to the comparative biology of breast cancer in Ghanaian African, African American, and white/European American patients. Currently, the International Breast Registry has expanded to include African American patients throughout the United States by partnering with the Sisters Network (a national African American breast cancer survivors' organization) and additional sites in Ghana (representing West Africa) as well as Ethiopia (representing East Africa). Its activities are now coordinated through the Henry Ford Health System International Center for the Study of Breast Cancer Subtypes. Herein, we review the history and results of this international program at its 10-year anniversary.
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Affiliation(s)
- Evelyn Jiagge
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Joseph Kwaku Oppong
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Jessica Bensenhaver
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Francis Aitpillah
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Kofi Gyan
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Ishmael Kyei
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Ernest Osei-Bonsu
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Ernest Adjei
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Michael Ohene-Yeboah
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Kathy Toy
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Karen Eubanks Jackson
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Marian Akpaloo
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Dorcas Acheampong
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Beatrice Antwi
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Faustina Obeng Agyeman
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Zainab Alhassan
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Linda Ahenkorah Fondjo
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Osei Owusu-Afriyie
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Robert Newman Brewer
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Amma Gyamfuah
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Barbara Salem
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Timothy Johnson
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Max Wicha
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Sofia Merajver
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Celina Kleer
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Judy Pang
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Emmanuel Amankwaa-Frempong
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Azadeh Stark
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Francis Abantanga
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Lisa Newman
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
| | - Baffour Awuah
- , , , , , , , , , , , , , , , and , Komfo Anokye Teaching Hospital; , Kwame Nkrumah University of Science and Technology, Kumasi; , University of Ghana Medical School and Korle-Bu, Accra, Ghana; , , , , , , , , , and , University of Michigan Medical School, Ann Arbor; , , , , and , Henry Ford Health System International Center for the Study of Breast Cancer Subtypes, Detroit, MI; and , Sisters Network, Houston, TX
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15
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Odonkor CA, Osei-Bonsu E, Tetteh O, Haig A, Mayer RS, Smith TJ. Minding the Gaps in Cancer Pain Management Education: A Multicenter Study of Clinical Residents and Fellows in a Low- Versus High-Resource Setting. J Glob Oncol 2016; 2:387-396. [PMID: 28717725 PMCID: PMC5493248 DOI: 10.1200/jgo.2015.003004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Inadequate pain management training has been reported as a major cause of undertreatment of cancer pain. Yet, past research has not comprehensively compared the quality of cancer pain management education among physicians in training in high-resource countries (HRCs) with those in low-resource countries (LRCs). The purpose of this study was to examine and compare gaps in cancer pain management education among physician trainees in an HRC (United States) versus an LRC (Ghana). Methods A cross section of physicians at four major academic medical centers completed surveys about the adequacy of cancer pain training. Participation in the study was completely voluntary, and paper or online surveys were completed anonymously. Results The response rate was 60% (N = 120). Major gaps were identified in cancer pain management education across the spectrum of medical school training. Training was rated as inadequate (by approximately 80% of trainees), although approximately 10% more trainees in HRCs versus LRCs felt this way; 35% said residency training was inadequate in both settings; and 50% in LRCs versus 44% in HRCs said fellowship training was less than good. On the basis of the lowest group means, the three key areas of perceived deficits included interventional pain procedures (2.34 ± 1.12), palliative care interventions (2.39 ± 1.12), and managing procedural and postoperative pain (2.94 ± 0.97), with significant differences in the distribution of deficits in 15 cancer-pain competencies between LRCs and HRCs (P < .05). Conclusion This study identifies priority areas that could be targeted synergistically by LRCs and HRCs to advance cancer care globally. The findings underscore differential opportunities to broaden and improve competencies in cancer pain management via exchange training, in which physicians from HRCs spend time in LRCs and vice versa.
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Affiliation(s)
- Charles Amoatey Odonkor
- , , and , Johns Hopkins University School of Medicine, Baltimore, MD; , Komfo Anokye Teaching Hospital, Kumasi; and , Korle-Bu Teaching Hospital, Accra, Ghana; and , University of Michigan-Ann Arbor, Ann Arbor, MI
| | - Ernest Osei-Bonsu
- , , and , Johns Hopkins University School of Medicine, Baltimore, MD; , Komfo Anokye Teaching Hospital, Kumasi; and , Korle-Bu Teaching Hospital, Accra, Ghana; and , University of Michigan-Ann Arbor, Ann Arbor, MI
| | - Oswald Tetteh
- , , and , Johns Hopkins University School of Medicine, Baltimore, MD; , Komfo Anokye Teaching Hospital, Kumasi; and , Korle-Bu Teaching Hospital, Accra, Ghana; and , University of Michigan-Ann Arbor, Ann Arbor, MI
| | - Andy Haig
- , , and , Johns Hopkins University School of Medicine, Baltimore, MD; , Komfo Anokye Teaching Hospital, Kumasi; and , Korle-Bu Teaching Hospital, Accra, Ghana; and , University of Michigan-Ann Arbor, Ann Arbor, MI
| | - Robert Samuel Mayer
- , , and , Johns Hopkins University School of Medicine, Baltimore, MD; , Komfo Anokye Teaching Hospital, Kumasi; and , Korle-Bu Teaching Hospital, Accra, Ghana; and , University of Michigan-Ann Arbor, Ann Arbor, MI
| | - Thomas J Smith
- , , and , Johns Hopkins University School of Medicine, Baltimore, MD; , Komfo Anokye Teaching Hospital, Kumasi; and , Korle-Bu Teaching Hospital, Accra, Ghana; and , University of Michigan-Ann Arbor, Ann Arbor, MI
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16
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Proctor E, Kidwell KM, Jiagge E, Bensenhaver J, Awuah B, Gyan K, Toy K, Oppong JK, Kyei I, Aitpillah F, Osei-Bonsu E, Adjei E, Ohene-Yeboah M, Brewer RN, Fondjo LA, Owusu-Afriyie O, Wicha M, Merajver S, Kleer C, Newman L. Characterizing Breast Cancer in a Population with Increased Prevalence of Triple-Negative Breast Cancer: Androgen Receptor and ALDH1 Expression in Ghanaian Women. Ann Surg Oncol 2015; 22:3831-5. [PMID: 25743329 PMCID: PMC5434705 DOI: 10.1245/s10434-015-4455-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND The androgen receptor (AR) is a commonly-expressed hormone receptor in breast cancer and may be a marker of response to targeted anti-androgen therapy, a particularly attractive option for triple-negative breast cancer (TNBC). Gene expression studies suggest that ARs may distinguish a luminal/AR TNBC subtype from stem cell-like subtypes. TNBC frequency is two to three times higher in African American and African breast cancers compared with White American and European breast cancers, yet little is known regarding TNBC subtypes in high-frequency African-ancestry populations. We evaluated ARs and the mammary stem cell marker aldehyde dehydrogenase 1 (ALDH1) among breast cancers from Ghana, Africa. METHODS Overall, 147 formalin-fixed, paraffin-embedded invasive breast cancers from the Komfo Anoyke Teaching Hospital in Ghana were studied at the University of Michigan, and analyzed immunohistochemically for estrogen receptor (ER), progesterone receptor (PR), HER2/neu, ALDH1, and AR expression. RESULTS The median age of patients was 45 years. Only 31 cases (21 %) were ER-positive, and 14 (10 %) were HER2-positive; 89 (61 %) were TNBCs. For the entire group, 44 % were AR-positive and 45 % were ALDH1-positive. ER/PR-positive tumors were more likely to be AR-positive compared with ER/PR-negative tumors (87 vs. 26 %; p < 0.0001), but there was no association between ALDH1 and AR expression. Among the TNBC cases, 45 % were ALDH1-positive and 24 % were AR-positive. ALDH1 positivity was associated with AR positivity within the subset of TNBC (36 vs. 14 %; p = 0.019). CONCLUSION We confirmed other studies showing a high frequency of TNBC in Africa. Surprisingly, ALDH1 was found to correlate with AR expression among TNBC, suggesting that novel TNBC subtypes may exist among populations with African ancestry.
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MESH Headings
- Adult
- Aldehyde Dehydrogenase 1 Family
- Carcinoma, Ductal, Breast/chemistry
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Lobular/chemistry
- Carcinoma, Lobular/epidemiology
- Female
- Ghana/epidemiology
- Humans
- Isoenzymes/analysis
- Middle Aged
- Prevalence
- Receptor, ErbB-2/analysis
- Receptors, Androgen/analysis
- Receptors, Estrogen/analysis
- Receptors, Progesterone/analysis
- Retinal Dehydrogenase/analysis
- Triple Negative Breast Neoplasms/chemistry
- Triple Negative Breast Neoplasms/epidemiology
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Affiliation(s)
- Erica Proctor
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Kelley M Kidwell
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Evelyn Jiagge
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
- Department of Surgery, Komfo Anoyke Teaching Hospital, Kumasi, Ghana
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jessica Bensenhaver
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
- Division of Surgical Oncology, University of Michigan Health Systems, Ann Arbor, MI, USA
- Breast Care Center, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI, USA
| | - Baffour Awuah
- Department of Oncology, Komfo Anoyke Teaching Hospital, Kumasi, Ghana
| | - Kofi Gyan
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Kathy Toy
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | | | - Ishmael Kyei
- Department of Surgery, Komfo Anoyke Teaching Hospital, Kumasi, Ghana
| | - Francis Aitpillah
- Department of Surgery, Komfo Anoyke Teaching Hospital, Kumasi, Ghana
| | - Ernest Osei-Bonsu
- Department of Oncology, Komfo Anoyke Teaching Hospital, Kumasi, Ghana
| | - Ernest Adjei
- Department of Pathology, Komfo Anoyke Teaching Hospital, Kumasi, Ghana
| | | | | | | | - Osei Owusu-Afriyie
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
- Department of Pathology, Komfo Anoyke Teaching Hospital, Kumasi, Ghana
| | - Max Wicha
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Breast Care Center, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI, USA
| | - Sofia Merajver
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Breast Care Center, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI, USA
| | - Celina Kleer
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
- Breast Care Center, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI, USA
| | - Lisa Newman
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
- Division of Surgical Oncology, University of Michigan Health Systems, Ann Arbor, MI, USA.
- Breast Care Center, University of Michigan, Comprehensive Cancer Center, Ann Arbor, MI, USA.
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17
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Obrist M, Osei-Bonsu E, Awuah B, Watanabe-Galloway S, Merajver SD, Schmid K, Soliman AS. Factors related to incomplete treatment of breast cancer in Kumasi, Ghana. Breast 2014; 23:821-8. [PMID: 25282667 DOI: 10.1016/j.breast.2014.08.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 08/16/2014] [Accepted: 08/28/2014] [Indexed: 11/19/2022] Open
Abstract
PURPOSE The burden of cancer in Africa is an enlarging public health challenge. Breast cancer in Ghana is the second most common cancer among Ghanaian women and the proportion of diagnosed patients who complete prescribed treatment is estimated to be very limited, thereby potentially adding to lower survival and poor quality of life after diagnosis. The objective of this study was to identify the patient and system factors related to incomplete treatment of breast cancer among patients. METHODS This study was conducted at the Komfo Anokye Teaching Hospital in Kumasi, Ghana. We interviewed 117 breast cancer patients and next of kin of breast cancer patients diagnosed from 2008 to 2010. RESULTS Islamic religion, seeking treatment with traditional healers, and lack of awareness about national health insurance coverage of breast cancer treatment were predictors of incomplete treatment. CONCLUSIONS The results of this study support that Ghanaian women with diagnosed breast cancer have multiple addressable and modifiable patient factors that may deter them from completing the prescribed treatment. The results highlight the need for developing and testing specific interventions about the importance of completing treatment with a special focus on addressing religious, cultural, and system navigation barriers in developing countries.
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Affiliation(s)
- Mark Obrist
- University of Nebraska Medical Center College of Public Health, Department of Epidemiology, Omaha, NE 68198, United States
| | - Ernest Osei-Bonsu
- Komfo Anokye Teaching Hospital, Department of Medical Oncology and Radiation, Kumasi, Ghana
| | - Baffour Awuah
- Komfo Anokye Teaching Hospital, Central Administration, Kumasi, Ghana
| | - Shinobu Watanabe-Galloway
- University of Nebraska Medical Center College of Public Health, Department of Epidemiology, Omaha, NE 68198, United States
| | - Sofia D Merajver
- University of Michigan School of Public Health, Department of Epidemiology, Ann Arbor, MI 48109, United States; University of Michigan College of Medicine, Department of Internal Medicine, Ann Arbor, MI 48109, United States
| | - Kendra Schmid
- University of Nebraska Medical Center College of Public Health, Department of Biostatistics, Omaha, NE 68198, United States
| | - Amr S Soliman
- University of Nebraska Medical Center College of Public Health, Department of Epidemiology, Omaha, NE 68198, United States.
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18
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Scherber S, Soliman AS, Awuah B, Osei-Bonsu E, Adjei E, Abantanga F, Merajver SD. Characterizing breast cancer treatment pathways in Kumasi, Ghana from onset of symptoms to final outcome: outlook towards cancer control. Breast Dis 2014; 34:139-149. [PMID: 24934170 PMCID: PMC4158614 DOI: 10.3233/bd-140372] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Cancer rates are increasing in Africa, including Ghana. Breast cancer is the second most common cancer in incidence and mortality in Ghana. OBJECTIVE We outlined both breast cancer patient characteristics and management at the Komfo Anokye Teaching Hospital (KATH), the main cancer management hospital in central Ghana. Moreover, we identified the treatment interventions predictive of patient outcome. METHODS Medical records of 597 breast cancer patients seen in 2008-2011 were abstracted to investigate management and treatment patterns. Abstracted variables included type and extent of surgery, number and cycles of chemotherapy and radiotherapy, as well as the course of treatment completed. RESULTS Late stage at diagnosis was common, treatment plans of the study hospital were relatively standardized according to disease severity, and defaulting/interrupting treatment in the records was also common. Patients diagnosed with late stage cancer who received adjuvant therapy and patients with hormone status evaluation were more likely to have complied with treatment guidelines and continued oncotherapy at the study hospital than those who never had hormone status requested or reported. CONCLUSIONS Our study lends support to improving patient outcomes in low- and middle-income countries through raising knowledge and reporting of tumor hormonal status and providing appropriately tailored treatment. Achieving improved outcomes should also consider enhancing public understanding of the importance of early detection and completion of treatment.
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Affiliation(s)
- Samuel Scherber
- Department of Epidemiology, University of Michigan School of Public Health, Omaha, NE, USA
| | - Amr S Soliman
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Baffour Awuah
- Central Administration, Komfo Anokye Teaching Hospital, Omaha, NE, USA
| | - Ernest Osei-Bonsu
- Department of Medical Oncology and Radiation, Komfo Anokye Teaching Hospital, Omaha, NE, USA
| | - Ernest Adjei
- Department of Pathology, Komfo Anokye Teaching Hospital, Omaha, NE, USA
| | - Frank Abantanga
- Department of Surgery, Komfo Anokye Teaching Hospital, Omaha, NE, USA
| | - Sofia D Merajver
- Department of Epidemiology, University of Michigan School of Public Health, Omaha, NE, USA Department of Internal Medicine, University of Michigan, Omaha, NE, USA
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19
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O’Brien KS, Soliman AS, Awuah B, Jiggae E, Osei-Bonsu E, Quayson S, Adjei E, Thaivalappil SS, Abantanga F, Merajver SD. Establishing effective registration systems in resource-limited settings: cancer registration in Kumasi, Ghana. J Registry Manag 2013; 40:70-77. [PMID: 24002131 PMCID: PMC4274943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Cancer control programs are needed worldwide to combat the increases in cancer incidence and mortality predicted for sub-Saharan Africa in the next decades. The effective design, implementation, and evaluation of such programs require population-based cancer registries. Ghana's second largest medical center, the Komfo Anokye Teaching Hospital (KATH) in Kumasi, has made initial progress at developing a cancer registry. This registry, however, is housed in the medical oncology/radiotherapy center at KATH and does not currently include data from other departments that also interact with cancer patients. The aim of this study was to improve KATH cancer registration by compiling cancer data from other major departments that see cancer patients. Using recent population estimates, we calculated crude cancer incidence rates of the "minimally-reported cases" for the Ashanti region. The most common cancers found in this study were breast (12.6 per 100,000), cervix (9.2 per 100,000), and prostate (8.8 per 100,000). These cancers occur at similar crude incidence rates in other West African countries. Females had overall higher incidence rates than males, which is consistent throughout the West African region. This study identified a number of methodological challenges facing cancer registries in Ghana that can be addressed to improve the quality of cancer registries in other resource-limited settings. Such registries should be tailored to the local health system context. A lack of coordination among the sources reporting cancer cases and a lack of understanding of local health-care systems and payment plans may interfere with the quality, completeness, and comparability of data from cancer registries in resource-limited settings. Steps, barriers, and solutions for improving cancer registration in Ghana and countries at similar levels are discussed.
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Affiliation(s)
| | - Amr S. Soliman
- University of Nebraska Medical Center College of Public Health, Omaha, Nebraska
| | | | - Evelyn Jiggae
- Komfo Anokye Teaching Hospital, Kumasi, Ghana
- University of Michigan School of Medicine, Ann Arbor, Michigan
| | | | | | | | | | | | - Sofia D. Merajver
- University of Michigan School of Public Health, Ann Arbor, Michigan
- University of Michigan School of Medicine, Ann Arbor, Michigan
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20
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Schwartz T, Stark A, Pang J, Awuah B, Kleer CG, Quayson S, Kingman S, Aitpillah F, Abantanga F, Jiagge E, Oppong JK, Osei-Bonsu E, Martin I, Yan X, Toy K, Adjei E, Wicha M, Newman LA. Expression of aldehyde dehydrogenase 1 as a marker of mammary stem cells in benign and malignant breast lesions of Ghanaian women. Cancer 2012; 119:488-94. [PMID: 22930220 DOI: 10.1002/cncr.27737] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 03/17/2012] [Accepted: 04/06/2012] [Indexed: 01/16/2023]
Abstract
BACKGROUND Breast cancers that are negative for the estrogen receptor (ER), the progesterone receptor (PR), and the HER2 (human epidermal growth factor receptor 2) marker are more prevalent among African women, and the biologically aggressive nature of these triple-negative breast cancers (TNBCs) may be attributed to their mammary stem cell features. Little is known about expression of the mammary stem cell marker aldehyde dehydrogenase 1 (ALDH1) in African women. Novel data are reported regarding ALDH1 expression in benign and cancerous breast tissue of Ghanaian women. METHODS Formalin-fixed, paraffin-embedded specimens were transported from the Komfo Anoyke Teaching Hospital in Kumasi, Ghana to the University of Michigan for centralized histopathology study. Expression of ER, PR, HER2, and ALDH1 was assessed by immunohistochemistry. ALDH1 staining was further characterized by its presence in stromal versus epithelial and/or tumor components of tissue. RESULTS A total of 173 women contributed to this study: 69 with benign breast conditions, mean age 24 years, and 104 with breast cancer, mean age 49 years. The proportion of benign breast conditions expressing stromal ALDH1 (n = 40, 58%) was significantly higher than those with cancer (n = 44, 42.3%) (P = .043). Among the cancers, TNBC had the highest prevalence of ALDH1 expression, either in stroma or in epithelial cells. More than 2-fold higher likelihood of ALDH1 expression was observed in TNBC cases compared with other breast cancer subtypes (odds ratio = 2.38, 95% confidence interval 1.03-5.52, P = .042). CONCLUSIONS ALDH1 expression was higher in stromal components of benign compared with cancerous lesions. Of the ER-, PR-, and HER2-defined subtypes of breast cancer, expression of ALDH1 was highest in TNBC.
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Affiliation(s)
- Theresa Schwartz
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
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