|Year : 2020 | Volume
| Issue : 4 | Page : 211-214
Biological characteristics of breast cancers in a teaching hospital in Northwestern Nigeria
Amina Ibrahim El-Yakub
Department of Surgery, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
|Date of Submission||03-May-2018|
|Date of Decision||27-Jun-2018|
|Date of Acceptance||03-Sep-2018|
|Date of Web Publication||23-Feb-2021|
Dr. Amina Ibrahim El-Yakub
Aminu Kano Teaching Hospital, Bayero University, Kano
Background: Breast cancer is the number one killer of women in the world, and its incidence is rising in developing countries including Nigeria. Breast cancer has expressed variation in terms of histological types, hormonal receptor status, and Her-2-Neu receptor status in different races and environments. These biological characteristics are relevant in disease presentation, treatment, and outcome. Objective: This study examined the histology, hormone receptor status, and Her-2-Neu receptor status of breast cancer patients. Materials and Methods: This is a retrospective review of histology reports of breast cancers diagnosed over a 5-year period from January 1, 2010, to December 31, 2015, in Aminu Kano Teaching Hospital, Kano, Northwestern Nigeria. Data regarding age of the patient, histological type, hormone receptor, and Her-2-Neu overexpression were obtained. Results: The records of 215 patients with breast cancer during the period of the study were requested. Out of this number, only the record of 153 patients could be obtained. Furthermore, of the 153 patients, only 103 had complete records and were included in the study. The age of the patients ranged between 25 and 80 years. The modal age of the groups was 31–40 and 41–50 years, each having 27 participants (26.2%). More than two-thirds of the study participants, 74 (71.8%), had intraductal carcinoma. Other variants of breast cancer in the participants were papillary and medullary carcinoma, each accounting for 4 (3.9%). After receptor typing, it was found that 39 (37.9%) of the participants were positive for Her-2 and progesterone receptors, respectively, while 32 (31.1%) were positive for estrogen receptors. The mean age of women triple-negative status was lower (46.8 years) than that of women without triple-negative status (48.9 years). However, this was not statistically significant (t = 0.74, P = 0.462). More than half of the premenopausal women, 32 (61.5%), had triple-negative status while more than two-thirds of women who had attained menopause, 35 (68.6%), had triple-negative status. However, the relationship between age and negative status was not significant (χ2 = 0.569, P = 0.451). Conclusion: The predominant histological type of breast cancer in the study area remains intraductal carcinoma, and many patients had triple-negative tumors.
Keywords: Breast cancer, Her-2-Neu receptors, hormonal receptors, Northwestern Nigeria
|How to cite this article:|
El-Yakub AI. Biological characteristics of breast cancers in a teaching hospital in Northwestern Nigeria. Sahel Med J 2020;23:211-4
| Introduction|| |
Breast cancer is a common disease in Nigeria, and majority of patients in our region present with advanced disease.,,, It is now recognized that cancer of the breast is of heterogeneous nature, and this implies that treatment could be planned according to the type of cancer.
Estrogens, progesterone, as well as other hormones are known to regulate the growth of breast tissue and have also been found to be important in growth of breast cancer cell. Her-2-Neu receptors are found in some cancers and can also influence carcinogenesis.
Clinically, estrogen receptor (ER), progesterone receptor (PR), as well as Her-2-Neu can be assessed, and the results could be used for treatment plans. Hormonal assay of estrogens, progesterone, as well as Her-2-Neu is a standard practice in the western world. However, only very few centers in Africa routinely check for these receptors in breast cancer tissues.
The study was done to determine the histological types and ER/PR and Her-2 status of breast cancer in Aminu Kano Teaching Hospital, a tertiary hospital in Northwest region of Nigeria.
| Materials and Methods|| |
The study was conducted between January 1, 2010, and December 31, 2015. All patients who had biopsy for a breast lump with a proven histological diagnosis breast cancer were recruited for the study. Biodemographic data such as age, sex, marital status, and menopausal status were obtained. Data on histology, grading, and receptor status were also obtained. All these were recorded in a pro forma. The pro forma for each of the patients was entered into Epi Info computer software version 3.2.2 (Center for Disease Control and prevention, USA) and analyzed. Results were expressed as mean/standard deviation and/or median with ranges. Chi-square was used to check for association where appropriate. A P ≤ 0.05 was considered statistically significant.
A much higher number of breast cancer patients are seen in center. However, the cost of the immunohistochemical (IHC) analysis precludes its routine use on all breast specimens as most patients could not afford the test.
| Results|| |
The records of 215 patients with breast cancer during the period of the study were requested. Out of this number, only the record of 153 patients could be obtained. Further, out of the 153 patients, only 103 had complete information and were included in the study.
All the 103 patients were females; the age range of these patients was between 25 and 80 years. The modal age groups were 31–40 and 41–50 years, each having 27 participants (26.2%). Majority of the participants, 66 (64.1%), had passed the fourth decade of life [Table 1].
Histological subgroups were such that more than two-thirds of the study participants, 74 (71.8%), had intraductal carcinoma. The other variants were papillary (3.9%) and medullary (3.9%) carcinoma, invasive carcinoma (2.9%), apocrine carcinoma (1.9%), and lobular carcinoma and others (13.6%).
More than half of the patients were premenopausal women; 32 (61.5%) of these premenopausal women had triple-negative status. Further, two-thirds of women who had attained menopause, 35 (68.6%) had triple-negative status. However, the relationship between age and triple-negative status was not significant (Chi-square = 0.569, P = 0.451) [Table 2].
| Discussion|| |
The most common histological type was infiltrating duct carcinoma in 74% similar to previous studies in the center, and studies in other parts of Nigeria.,
The frequency of ER- and PR-positive cancers was 68.9% for both, respectively, and 62% for Her-2-positive tumors. Earlier studies in Southern Nigeria showed estrogen-positive tumors to be 23% and Her-2 positive to be 19%. A study done at Kerala, India, by Rajan et al. revealed that 24% were ER positive, 34% were ER and PR positive, 10% were ER negative but PR positive, 66% were negative for ER and PR, and 26.5% positive for HER 2 but negative for hormonal receptors.
About one-third of the patients (35%) have triple-negative receptor status [Figure 1]. The mean age of women with triple-negative receptor status was slightly lower with 46.9 years than that of women without triple-negative receptors (48.9 years). However, this was not statistically significant (t = 0.74, P = 0.462) [Table 2].
Breast cancer patients with tumors that are ER positive and/or PR positive have lower risks of mortality after their diagnosis compared to women with ER- and/or PR-negative disease.,, Clinical trials have also shown that the survival advantage for women with hormone receptor-positive tumors is enhanced by treatment with adjuvant hormonal and/or chemotherapeutic regimens.,,
Previous studies have shown survival advantages among women with hormone receptor-positive tumors relative to women with hormone receptor-negative tumors.,, Another study by Grann et al., who also used data collected from the SEER program, reported that join ER/PR status was an independent predictor of outcome in a large cohort of women with breast carcinoma.
Researchers who examined the risk of invasive breast carcinoma diagnosed among women of different races reported that certain ethnicities have elevated risks of presenting with ER−/PR− tumors. African-Americans, Asians, Native Americans, and Hispanic Whites were found to have greater risk of presenting with ER−/PR− breast tumors compared to non-Hispanic Whites.,,, However, it has been shown that women of certain racial/ethnic groups have increased risks of developing hormone receptor-negative tumors. The exclusion of subjects with no recorded ER/PR data is a second potential limitation of this study.
In addition, women with ER−PR+ and ER−/PR− tumors were somewhat less likely to have lobular, ductal/lobular, mucinous, or tubular carcinomas and were somewhat more likely to have inflammatory, comedo, or medullary carcinomas.
Most, 65.1%, of the tumors were ER+, 54.7% were PR+, and 79.7% were Her-2 negative. Majority of the tumors, 77.6%, were luminal type A, 2.6% were luminal type B, 15.8% were basal type, and the remaining 4.0% (6/152) were HER2+/ER− subtype.
ER/PR testing was done in 120: 24% had ER-positive tumors, 34% were ER and/or PR positive, 10% were ER-negative but PR-positive tumors, and 66% were negative for ER and PR. ER/PR positivity was not associated with stage (P = 0.28) and was not related to age, parity, and menopausal status (or node metastases). Increasing tumor grade was associated with PR expression (P = 0.02) with decreasing frequency of PR-positive tumors as histological grade increased; there was weak evidence of an association between grade and ER expression (P = 0.06). Of the cases tested, 26.5% overexpressed Her-2.
Interestingly, this disparity of nativity was not apparent when observing risk of triple-negative breast cancer (TNBC) in African-American women. Elevated risk was also reported among contemporary populations in continental Africa, suggesting the presence of a heritable risk factor for TNBC in all of the African ancestry.,,
“The patients were of young age with an advanced stage at the time of presentation. The same trend was observed in Kenya where the patients had an advanced stage of the disease with a low percentage likely to be hormonal sensitive in all stages of the disease. In those studies, Her-2 was not tested.”
The pattern of presentation differs from that in the western world where most patients are postmenopausal and present with small-sized early tumors and less aggressive disease. This is more a reflection of the differences in the demographic pattern of these societies than that of assumed differences in the intrinsic biology of the disease in the two populations. The predominance of invasive ductal carcinoma is also akin to what is seen in other parts of the world.
Based on greater than 1000 receptor-characterized tumors, ER positivity (65% overall and 63% in Black women) in South African breast cancer patients was consistent with that of Black American women older than 50 years and very similar to a Nigerian study (65%), which was also based on IHC at diagnosis, and to others in South Africa and Sudan.,, However, several African studies have reported that fewer than 40% of tumors were ERP.,,,, One of the later studies (Bird et al.) also observed that TRNs constituted >50% of tumors compared with 20% observed here.
| Conclusion|| |
Intraductal carcinoma remains the predominant histological variant of breast cancer in our environment. Majority of the tumors were estrogen and/or progesterone positive which lends an opportunity for hormonal therapy as part of the treatment armamentarium. Her-2 receptor overexpression in this study was low. However, triple-negative breast tumors were high.
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Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]