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ORIGINAL ARTICLE
Year : 2020  |  Volume : 23  |  Issue : 4  |  Page : 211-214

Biological characteristics of breast cancers in a teaching hospital in Northwestern Nigeria


Department of Surgery, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria

Date of Submission03-May-2018
Date of Decision27-Jun-2018
Date of Acceptance03-Sep-2018
Date of Web Publication23-Feb-2021

Correspondence Address:
Dr. Amina Ibrahim El-Yakub
Aminu Kano Teaching Hospital, Bayero University, Kano
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/smj.smj_23_18

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  Abstract 


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

How to cite this URL:
El-Yakub AI. Biological characteristics of breast cancers in a teaching hospital in Northwestern Nigeria. Sahel Med J [serial online] 2020 [cited 2024 Mar 29];23:211-4. Available from: https://www.smjonline.org/text.asp?2020/23/4/211/310021




  Introduction Top


Breast cancer is a common disease in Nigeria, and majority of patients in our region present with advanced disease.[1],[2],[3],[4] 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.[5]

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.[6] Her-2-Neu receptors are found in some cancers and can also influence carcinogenesis.[7]

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.[4] 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.[8]

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 Top


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.

Limitations

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 Top


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].
Table 1: Age distribution of the participants (n=103)

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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].
Table 2: Relationship between triple-negative status and age

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  Discussion Top


The most common histological type was infiltrating duct carcinoma in 74% similar to previous studies in the center[9],[10] and studies in other parts of Nigeria.[11],[12]

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%.[13] A study done at Kerala, India, by Rajan et al.[14] 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].
Figure 1: Histological subtypes of Breast Cancer among the patients

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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.[4],[15],[16] 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.[17],[18],[19]

Previous studies have shown survival advantages among women with hormone receptor-positive tumors relative to women with hormone receptor-negative tumors.[2],[15],[20] Another study by Grann et al.,[21] 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.[4],[16],[22],[23] 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.[24],[25],[26]

“The patients were of young age with an advanced stage at the time of presentation.[1] 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.[2] 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.[3] 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.[13],[27],[28] However, several African studies have reported that fewer than 40% of tumors were ERP.[1],[2],[15],[16],[24] One of the later studies (Bird et al.)[15] also observed that TRNs constituted >50% of tumors compared with 20% observed here.


  Conclusion Top


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.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ikpatt OF, Kuopio T, Ndoma-Egba R, Collan Y. Breast cancer in Nigeria and Finland: Epidemiological, clinical and histological comparison. Anticancer Res 2002;22:3005-12.  Back to cited text no. 1
    
2.
Stark A, Kleer CG, Martin I, Awuah B, Nsiah-Asare A, Takyi V, et al. African ancestry and higher prevalence of triple-negative breast cancer: Findings from an international study. Cancer 2010;116:4926-32.  Back to cited text no. 2
    
3.
Anderson WF, Katki HA, Rosenberg PS. Incidence of breast cancer in the United States: Current and future trends. J Natl Cancer Inst 2011;103:1397-402.  Back to cited text no. 3
    
4.
Jemal A, Fedewa SA. Is the prevalence of ER-negative breast cancer in the US higher among Africa-born than US-born black women? Breast Cancer Res Treat 2012;135:867-73.  Back to cited text no. 4
    
5.
Yaziji H, Taylor CR, Goldstein NS, Dabbs DJ, Hammond EH, Hewlett B, et al. Consensus recommendations on estrogen receptor testing in breast cancer by immunohistochemistry. Appl Immunohistochem Mol Morphol 2008;16:513-20.  Back to cited text no. 5
    
6.
Fergenbaum JH, Garcia-Closas M, Hewitt SM, Lissowska J, Sakoda LC, Sherman ME, et al. Loss of antigenicity in stored sections of breast cancer tissue microarrays. Cancer Epidemiol Biomarkers Prev 2004;13:667-72.  Back to cited text no. 6
    
7.
Nielsen TO, Hsu FD, Jensen K, Cheang M, Karaca G, Hu Z, et al. Immunohistochemical and clinical characterization of the basal-like subtype of invasive breast carcinoma. Clin Cancer Res 2004;10:5367-74.  Back to cited text no. 7
    
8.
Kantelhardt EJ, Muluken G, Sefonias G, Wondimu A, Gebert HC, Unverzagt S, et al. A review on breast cancer care in Africa. Breast Care (Basel) 2015;10:364-70.  Back to cited text no. 8
    
9.
Edino ST, Ochicha O, Alhassan S, Mohammed AZ, Ajayi OO. Clinico-pathologic review of breast cancer in Kano, North-Western Nigeria. Nig J Surg 2000;7:70-5.  Back to cited text no. 9
    
10.
Imam MI, Yawale I, Aminu ZM. Histopathological review of breast tumours in Kano, Northern Nigeria. Sub-Saharan Afr J Med 2015;2:47-51.  Back to cited text no. 10
    
11.
Mayun AA, Obiano SK, Shehu SK, Abdulazeez JO. Breast malignancy in a tertiary health setting in north Eastern Nigeria: A histopathological review. Afr J Med Sci 2009;38:337-41.  Back to cited text no. 11
    
12.
Gogo-Abite M, Nwosu SO. Histopathological characteristics of female breast carcinomas seen at the University of port Harcourt Teaching Hospital, Port Harcourt Nigeria. Niger J Med 2005;14:72-6.  Back to cited text no. 12
    
13.
Adebamowo CA, Famooto A, Ogundiran TO, Aniagwu T, Nkwodimmah C, Akang EE, et al. Immunohistochemical and molecular subtypes of breast cancer in Nigeria. Breast Cancer Res Treat 2008;110:183-8.  Back to cited text no. 13
    
14.
Rajan G, Culas TB, Jayalakshmy PS. Estrogen and progesterone receptor status in breast cancer: A cross-sectional study of 450 women in Kerala, South India. World J Surg Oncol 2014;12:120.  Back to cited text no. 14
    
15.
Bird PA, Hill AG, Houssami N. Poor hormone receptor expression in East African breast cancer: Evidence of a biologically different disease? Ann Surg Oncol 2008;15:1983-8.  Back to cited text no. 15
    
16.
Huo D, Ikpatt F, Khramtsov A, Dangou JM, Nanda R, Dignam J, et al. Population differences in breast cancer: Survey in indigenous African women reveals over-representation of triple-negative breast cancer. J Clin Oncol 2009;27:4515-21.  Back to cited text no. 16
    
17.
Smith RE, Good BC. Chemoprevention of breast cancer and the trials of the national surgical adjuvant breast and bowel project and others. Endocr Relat Cancer 2003;10:347-57.  Back to cited text no. 17
    
18.
Goldhirsch A, Wood WC, Gelber RD, Coates AS, Thürlimann B, Senn HJ, et al. Meeting highlights: Updated international expert consensus on the primary therapy of early breast cancer. J Clin Oncol 2003;21:3357-65.  Back to cited text no. 18
    
19.
Fisher B, Jeong JH, Bryant J, Anderson S, Dignam J, Fisher ER, et al. Treatment of lymph-node-negative, oestrogen-receptor-positive breast cancer: Long-term findings from National Surgical Adjuvant Breast and Bowel Project randomised clinical trials. Lancet 2004;364:858-68.  Back to cited text no. 19
    
20.
Anderson WF, Luo S, Chatterjee N, Rosenberg PS, Matsuno RK, Goodman MT, et al. Human epidermal growth factor receptor-2 and estrogen receptor expression, a demonstration project using the residual tissue repository of the surveillance, epidemiology, and end results (SEER) program. Breast Cancer Res Treat 2009;113:189-96.  Back to cited text no. 20
    
21.
Grann VR, Troxel AB, Zojwalla NJ, Jacobson JS, Hershman D, Neugut AI, et al. Hormone receptor status and survival in a population-based cohort of patients with breast carcinoma. Cancer 2005;103:2241-51.  Back to cited text no. 21
    
22.
Carey LA, Perou CM, Livasy CA, Dressler LG, Cowan D, Conway K, et al. Race, breast cancer subtypes, and survival in the Carolina breast cancer study. JAMA 2006;295:2492-502.  Back to cited text no. 22
    
23.
Elledge RM, Clark GM, Chamness GC, Osborne CK. Tumor biologic factors and breast cancer prognosis among white, Hispanic, and black women in the United States. J Natl Cancer Inst 1994;86:705-12.  Back to cited text no. 23
    
24.
Gukas ID, Jennings BA, Mandong BM, Igun GO, Girling AC, Manasseh AN, et al. Clinicopathological features and molecular markers of breast cancer in Jos, Nigeria. West Afr J Med 2005;24:209-13.  Back to cited text no. 24
    
25.
Macfarlane R, Seal M, Speers C, Woods R, Masoudi H, Aparicio S, et al. Molecular alterations between the primary breast cancer and the subsequent locoregional/metastatic tumor. Oncologist 2012;17:172-8.  Back to cited text no. 25
    
26.
Li CI, Daling JR, Malone KE. Incidence of invasive breast cancer by hormone receptor status from 1992 to 1998. J Clin Oncol 2003;21:28-34.  Back to cited text no. 26
    
27.
Awadelkarim KD, Arizzi C, Elamin EO, Hamad HM, De Blasio P, Mekki SO, et al. Pathological, clinical and prognostic characteristics of breast cancer in Central Sudan versus Northern Italy: Implications for breast cancer in Africa. Histopathology 2008;52:445-56.  Back to cited text no. 27
    
28.
Basro S, Apffelstaedt JP. Breast cancer in young women in a limited-resource environment. World J Surg 2010;34:1427-33.  Back to cited text no. 28
    


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