Abstract
BackgroundBreast cancer is a leading cause of morbidity and deaths among women worldwide. In Tanzania there is no published data on human epidermal growth receptor-2 (HER2/neu) expression in breast carcinoma. Hormonal receptors and HER2/neu status reportedly influence post-mastectomy adjuvant therapy and predict treatment outcome and prognosis. Here we evaluate hormonal receptors and HER-2 status in biopsies of women with breast cancer at Muhimbili National Hospital (MNH).MethodsA cross-sectional study of female breast post-modified radical mastectomy (MRM)/incisional biopsies confirmed to be carcinoma at the Histopathology Unit (January–December 2013). Tissue blocks having poor morphology, without tumor, secondary tumors, cases outside the study period and male patients were excluded. Routine staining was done followed by immunohistochemistry for estrogen (ER), and progesterone (PgR) receptors and HER2. Data analyzed using Statistical Package for Social Sciences (SPSS).ResultsA total of 218 cases were confirmed to be carcinoma including 70 meeting inclusion criteria. Age at diagnosis ranged 18–75 years and mean age was 48.36 years. Majority (64.3%) were in the 36–55 years age-group. Histologically, most (88.6%) women had invasive ductal carcinoma including 43.1% of intermediate grade. A great majority (78%) were stage three. Due to logistical constrains, 75.7% (n = 53/70) cases where immunostained for hormones including 43.4% (ER+), 26.4% (PgR+), and 28% (ER+/PgR+). Furthermore, 65.7% (n = 46/70) cases were immunostained for HER-2 and 15.2% (n = 7/46) were positive, 45.6% were triple negative (ER-,PgR-,HER2-), 23.9% (ER+,PgR+,HER2-) or luminal B, 2.2% (ER+,PgR-,HER2+),13% (ER-,PgR-,HER2+) and 15% (ER+,PgR-,HER2-) with none being triple positive.ConclusionsHormonal receptors and HER2 expression at MNH appears to be comparable to previous Africans/African Americans reports but not with studies among Caucasians and the current proportion of triple negative breast carcinomas (TNBC) is higher than in a previous Tanzanian report and majority are luminal. HER2 over-expression is relatively common. It is strongly recommended that receptor status assessment be made routine for breast cancer patients at MNH.
Highlights
Breast cancer is a leading cause of morbidity and deaths among women worldwide
Clinico-pathological prognostic indicators of breast carcinoma Only 54/70 women presented with a biopsy from the primary tumor and majority (48.1%, n = 26/54) of these had T4 disease followed by T3 disease (24.1%, n = 13/54) implying late presentation (Table 2)
HER2 expression Our current study found that only 15.2% IHCtested breast cancer biopsies at Muhimbili National Hospital (MNH) showed HER2 expression while the rest were negative for this protein (Table 9, Fig. 2 (f&g)) and this was not statistically significant (P-value = 0.213), we found that out of 22 biopsies positive for estrogen receptors, only 4.5%
Summary
Breast cancer is a leading cause of morbidity and deaths among women worldwide. In Tanzania there is no published data on human epidermal growth receptor-2 (HER2/neu) expression in breast carcinoma. Breast cancer is the most common malignant tumour and leading cause of cancer deaths among women worldwide and the second most common malignancy among females in sub-Saharan African countries including Tanzania, after cancer of uterine cervix [1, 2]. While data for developing countries is limited, cancer registries suggest that age-standardized incidence rates are rising even more rapidly in low-incidence regions such as Africa and Asia [4, 5]. Reasons for these rising trends are not completely understood, but they may possibly reflect changes in reproductive patterns, obesity, physical inactivity and some breast cancer screening programs [6]. Extensive research suggests that genetic, hormonal and environmental factors may possibly be related to its aetiology [7, 8]
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