Abstract
PurposeBreast cancer (BC) is the second most common cancer among Tanzanian women. Oestrogen (ER), progesterone and human epidermal growth factor receptor 2 play major roles in prognosis and treatment but data for Tanzania are sparse. This study aimed to determine these patterns and histological types, tumour grading and staging of BC patients in northern Tanzania for a better understanding of BC in the Sub-Saharan African (SSA) setting.MethodsA cross-sectional study recorded newly diagnosed BC cases at Kilimanjaro Christian Medical Centre between October 2018 and March 2019. Receptor status, histological types and grade, clinical stage and socio-demographic were recorded and descriptive and bivariate analyses performed.Results116 patients were enrolled. Median age was 53 years, 71.6% were ≥45 years. The commonest molecular subtype was triple negative breast cancer (TNBC) (n = 33; 28.4%). One hundred and two (87.9%) patients had invasive ductal carcinoma (IDC), poorly differentiated tumours (60; 51.7%) and clinical stage III disease (62; 53.0%). ER negative tumours were associated with poorly differentiated histological grade (relative risk (RR): 1.34 (0.87–2.07)), tumour size > 5 cm (RR: 1.67 (0.33–8.35)) and IDC (RR: 3.35 (0.56–20.23)). Clinical stages III & IV (odds ratio (OR): 1.64 (0.63–4.24)) were associated with hormone receptor (HR) negative tumours and metastasis (OR: 1.60 (0.68–3.74)) with TNBC. 18% of the patients reported about first-degree relatives with BC.ConclusionsMost patients presented in advanced stages and TNBC in their menopause. HR negative tumours were associated with poor histological differentiation and IDC. The high percentage of positive family history of BC and the differences in receptor patterns compared to other parts of the world should urge further genetic research on BC in SSA.
Highlights
The rising cancer burden among men and women has accounted to 18.1 million new cases and 9.6 million cancer related deaths in the year 2018 [1]
Sixty-two (53.4%) patients were negative for ER and 88 (75.9%) patients were negative for PR. 44% of patients were human epidermal growth factor receptor 2 (HER2) negative (0 and 1+) and the same number of patients was HER2 positive (3+)
The major findings in regard to the IHC pattern were that half of the patients had hormone receptor (HR) positive tumours while triple negative breast cancer (TNBC) was reported in 28.4% followed by the HER2 enriched tumours as the least common molecular subtype
Summary
The rising cancer burden among men and women has accounted to 18.1 million new cases and 9.6 million cancer related deaths in the year 2018 [1]. Among 8.6 million newly diagnosed cancers in women, BC accounted for 2.1 million (24.2%) and among 4.2 million cancer related deaths in women, BC caused 630,000 (15.0%) in 2018 [1]. Africa and Asia have higher proportions of cancer related mortality (7.3% and 57.3%) than incidence (5.8% and 48.4%) and is attributed by higher frequencies of cancers associated with poorer prognosis, with limited access to health care, and late-stage presentation in many countries in these regions [1]. In Tanzania, with respect to estimates from the Global Cancer Observatory (GLOBOCAN) in 2018, cancer incidence in women was 25,028 of which 3,037 (12.1%) attributed to BC while the cancer mortality in women was 16,501 with 1,303 (7.9%) deaths from BC [4]. A projected 82% increase in BC incidence by 2030 has been predicted in Tanzania [5] due to changes in reproductive factors, implementation of screening programmes for prevention and early detection and improvement in health facilities [6]
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