Breast Cancer In African Women Research Articles

Oncoplastic Breast-Conserving Surgery in African Women: A Systematic Review.

Breast cancer is the most frequently diagnosed cancer in women worldwide. Surgery is a major treatment modality for breast cancer, and over the years, breast-conserving surgeries with breast radiation have shown similar outcomes with mastectomy. Not much is known about the frequency and outcome of breast-conserving surgery in Africa. This systematic review provides a comprehensive summary of the evidence evaluating cosmetic and oncologic outcomes after oncoplastic breast-conserving surgery (OBCS) for breast cancer in African women. This review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Databases were systematically searched for studies on African women undergoing OBCS. The oncologic and cosmetic outcomes, as well as the localization and reconstruction techniques, were evaluated. Descriptive statistics were used to summarize the frequency and proportions of the extracted variables. The literature search yielded 266 articles but only 26 of these were included in the review. Majority of the studies were from Egypt and South Africa. These studies collectively evaluated 1,896 patients with a mean age of 48.2 years and a mean follow-up period of 36.9 months. The most common histopathology was T2 (71.4%) invasive ductal carcinoma. Hook wire localization was the most common technique used for nonpalpable lesions in 85.3% of patients. Of the studies reporting oncoplastic technique, the latissimus dorsi volume replacement technique was the most reported (15%). Most patients were satisfied with their cosmetic outcome. Seroma was the most common postoperative complication (44.6%). Among studies that reported oncologic outcome data, the crude overall survival and disease-free survival were 93.1% and 89.4%, respectively. This systematic review revealed that the outcome of OBCS in African women compares with that in developed countries.

A Review of the Nucleic Acid-Based Lateral Flow Assay for Detection of Breast Cancer from Circulating Biomarkers at a Point-of-Care in Low Income Countries.

The current levels of breast cancer in African women have contributed to the high mortality rates among them. In South Africa, the incidence of breast cancer is also on the rise due to changes in behavioural and biological risk factors. Such low survival rates can be attributed to the late diagnosis of the disease due to a lack of access and the high costs of the current diagnostic tools. Breast cancer is asymptomatic at early stages, which is the best time to detect it and intervene to prevent high mortality rates. Proper risk assessment, campaigns, and access to adequate healthcare need to be prioritised among patients at an early stage. Early detection of breast cancer can significantly improve the survival rate of breast cancer patients, since therapeutic strategies are more effective at this stage. Early detection of breast cancer can be achieved by developing devices that are simple, sensitive, low-cost, and employed at point-of-care (POC), especially in low-income countries (LICs). Nucleic-acid-based lateral flow assays (NABLFAs) that combine molecular detection with the immunochemical visualisation principles, have recently emerged as tools for disease diagnosis, even for low biomarker concentrations. Detection of circulating genetic biomarkers in non-invasively collected biological fluids with NABLFAs presents an appealing and suitable method for POC testing in resource-limited regions and/or LICs. Diagnosis of breast cancer at an early stage will improve the survival rates of the patients. This review covers the analysis of the current state of NABLFA technologies used in developing countries to reduce the scourge of breast cancer.

Breast cancer risk prediction in African women using Random Forest Classifier

IntroductionOne of the most important steps in combating breast cancer is early and accurate diagnosis. Unfortunately, breast cancer is asymptomatic at the early stage, although some symptoms are presented at a later time, but at symptomatic stage treatment could be complicated or even become impossible thereby leading to death. Proper risk assessment is hence very important in reducing mortality. Some computational techniques have been developed for breast cancer risk assessment in the developed world, but such techniques do not work well in Africa because of the difference in risk profiles of African women e.g. later menarche, low drug abuse and low smoking rate. AimIn this work, we propose a bespoke risk prediction model for African women using Random Forest Classifier (RFC) machine learning technique. MethodsA total of 180 subjects were studied out of which 90 were confirmed cases of breast cancer and 90 were benign. Twenty-five risk factors were included, for example, smoking, alcohol intake, occupational hazards and age at menopause. Four approaches were empirically used in the feature selection, these are the use of Chi-Square, mutual information gain, Spearman correlation and the entire features. RFC algorithm was used to develop the prediction model. ResultsWe found that family history of breast cancer, dense breast, deliberate abortion, age at first child, fruit intake and regular exercise are predictors of breast cancer. The RFC model gave an accuracy of 91.67%, sensitivity of 87.10%, specificity of 96.55% and Area under curve (AUC) of 92% when all the risk factors were included in the model while an accuracy of 96.67%, sensitivity of 93.75%, specificity of 100% and AUC of 97% were obtained when correlation-selected features were included in the model. The Chi-Square selected features gave the best performance with 98.33% accuracy, 100% sensitivity, 96.55 specificity and 98% AUC. Mutual information gain selected feature gave the same results as Chi-Square selected features. ConclusionRandom Forest Classifier has a good potential at predicting the risk of breast cancer in African women. The study helped to identify the risk factors of breast cancer in African women. This is a valuable information which can help African women to pay attention to those risk factors with the intention of reducing the incidence of breast cancer in Africa.

Random Forest Classifier for Diagnosis of Breast Cancer in African Women

Introduction: Breast cancer is the highest cause of cancer-related mortality among women globally. It is documented that 15% of all female cancer is breast cancer. Diagnosis and treatment of breast cancer in its earliest stage remains the only way to improve its outcome and reduce mortality, thus early and accurate diagnosis of breast cancer is important. Early detection of breast cancer among women in Sub-Saharan Africa (SSA) is very challenging to say the least as factors such as low knowledge of breast cancer, lack of awareness of early detection treatment, treatment cost, poor perception of breast cancer, socio-cultural factors such as belief, traditions and fears affect health seeking behaviour of African women but there is limited research efforts in computational approach to diagnosis of breast cancer in SSA. Aim: Here, we propose a novel diagnosis model for African women using Random Forest (RF) machine learning technique. Methods: Study data comprised of technical indicators for breast cancer diagnosis, collected from breast cancer patients attending oncology clinic in Lagos State University teaching hospital. A total of 180 subjects were studied out of which 90 were confirmed cases of breast cancer and 90 were benign. Nine diagnostic parameters were included. These are clump thickness, marginal adhesion, uniformity of cell size, uniformity of cell shape, single epithelial cell, bare nuclei, bland chromatin, normal nucleoli and mitosis. Principal Component Analysis (PCA) was used for feature selection and RF model was used for classification. Results: The RF model gave an accuracy of 98.23%, sensitivity of 95.24%, and specificity of 100.00% and Area under curve (AUC) of 98%. Conclusion: The proposed Random Forest model has a good potential at classifying breast cancer in African women. Adoption of computational diagnosis approach in SSA can lead to early diagnosis and reduction of mortality rate.

Distribution of Breast Cancer Subtypes Among Nigerian Women and Correlation to the Risk Factors and Clinicopathological Characteristics.

BackgroundBreast cancer in African women differs from the Caucasian. Understanding the profile of Nigerian women with breast cancer will help with preventive measures and treatment. This study focused on the clinico-pathological characteristics, with risk factors of breast cancer patients in Nigeria.MethodsNewly diagnosed female patients with breast cancer were assessed over 12 months. Patients were reviewed using a predesigned proforma which focused on socio-demographic information, clinical information, risk factors and tumor biology.ResultsA total of 251 women were identified; their mean age was 46 years. More than half (62.5%) are premenopausal at presentation, 37.8% with Eastern Cooperative Oncology Group (ECOG) score of 0 and right side (50.2%) as the most common primary site of disease. Less than half of them (43.0%) are estrogen receptor (ER) positive, 27.9% are progesterone receptor (PR) positive, 43.8% and 47.4% are hormone receptor positive and triple negative, respectively. Most patients presented at the latter stage of the disease, stage III (66.9%) and stage IV (18.3%). Only 15.9% are well differentiated and almost all (92.8%) had invasive ductal histological type. Obesity (66.2%) and physical inactivity (41.9%) are the most common risk factors for the disease. A significant relationship was found between immunohistochemistry status and family history of breast cancer, tumor site, previous breast surgery, previous lump and alcohol intake.ConclusionFindings from this study showed that Nigerian breast cancer patients differ from their counterparts in the high human development index (H-HDI) countries in terms of the patients and disease characteristics. In view of this, prevention and treatment options should consider this uniqueness to ensure better outcome.

Mammogram history in Nigerian women: Age-related risk factors for breast cancer and educational implications

Background: Breast cancer accounts for 25% of diagnosed cancers and 20% of cancer-related mortality in women from sub-Saharan Africa. Given the early onset of breast cancer in African women, there is a need to better understand how age-related risk factors contribute to mammography uptake in this population.Aim: To identify age-related risk factors for breast cancer associated with previous uptake of mammograms in asymptomatic Nigerian women and consider implications for health education campaigns.Method: Participants comprised 544 asymptomatic Nigerian women (aged 28–75 years) responding to breast cancer public awareness campaigns, by presenting for baseline or screening mammography at a local hospital. Information about mammography history and age-related risk factors (menarche, menopausal and chronological age) were obtained by interviewing the participants face-to-face, before proceeding with mammography. Hierarchical logistic regression was used to estimate the odds of previous mammograms based on the age-related risk factors.Results: The likelihood of previous mammography screening increased by a factor of 1.07 (95% confidence interval [CI]: 1.00–1.14) for every year older chronologically and decreased by a factor of 1.12 (95% CI: 1.24–1.01) for every year older at menarche. Age at menarche partly mediated the relationship between chronological age and mammography history (effect = –0.01, 95% CI: –0.01, –0.00). Women with a history of breast cancer were 6.11 times more likely to have previously undertaken mammography screening (95% CI: 2.49–14.97). Age at menopause and age at first confinement were unrelated to mammography history.Conclusions: Nigerian women may recognise the need for mammograms because of adverse age-related risk factors for breast cancer, notably menarche and chronological age. However, awareness of menopausal age as a risk factor and basis for mammography screening may be deficient. It is therefore recommended that public awareness campaigns should emphasise the importance of older menopausal age in breast cancer risk and as a basis for requesting mammograms.

Clinical and Molecular Significance of Poly (ADP-Ribose) Polymerase-1 (PARP-1) in Breast Cancer of African Women and its Potential as a Targeted Therapy

Background: The therapeutic effects of Poly (ADP-ribose) polymerase-1 (PARP -1) inhibition are currently studied in a clinical trial that is recruiting African- American (A-A) women with breast cancer (BC). Although, A-A and West African women are likely to share the same ancestry, there are overwhelming evidences, that BC is undoubtedly heterogeneous which might influence results obtained in these Nationalities. Thus, this study aims to investigate PARP-1 expression in a large and annotated series of breast cancer from Nigerian women to determine its clinical and biological significance for the indigenous African women. Methods: PARP-1 protein expression was assessed immunohistochemically in 204 formalin fixed paraffin samples from Nigerian breast cancer women prepared as TMA. Results: PARP-1 was inversely associated with steroid hormone receptors (oestrogen (ER) and progesterone (PR) receptor), the Homologous Recombination marker BRCA1 associated ring domain 1 (BARD1) and p27. Conversely, a positive association was established between PARP-1 and high histologic grade, expression of basal markers (cytokeratins (CK) 5/6 and 14) and epidermal growth factor receptor (EGFR)), DNA damage-repair markers (protein inhibitor of activator signal transducer gamma (PIAS)), the BRCA1 inhibitor (metastasis tumour antigen-1 (MTA1), p53, the proliferation markers (KI-67, Phosphoinositide-3-kinases (PI3KCA)), the triple-negative and basal-like phenotypes. Outcome analysis indicated PARP-1 as a predictor of poor survival independent of tumour size, histological grade and lymph node involvement. Conclusion: These results provide evidence that PARP-1 plays an important role in Nigerian women with breast cancer. It is recommended that indigenous Black women from Africa are included in the ongoing clinical trial of PARP1 inhibitors that is aimed at determining the efficiency of the drug in black BC women outside United States.

Biology of breast cancer in Nigerian women: a pilot study.

Compared to the developed world, there are relatively few studies that describe the tumor biology of breast cancer in African women. While little is known about the tumor biology, clinical and epidemiologic studies suggest that breast cancer in African women are characterized by presentation at late stage and poor clinical outcomes. Analysis of the biological features of breast cancers in Nigerian women was designed to bring additional insight to better understand the spectrum of disease, the phenotypes that present, and the types of interventions that might improve outcomes. We performed histological analyses for hormone receptors (estrogen and progesterone receptors), HER2, and tumor infiltrating macrophages (TAM) on 17 breast cancers, obtained from Abia State University Teaching Hospital (Aba, Nigeria), between November 2008 and October 2009. On a subset of these cases, we investigated the potential role of a virus in the etiology of these aggressive cancers. The majority of cases in this cohort were characterized as high grade (100% were grade III), triple-negative (65%), and occur in young women (mean age 47 years). We observed high infiltration of TAMs in these tumors, but no evidence of a viral etiology. Our findings indicate that breast cancers in Nigerian women have a highly aggressive phenotype (high grade, hormone receptor negative), which is similar to other studies from Africa and other developing nations, as well as from African American women, but is significantly different from Caucasian women in the developed world. The presence of high numbers of TAMs in these tumors raises the possibility of targeting the immune microenvironment for therapeutic interventions.

P3-04-01: Molecular Characterization of African Breast Cancer; Results from a Large Tissue Microarray Study.

Abstract Introduction: Breast cancer in African women has been understudied for decades. Evidence derived mainly from studies on African-American women, supports that tumours of black women are biologically different and more aggressive than those occurring in the white population. Of the 4 main taxonomic groups of breast cancer, basal tumours are more represented in those women. In the present state of knowledge, very little is known about the biology and molecular profile of breast cancer in Africa. The aim of this study was to test the hypothesis that the molecular profile of African breast cancer is distinct from its Western counterpart. This was achieved by collecting a large cohort of breast carcinomas from an indigenous African population for phenotypical characterization and testing for expression of potential predictive and prognostic markers. Methods: Breast tumours were collected via collaboration with five centres in Nigeria (the most populous country in Africa) and assembled into tissue microarrays (TMAs). All tumours were reviewed by a specialist breast pathologist following the Royal College of Pathologists (RCPath) guidelines to confirm diagnosis, type, grade and nodal status. Patients age, tumour size and clinical data, where available, were collected from the original pathology reports and case notes. Representative tumour areas were selected and marked for TMA construction. TMA sections were stained for a range of markers including hormone receptors (ERα, ERβ, PR, AR), cyclin D, HER2, Ki67, bcl2, basal (CK5/6, CK14) and luminal cytokeratins (CK18, 19). Results: A total of 830 tumours were assembled into TMAs. The mean age at diagnosis was 47.69yrs with 58% of patients presenting under the age of 50. Only 8.5% of tumours were of grade 1. Most tumours (87%) were of ductal no special type, followed by lobular and metaplastic carcinomas. The majority of the tumours were ERα, PR and HER2 negative (77%, 80% and 81% respectively). The triple negative tumours were the predominant phenotype (55.6%). Luminal A type tumours comprised 24.3% followed by the HER2 positive (13.9%) and luminal B tumours (6.2%). The differences of all those parameters were statistically highly significant (p<0.001). Most tumours expressed ERß including 75% of those that were ERα/PR negative. A large proportion of the tumours (22%) were of the basal phenotype of which two thirds were also triple negative. Over half of the triple negative tumours were also node positive. Hierarchal cluster analysis showed the basal tumours dendrogram to comprise two groups; one showing clustering of ***ERα/PR/HER2 and the second showing clustering of ERß with CK5 and CK14. Conclusion: To our knowledge, this is largest and most comprehensive study of African breast cancer to date. Our data confirms the hypothesis that African breast cancer is biologically distinct and shows remarkable differences in histological type, grade, hormone receptors & HER2 status when compared with breast cancer in white women. The early age at presentation, predominance of high grade and triple negative, but not necessarily basal phenotype, may explain the poor prognosis and requires tailoring treatment strategies to target this unique profile. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-04-01.

Prevention of breast Cancer in African women

Prevention of breast Cancer in African women

Breast Cancer in African women: the magnitude of the problem

Breast Cancer in African women: the magnitude of the problem

Ethnic variation in the HER-2 codon 655 genetic polymorphism previously associated with breast cancer.

HER-2, a protooncogene located on chromosome 17q21, encodes a transmembrane glycoprotein (p185) with tyrosine kinase activity. Alterations of the HER-2 gene have been implicated in the carcinogenesis and prognosis of breast cancer and other solid tumors. It is also a cancer-therapeutic target for antibody-based therapy against the HER-2 protein. A single-nucleotide polymorphism (SNP) at codon 655, resulting in a G-to-A transition (Ile655Val) in the transmembrane domain-coding region of this gene has been associated with an increased risk of breast cancer, particularly among younger women. To understand the importance of this finding throughout the world, we evaluated this polymorphism in Ghanaian, Kenyan, Sudanese, Caucasian, African-American, Saudi, and Filipino subjects using a polymerase chain reaction-restriction fragment length polymorphism assay. The frequency of the Val allele, which is associated with increased breast cancer risk, was highly variable between populations (0%-24%). Continental African populations had a lower frequency of the Val allele than did Saudi, Chinese, Filipino, Caucasian, and African-American subjects. The data suggest that this SNP has variable frequency in different ethnic groups. The findings in this study correspond with the lower incidence and lower risk of breast cancer in African women compared with Caucasian and African-American women.