High Incidence of Triple-Negative Tumors in Sub-Saharan Africa: A Prospective Study of Breast Cancer Characteristics and Risk Factors in Malian Women Seen in a Bamako University Hospital

Abstract

Objective: Few studies have been conducted on breast cancer in Sub-Saharan Africa and their results have been suspected to be impaired by artefacts. This prospective study was designed to determine tumor and patient characteristics in Mali with control of each methodological step. These data are necessary to define breast cancer treatment guidelines in this country. Methods: Clinical and tumor characteristics and known risk factors were obtained in a consecutive series of 114 patients. Each technical step for the determination of tumor characteristics [histology, TNM, grade, estrogen (ER) and progesterone receptors (PR), HER2, and Ki67] was controlled. Results: Patients had a mean age of 46 years. Most tumors were invasive ductal carcinomas (94%), T3-T4 (90%) with positive nodes (91%), grade III (78%), and ER (61%) and PR (72%) negative. HER2 was overexpressed in 18% of cases. The triple-negative subgroup represented 46%, displaying a particularly aggressive pattern (90% grade III; 88% Ki67 >20%). Conclusion: This study demonstrates the high incidence of aggressive triple-negative tumors in Mali. Apart from a higher prevalence of premenopausal women, no significant difference in risk factors was observed between triple-negative tumors and other tumors. The hormonal therapy systematically prescribed therefore needs to be revised in light of this study.

Receptor-Defined Subtypes of Breast Cancer in Indigenous Populations in Africa: A Systematic Review and Meta-Analysis

“…The most common method for assessing receptor status was monoclonal assays (i.e., the quantitative enzyme immunoassay and, more often, the semi-quantitative IHC approach), but ER status was ascertained by ligand binding assays (e.g., dextran-coated charcoal [DCC] method) in some earlier studies (Tables 1 and 2) [51],[89]–[91]. FISH, CISH, or SISH to ascertain the HER2 status of specimens with an equivocal IHC score of 2+ was only performed in a few studies (Tables 1 and 2) [34],[42],[48],[55],[65],[69],[76],[78],[82],[84],[87].…”

Pathologically confirmed breast cancer in Malawi: a descriptive study: Clinical profile of breast cancer

“…In particular, the absence of HR status testing in most African settings is a major deficiency in care that requires correction, not only in Malawi but throughout the region. HR positivity varies widely across Africa, 4,12,13 and routine testing would ensure that women with HR-negative cancers are spared ineffective hormonal therapy. It would also identify many women who would benefit from tamoxifen, which is relatively inexpensive, well-tolerated, and available in Malawi.…”

Why Do Women with Breast Cancer Get Diagnosed and Treated Late in Sub-Saharan Africa Perspectives from Women and Patients in Bamako, Mali

“…Conclusion: Multilevel interventions are needed to ensure access, availability, and affordability of a minimum standard of care for breast cancer patients in sub-Saharan Africa. [13,14]. To understand major barriers to early diagnosis and treatment, we used the model of pathway to treatment [15] recommended by the Aarhus statement [16] which is intended to improve the design and reporting of studies on delayed diagnosis.…”