No difference in the prevalence of benign breast changes between women from Ghana and Norway: an autopsy study

Abstract

Breast carcinoma develops gradually through multiple steps, some of which are recognizable as benign or premalignant histological changes. The age-standardized breast-cancer incidence rate is three times higher in Norway than in Ghana. A similar difference in the prevalence of benign and premalignant breast changes in the general populations would be expected if the difference in incidence rates were mainly due to cancer initiation factors, but not if it were caused by later stage promotion and progression factors. Breast tissue was taken by a standardized protocol from the autopsies of 44 Ghanaian and 26 Norwegian women between 15 and 60 years of age. Blind-labelled hematoxylin and eosin stained sections were examined independently by each of the three authors and the occurrence of histological changes in each section was recorded. The study revealed no significant difference between Norwegian and Ghanaian women in the prevalence of either proliferative or non-proliferative breast changes. The recorded incidence of breast cancer in Ghana may be under-estimated because of lower access to health services, lower patient awareness, and absence of population screening for breast cancer. Otherwise, the results support the conclusion that the lower incidence of breast cancer in Ghana than in Norway is mainly due to late-stage promotion and progression rather than initiation factors.

Prevalence of incidental breast cancer and precursor lesions in autopsy studies: a systematic review and meta-analysis

“…Several of the remaining 16 studies used overlapping data: for each set of potentially overlapping reports, we chose the one that reported on the largest number of women, in the most detail (usually the most recent report), which resulted in 10 studies included from the original search. A further 10 potential papers were identified from the references and forward citation searches of the 10 included papers; of these 3 studies were included, with one [ 25 ] contributing two datasets (studies performed in two different countries). A total of 13 studies [ 25 – 37 ], contributing 14 datasets were included in the study level analysis, Table 1 .…”

“…A further 10 potential papers were identified from the references and forward citation searches of the 10 included papers; of these 3 studies were included, with one [ 25 ] contributing two datasets (studies performed in two different countries). A total of 13 studies [ 25 – 37 ], contributing 14 datasets were included in the study level analysis, Table 1 . There were 2363 women and 99 cases.…”

“…2 a : Cancer or precursor lesion 2 b : Invasive cancer 2 c : In-situ cancer 2 d : Atypical Hyperplasia. Data points are proportional to total number of women in each study and are numbered according to year of study as follows: 1: Kiaer [ 26 ], 2: Ryan [ 27 ]; 3: Sarnelli [ 28 ]; 4: Kramer [ 29 ]; 5: Nielsen 1984 [ 30 ]; 6: Bartow [ 31 ]; 7: Nielsen 1987 [ 32 ]; 8: Alpers [ 33 ]; 9: Pisano [ 34 ]; 10: Bhathal [ 35 ]; 11: Giarelli [ 36 ]; 12: Inai [ 37 ]; 13: Stalsberg (Ghana) [ 25 ]; 14: Stalsberg (Norway) [ 25 ] …”

“…There was weak evidence for higher prevalence of in-situ cancer in studies that used consecutive cases ( p = 0.06), and of all categories combined for more recent studies ( p = 0.09), but this disappeared after adjusting for thoroughness of pathology examination ( p = 0.11 and p = 0.37 respectively). There was a higher prevalence of invasive cancer , (but not in-situ cancer or atypical hyperplasia ), for the study (contributing two datasets) [ 25 ] reporting breast cancer discovered at autopsy which may have contributed to the women’s deaths. None of the other available validity characteristics were statistically significant.…”

Prevalence of silent breast cancer in autopsy specimens, as studied by the disease being held by image‑guided biopsies: The pilot study and literature review

“…In the present study, a thorough MEDLINE database search (from 1953 to the present day) was performed using the medical subject heading (MeSH) terms of ‘breast’ AND ‘autopsy/ies’, where, after the exclusion of case reports, hospital autopsies, breast benign disease and series over autopsies in patients with breast cancer, five publications ( 2 – 6 ) were identified, one of them being a meta-analysis ( 4 ) of the papers published between 1966–1997.…”