Triple-negative breast cancer - a retrospective audit of 151 cases seen at the Charlotte Maxeke Johannesburg Academic Hospital Breast Unit

Abstract

BACKGROUND: Triple-negative breast cancer (TNBC) is an aggressive, rapidly lethal subgroup of breast cancer which disproportionately affects women of African descent. Lacking hormone receptor expression and human epidermal growth factor receptor 2 (HER2) overexpression, it is difficult to treat. Despite an initial good response to chemotherapy, relapse is common and survival short. The aim of this study of treatment-naive women with TNBC was examination of clinicopathological characteristics and any association of these with patient demographics. METHODS: Demographic data was captured together with the clinical, pathological and histological features of the cancers. Statistical analysis was performed. RESULTS: Of the 960 patients entered in the database of the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) Breast Unit (BU) over a 3-year period, 151 (15.7%) had TNBC. All patients were female aged 25 to 98 years, and 60.3% were postmenopausal (mean age 64 years). The majority (80.2%) self-identified as black African. Most patients had clinical stage 3 disease, and 17.2% had distant metastases. One hundred women were HIV negative, 35 positive and 20 untested. Tumour biology revealed high-grade morphology in 70% of cases with a mean Ki-67 value of 60%. Forty patients died within 18 months of entry in the database. CONCLUSION: In this series, most patients with TNBC were older, postmenopausal women. This patient cohort may represent a non-basal subtype of TNBC but gene expression profiling was not available. Tumours were locally advanced, rapidly proliferative but not associated with HIV status. The short survival times emphasise the importance of neoadjuvant chemotherapy as soon as the diagnosis of TNBC is made.

Recent trends in hereditary breast cancer incidence by race and age in KwaZulu‐Natal, South Africa: An 11‐year single‐centre retrospective study (2011‐2021)

“…22,28,29 KwaZulu-Natal is the second most populated province with a population estimate of 10.3 million people (1/6 of SA) comprising 86.6% Blacks, 7.47% Indian, 4.2% White and 1.4% Coloureds. 25,30 As the name suggests, it is the "home of the Zulu," which is one of the tribes within the Black population. It encompasses a city named Durban, one of the most ethnically Indian-populated city outside India.…”

“…Even in SA, available data mainly comes from the Gauteng Province, while other provinces such as KZN remain understudied 22,28,29 . KwaZulu‐Natal is the second most populated province with a population estimate of ~10.3 million people (1/6 of SA) comprising 86.6% Blacks, 7.47% Indian, 4.2% White and 1.4% Coloureds 25,30 . As the name suggests, it is the “home of the Zulu,” which is one of the tribes within the Black population.…”

“…It encompasses a city named Durban, one of the most ethnically Indian‐populated city outside India 31 . Currently, BC is the second most common female cancer in KZN after cervical cancer., 30,32 although the clinical, demographic and genetic trends of KZN have not been well described. It is imperative to describe population trends at the micro level as evidence suggests its importance in the risk and prognosis of the disease 9,10,21,22,23 …”