Triple negative breast cancer in a poor resource setting in North-Western Tanzania: a preliminary study of 52 patients

Abstract

BackgroundBreast cancer is the second leading cancer worldwide. In Tanzania, though it ranks as the second leading cancer in women after cervical cancer, hormonal receptor status is not carried out routinely in patients. Adjuvant hormonal therapy is given without prior knowledge of hormonal receptors status and patients can incur unnecessary costs and side effects. This study was performed to investigate the expression of hormonal receptors, epidermal growth factor receptors (HER-2) and proliferation index of the breast cancer by Ki-67 in a few selected patients with breast cancer at referral hospital in North-Western Tanzania. The study classified breast cancer subtypes based on hormonal receptors status and the expression of epidermal growth factor receptors.ResultsA total of 52 cases of breast cancer were investigated. Patients’ mean age at diagnosis was 49 years. The majority of the tumors was invasive ductal carcinoma 47 (90.4%) and 40 (76.9%) were of histological grade III. Thirty-eight (73.1%) of the patient had lymph node metastasis at the time of diagnosis and 36 (69.2%) were at clinical stage III. Only 3 (5.8%) patients were in clinical stage I. There was a tendency of a low level of expression of the receptors, whereby Estrogen Receptor (ER) positive tumors were 17 (32.7%), progesterone receptor (PR) positive tumors were 22 (42.3%), and HER-2 positive tumors were 12 (23.1%). Triple negative tumors constituted 20 (38.4%) of the patients. Most of the tumors (75%) showed high proliferation by Ki-67. Lymph node metastasis was more common in Triple Negative and HER enriched tumors.ConclusionThis study showed a tendency for a low level of expression of hormonal receptors. There was a significant proportion of Triple Negative breast cancers. Routine testing for hormonal receptors in breast cancer is recommended before the initiation of adjuvant hormonal therapy.

Hormonal Receptors, Human Epidermal Growth Factor Receptor-2 and Triple Negative Immunohistochemical Typing of Women Breast Cancer in Kampala, Uganda.

“…This is similar to the reports in most of the African countries that reported aggressive BC to be high among young patients [15,19]. For example, in Uganda, Kenya and Tanzania it was reported that, most patients with BC were aged 50 years or younger and most of them 67.4%, 41.1% and 76.9%, respectively had tumour grade 3 [11,13,15]. However, these ndings differ from results of studies conducted in developed countries.…”

“…Also Purdie et al reported that, ER-positive BC cases are more likely to be HER2-positive than PR-negative BC cases [29]. The expression of HER of 18.4% in the present study was similar to 18.5% which was reported in Brazil and lower than 40.7%, 24%, 23.1% and 22% that were reported in India, Ghana, Tanzania and Uganda [11,15,17,28]. Studies have shown that, expression of HER in both African American and African patients with BC is higher compared to Caucasians.…”

“…In Tanzania the expression of ER in patients with BC was also reported to vary across different studies at different periods. For example, Mwakigonja et al, Mbonde et al and Rambau et al reported 43%, 33% and 32.7%, respectively [10][11][12]. These ndings indicate how the prevalence of ER expression vary across different studies within the same setting.…”

“…In the study that was done in West Africa it was found that, hormonal receptors negative and triple negative breast cancer (TNBC) were representing the majority of cases [9]. Three studies done in Tanzania by Mbonde et al [10] reported 33% and 18% of ER and PR expression, respectively, Rambau et al [11] reported 32.7%, 42.3%, 23.1% and 38.4% for ER, PR, HER2 and TNBC, respectively and Mwakigonja et al [12] also reported 43.4%, 26.4%, 28%, 15.2% and 45.6% for ER, PR, HER2 and TNBC, respectively of the patients were expressing the markers and therefore, they were expected to bene t from hormonal therapy. In all the three studies, most of the patients were of young age and had advanced stage at the time of presentation.…”

Access to Breast Cancer Care in Jos, North Central

“…Hormonal therapy is another modality of breast cancer care. It is offered to patients with hormone receptor (ER and or PR) positive tumor [28,29]. There are various hormonal agents, and a single agent is usually given for a protracted period of about five years or more unless there is disease progression or relapse, and then they are switched to another [30,31].…”