Stalsberg Helge, Adjei Ernest Kwasi, Owusu-Afriyie Osei
Department of Clinical Pathology, University Hospital of North Norway, 9038, Tromsø, Norway,
Breast Cancer Res Treat. 2015 May;151(1):177-82. doi: 10.1007/s10549-015-3384-5. Epub 2015 Apr 17.
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.
乳腺癌是通过多个步骤逐渐发展的，其中一些步骤可被识别为良性或癌前组织学变化。挪威的年龄标准化乳腺癌发病率比加纳高两倍。如果发病率的差异主要是由癌症起始因素导致的，那么在一般人群中，良性和癌前乳腺变化的患病率也会有类似差异；但如果是由后期的促进和进展因素引起的，则不会出现这种情况。按照标准化方案，从44名15至60岁的加纳女性和26名挪威女性的尸检中获取乳腺组织。三位作者分别独立检查盲法标记的苏木精和伊红染色切片，并记录每片组织学变化的发生情况。研究发现，挪威和加纳女性在增殖性或非增殖性乳腺变化的患病率上没有显著差异。由于获得医疗服务的机会较少、患者意识较低以及缺乏乳腺癌人群筛查，加纳记录的乳腺癌发病率可能被低估。否则，这些结果支持以下结论：加纳乳腺癌发病率低于挪威主要是由于后期的促进和进展，而非起始因素。
