Department of Pathology, Kilimanjaro Christian Medical University College, Moshi, Tanzania.
Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina, United States of America.
PLoS One. 2019 Nov 8;14(11):e0224760. doi: 10.1371/journal.pone.0224760. eCollection 2019.
Breast cancer is a major cause of morbidity and mortality for women in Sub-Saharan Africa and for black American women. There is evidence that the pathologic characteristics of breast cancers in both African women and black American women may differ from their counterparts of European ancestry. However, despite the great burden of disease, data on pathologic features of breast carcinoma in Sub-Saharan Africa is limited and often contradictory. This lack of information makes it difficult to prioritize resource use in efforts to improve breast cancer outcomes in the region.
We examined consecutive cases of breast cancer in Tanzanian women (n = 83), black American women (n = 120), and white American women (n = 120). Each case was assessed for tumor type, grade, mitotic count, ER and HER2 status, and tumor infiltrating lymphocyte involvement.
The Tanzanian subjects were younger and had higher stage tumors than the subjects in either American group. Breast cancers in the Tanzanian and black American groups were more likely to be high grade (p = 0.008), to have a high mitotic rate (p<0.0001), and to be ER-negative (p<0.001) than the tumors in the white American group. Higher levels of tumor infiltrating lymphocyte involvement were seen among Tanzanian and black American subjects compared to white American subjects (p = 0.0001). Among all subjects, tumor infiltrating lymphocyte levels were higher in tumors with a high mitotic rate. Among Tanzanian and black American subjects, tumor infiltrating lymphocyte levels were higher in ER-negative tumors. These findings have implications for treatment priorities for breast cancer in Tanzania and other Sub-Saharan African countries.
乳腺癌是撒哈拉以南非洲地区女性和非裔美国女性发病率和死亡率的主要原因。有证据表明，非洲女性和非裔美国女性的乳腺癌病理特征可能与欧洲裔女性不同。然而，尽管疾病负担巨大，但撒哈拉以南非洲地区乳腺癌病理特征的数据有限，且往往相互矛盾。这种信息的缺乏使得难以确定资源利用的优先顺序，从而改善该地区的乳腺癌治疗效果。
我们检查了坦桑尼亚女性（n = 83）、非裔美国女性（n = 120）和白种美国女性（n = 120）连续的乳腺癌病例。对每个病例进行肿瘤类型、分级、有丝分裂计数、ER 和 HER2 状态以及肿瘤浸润淋巴细胞浸润的评估。
坦桑尼亚组的受试者比任何一个美国组的受试者都更年轻，且肿瘤分期更高。坦桑尼亚组和非裔美国组的乳腺癌更有可能是高级别（p = 0.008）、具有高有丝分裂率（p<0.0001）和 ER 阴性（p<0.001），而非白种美国组的肿瘤。与白种美国组相比，坦桑尼亚组和非裔美国组的肿瘤浸润淋巴细胞浸润水平更高（p = 0.0001）。在所有受试者中，高有丝分裂率的肿瘤中浸润淋巴细胞水平更高。在坦桑尼亚组和非裔美国组中，ER 阴性肿瘤中浸润淋巴细胞水平更高。这些发现对坦桑尼亚和其他撒哈拉以南非洲国家的乳腺癌治疗重点具有重要意义。
