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.
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References
Lopez-Garcia MA, Geyer FC, Lacroix-Triki M, Marchió C, Reis-Filho JS (2010) Breast cancer precursors revisited: molecular features and progression pathways. Histopathology 57:171–192
Aulmann S, Braun L, Mietzsch F, Longerich T, Penzel R, Schirmacher P, Sinn HP (2012) Transitions between flat epithelial atypia and low-grade ductal carcinoma in situ of the breast. Am J Surg Pathol 36:1247–1252
Dupont WD, Page DL (1985) Risk factors for breast cancer in women with proliferative breast disease. N Engl J Med 312:146–151
Fitzgibbons PL, Henson DE, Hutter RV (1998) Benign breast changes and the risk for subsequent breast cancer: an update of the 1985 consensus statement. Cancer Committee of the College of American Pathologists. Arch Pathol Lab Med 122:1053–1055
Lakhani SR (1999) The transition from hyperplasia to invasive carcinoma of the breast. J Pathol 187:272–278
Dabbs DJ, Carter G, Fudge M, Peng Y, Swalsky P, Finkelstein S (2006) Molecular alterations in columnar cell lesions of the breast. Mod Pathol 19:344–349
Simpson PT, Gale T, Reis-Filho JS, Jones C, Parry S, Sloane JP, Hanby A, Pinder SE, Lee AH, Humphreys S, Ellis IO, Lakhani SR (2005) Columnar cell lesions of the breast: the missing link in breast cancer progression? A morphological and molecular analysis. Am J Surg Pathol 29:734–746
Page DL, Vander Zwaag R, Rogers LW, Williams LT, Walker WE, Hartmann WH (1978) Relation between component parts of fibrocystic disease complex and breast cancer. J Natl Cancer Inst 61:1055–1063
Carter CL, Corle DK, Micozzi MS, Schatzkin A, Taylor PR (1988) A prospective study of the development of breast cancer in 16,692 women with benign breast disease. Am J Epidemiol 128:467–477
Hutchinson WB, Thomas DB, Hamlin WB, Roth GJ, Peterson AV, Williams B (1980) Risk of breast cancer in women with benign breast disease. J Natl Cancer Inst 65:13–20
Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F (2013) GLOBOCAN 2012 v1.0, cancer incidence and mortality worldwide: IARC CancerBase No. 11. International Agency for Research on Cancer, Lyon
Bartow SA, Pathak DR, Black WC, Key CR, Teaf SR (1987) Prevalence of benign, atypical, and malignant breast lesions in populations at different risk for breast cancer. A forensic autopsy study. Cancer 60:2751–2760
Jensen HM, Rice JR, Wellings SR (1976) Preneoplastic lesions in the human breast. Science 191:295–297
Nielsen M, Thomsen JL, Primdahl S, Dyreborg U, Andersen JA (1987) Breast cancer and atypia among young and middle-aged women: a study of 110 medicolegal autopsies. Br J Cancer 56:814–819
Sarnelli R, Squartini F (1991) Fibrocystic condition and “at risk” lesions in asymptomatic breasts: a morphologic study of postmenopausal women. Clin Exp Obstet Gynecol 18:271–279
Goehring C, Morabia A (1997) Epidemiology of benign breast disease, with special attention to histologic types. Epidemiol Rev 19:310–327
Stalsberg H, Awuah B, Ibarra JA, Nsiah-Asare A (2008) Re-establishing a surgical pathology service in Kumasi, Ghana: case report and discussion of barriers and key elements of a successful collaboration between low- and high-resource countries. Cancer 113(8 Suppl):2338–2346
Olu-Eddo AN, Ugiagbe EE (2011) Benign breast lesions in an African population: a 25-year histopathological review of 1864 cases. Niger Med J 52:211–216
Ihekwaba FN (1994) Benign breast disease in Nigerian women: a study of 657 patients. J R Coll Surg Edinb 39:280–283
Schuerch C 3rd, Rosen PP, Hirota T, Itabashi M, Yamamoto H, Kinne DW, Beattie EJ Jr (1982) A pathologic study of benign breast diseases in Tokyo and New York. Cancer 50:1899–1903
Aaman TB, Stalsberg H, Thomas DB (1997) Extratumoral breast tissue in breast cancer patients: a multinational study of variations with age and country of residence in low- and high-risk countries. WHO collaborative study of neoplasia and steroid contraceptives. Int J Cancer 71:333–339
Ziegler RG, Hoover RN, Pike MC, Hildesheim A, Nomura AM, West DW, Wu-Williams AH, Kolonel LN, Horn-Ross PL, Rosenthal JF, Hyer MB (1993) Migration patterns and breast cancer risk in Asian-American women. J Natl Cancer Inst 85:1819–1827
Kliewer EV, Smith KR (1995) Breast cancer mortality among immigrants in Australia and Canada. J Natl Cancer Inst 87:1154–1161
Stoll BA (1999) Premalignant breast lesions: role for biological markers in predicting progression to cancer. Eur J Cancer 35:693–697
Ohene-Yeboah M, Adjei E (2012) Breast cancer in Kumasi, Ghana. Ghana Med J 46:8–13
Adjei EK, Owusu-Afriyie O, Awuah B, Stalsberg H (2014) Hormone receptors and Her2 expression in breast cancer in sub-Saharan Africa. A comparative study of biopsies from Ghana and Norway. Breast J 20:308–311
Adebamowo CA, Famooto A, Ogundiran TO, Aniagwu T, Nkwodimmah C, Akang EE (2008) Immunohistochemical and molecular subtypes of breast cancer in Nigeria. Breast Cancer Res Treat 110:183–188
Awadelkarim KD, Arizzi C, Elamin EO, Hamad HM, De Blasio P, Mekki SO, Osman I, Biunno I, Elwali NE, Mariani-Costantini R, Barberis MC (2008) Pathological, clinical and prognostic characteristics of breast cancer in Central Sudan versus Northern Italy: implications for breast cancer in Africa. Histopathology 52:445–456
Mbonde MP, Amir H, Akslen LA, Kitinya JN (2001) Expression of oestrogen and progesterone receptors, Ki-67, p53 and BCL-2 proteins, cathepsin D, urokinase plasminogen activator and urokinase plasminogen activator-receptors in carcinomas of the female breast in an African population. East Afr Med J 78:360–365
Anderson WF, Rosenberg PS, Prat A, Perou CM, Sherman ME (2014) How many etiological subtypes of breast cancer: two, three, four, or more? J Natl Cancer Inst. doi:10.1093/jnci/dju165
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The study was approved by the Committee on human research, publications and ethics, School of medical sciences, Kwame Nkrumah University of Science & Technology, Kumasi, and the Regional committee for medical and health-related research ethics of North Norway.
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None of the authors have any conflict of interest.
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The performance of the study complies with the current laws of Ghana and Norway.
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Stalsberg, H., Adjei, E.K. & Owusu-Afriyie, O. No difference in the prevalence of benign breast changes between women from Ghana and Norway: an autopsy study. Breast Cancer Res Treat 151, 177–182 (2015). https://doi.org/10.1007/s10549-015-3384-5
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DOI: https://doi.org/10.1007/s10549-015-3384-5