No difference in the prevalence of benign breast changes between women from Ghana and Norway: an autopsy study
- 97 Downloads
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.
KeywordsBenign breast disease Prevalence Ghana Norway Autopsy Comparative study
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.
Conflict of interest
None of the authors have any conflict of interest.
The performance of the study complies with the current laws of Ghana and Norway.
- 7.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 29:734–746CrossRefPubMedGoogle Scholar
- 11.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, LyonGoogle Scholar
- 17.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):2338–2346CrossRefPubMedGoogle Scholar
- 21.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 71:333–339CrossRefPubMedGoogle Scholar
- 28.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 52:445–456CrossRefPubMedGoogle Scholar
- 29.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 78:360–365CrossRefPubMedGoogle Scholar