title: Apoptosis in breast cancer: Nigerian vs. Finnish material.
abstract: OBJECTIVE
  To evaluate apoptotic activity in breast cancer from Nigerian (n = 300) and Finnish (n=285) women.
  
  
  METHODS
  Apoptotic bodies were expressed as square millimeters of neoplastic tissue (apoptotic index [AI]). The standardized mitotic index (SMI) and mitotic activity index (MAI) estimated proliferation.
  
  
  RESULTS
  The mean (+/- SD) AI was higher in Nigeria (9.6+/-14.8/mm2) than in Finland (5.2+/-6.1/ mm2). In both populations, AI values were higher in premenopausal than postmenopausal women, in lymph node positive than lymph node negative tumors and in larger than smaller tumors. However, the differences were not statistically significant. Increasing histologic grade was associated with increasing AI values (Nigeria, P =.012; Finland, P= .0001). AI in infiltrating ductal carcinomas were higher than in special types of breast cancer (Nigeria, P = .0700; Finland, P = .0168). As a continuous variable, AI was a significant prognosticator (Nigeria, P = .0125, Finland, P = .0466). Increasing AI appeared to be associated with tumor progression and dedifferentiation. The higher SMI/AI in Nigeria (9.2) than in Finland (4.5) reflects higher proliferative activity in the Nigerian material. In multivariate analysis of AI, SMI, MAI and tumor size, the proliferative indices (SMI and MAI) and tumor size only were significant independent prognosticators.
  
  
  CONCLUSIONS
  In Nigerian and Finnish material, AI has limited prognostic value as a tool in grading breast cancer. The higher mean SMI/AI in Nigerian cancer suggests a shift in the proliferation/cell death balance, which may be associated with a later phase of the cancer progression cascade.
authors.affiliation: Department of Pathology, University of Calabar Teaching Hospital, Nigeria. ofrikpatt@yahoo.com
authors.forename: Francis
authors.initials: F
authors.lastname: Ikpatt
authors.forename: Teijo
authors.initials: T
authors.lastname: Kuopio
authors.forename: Aras
authors.initials: A
authors.lastname: Erekul
authors.forename: Yrjö
authors.initials: Y
authors.lastname: Collan
mesh_terms: D000328:Adult; D017209:Apoptosis; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D018270:Carcinoma, Ductal, Breast / Q000401:mortality / Q000556:secondary* / Q000628:therapy; D002452:Cell Count; D003131:Combined Modality Therapy; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis / Q000473:pathology; D008593:Menopause; D008875:Middle Aged; D008940:Mitotic Index; D009367:Neoplasm Staging; D009549:Nigeria / Q000453:epidemiology; D011379:Prognosis; D015996:Survival Rate