title: High incidence of triple-negative tumors in sub-saharan Africa: a prospective study of breast cancer characteristics and risk factors in Malian women seen in a Bamako university hospital.
abstract: OBJECTIVE
  Few studies have been conducted on breast cancer in Sub-Saharan Africa and their results have been suspected to be impaired by artefacts. This prospective study was designed to determine tumor and patient characteristics in Mali with control of each methodological step. These data are necessary to define breast cancer treatment guidelines in this country.
  
  
  METHODS
  Clinical and tumor characteristics and known risk factors were obtained in a consecutive series of 114 patients. Each technical step for the determination of tumor characteristics [histology, TNM, grade, estrogen (ER) and progesterone receptors (PR), HER2, and Ki67] was controlled.
  
  
  RESULTS
  Patients had a mean age of 46 years. Most tumors were invasive ductal carcinomas (94%), T3-T4 (90%) with positive nodes (91%), grade III (78%), and ER (61%) and PR (72%) negative. HER2 was overexpressed in 18% of cases. The triple-negative subgroup represented 46%, displaying a particularly aggressive pattern (90% grade III; 88% Ki67 >20%).
  
  
  CONCLUSIONS
  This study demonstrates the high incidence of aggressive triple-negative tumors in Mali. Apart from a higher prevalence of premenopausal women, no significant difference in risk factors was observed between triple-negative tumors and other tumors. The hormonal therapy systematically prescribed therefore needs to be revised in light of this study.
authors.affiliation: Service d'Hématologie et d'Oncologie Médicale, Hôpital du Point G, Bamako, Mali. madanily@sante.gov.ml
authors.forename: Madani
authors.initials: M
authors.lastname: Ly
authors.forename: Martine
authors.initials: M
authors.lastname: Antoine
authors.forename: Abdoul Karim
authors.initials: AK
authors.lastname: Dembélé
authors.forename: Pierre
authors.initials: P
authors.lastname: Levy
authors.forename: Anita
authors.initials: A
authors.lastname: Rodenas
authors.forename: Boubacari Ali
authors.initials: BA
authors.lastname: Touré
authors.forename: Youssouf
authors.initials: Y
authors.lastname: Badiaga
authors.forename: Bakary Kossa
authors.initials: BK
authors.lastname: Dembélé
authors.forename: Djénèba Coulibaly
authors.initials: DC
authors.lastname: Bagayogo
authors.forename: Yacouba Lazare
authors.initials: YL
authors.lastname: Diallo
authors.forename: Abdramane A
authors.initials: AA
authors.lastname: Koné
authors.forename: Patrice
authors.initials: P
authors.lastname: Callard
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Bernaudin
authors.forename: Dapa Aly
authors.initials: DA
authors.lastname: Diallo
mesh_terms: D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D014408:Biomarkers, Tumor / Q000032:analysis*; D001706:Biopsy; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000737:chemistry* / Q000453:epidemiology* / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000737:chemistry / Q000453:epidemiology; D005260:Female; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007150:Immunohistochemistry; D017404:In Situ Hybridization, Fluorescence; D015994:Incidence; D019394:Ki-67 Antigen / Q000032:analysis; D008207:Lymphatic Metastasis; D008302:Mali / Q000453:epidemiology; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D017697:Premenopause; D011446:Prospective Studies; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000032:analysis*; D011960:Receptors, Estrogen / Q000032:analysis*; D011980:Receptors, Progesterone / Q000032:analysis*; D017584:Reproductive History; D012307:Risk Factors
chemical_list: D014408:Biomarkers, Tumor; D019394:Ki-67 Antigen; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; C508053:ERBB2 protein, human