title: Breast cancer receptor status and stage at diagnosis in over 1,200 consecutive public hospital patients in Soweto, South Africa: a case series.
abstract: BACKGROUND
  Estimates of the proportion of estrogen receptor negative (ERN) and triple-negative (TRN) breast cancer from sub-Saharan Africa are variable and include high values. Large studies of receptor status conducted on non-archival tissue are lacking from this region.
  
  
  METHODS
  We identified 1218 consecutive women (91% black) diagnosed with invasive breast cancer from 2006–2012 at a public hospital in Soweto, South Africa. Immunohistochemistry based ER, progesterone receptor (PR) and human epidermal factor 2 (HER2) receptors were assessed at diagnosis on pre-treatment biopsy specimens. Mutually adjusted associations of receptor status with stage, age, and race were examined using risk ratios (RRs). ER status was compared with age-stratified US Surveillance Epidemiology and End Results program (SEER) data.
  
  
  RESULTS
  35% (95% confidence interval (CI): 32-38) of tumors were ERN, 47% (45-52) PRN, 26% (23-29) HER2P and 21% (18-23) TRN. Later stage tumors were more likely to be ERN and PRN (RRs 1.9 (1.1-2.9) and 2.0 (1.3-3.1) for stage III vs. I) but were not strongly associated with HER2 status. Age was not strongly associated with ER or PR status, but older women were less likely to have HER2P tumors (RR, 0.95 (0.92-0.99) per 5 years). During the study, stage III + IV tumors decreased from 66% to 46%. In black women the percentage of ERN (37% (34-40)) and PRN tumors (48% (45-52)) was higher than in non-black patients (22% (14-31) and 34% (25-44), respectively, P = 0.004 and P = 0.02), which remained after age and stage adjustment. Age-specific ERN proportions in black South African women were similar to those of US black women, especially for women diagnosed over age 50.
  
  
  CONCLUSIONS
  Although a greater proportion of black than non-black South African women had ER-negative or TRN breast cancer, in all racial groups in this study breast cancer was predominantly ER-positive and was being diagnosed at earlier stages over time. These observations provide initial indications that late-stage aggressive breast cancers may not be an inherent feature of the breast cancer burden across Africa.
authors.forename: Valerie A
authors.initials: VA
authors.lastname: McCormack
authors.forename: Maureen
authors.initials: M
authors.lastname: Joffe
authors.forename: Eunice
authors.initials: E
authors.lastname: van den Berg
authors.forename: Nadine
authors.initials: N
authors.lastname: Broeze
authors.forename: Isabel dos Santos
authors.initials: Idos S
authors.lastname: Silva
authors.forename: Isabelle
authors.initials: I
authors.lastname: Romieu
authors.forename: Judith S
authors.initials: JS
authors.lastname: Jacobson
authors.forename: Alfred I
authors.initials: AI
authors.lastname: Neugut
authors.forename: Joachim
authors.initials: J
authors.lastname: Schüz
authors.forename: Herbert
authors.initials: H
authors.lastname: Cubasch
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000378:metabolism* / Q000473:pathology*; D018567:Breast Neoplasms, Male / Q000175:diagnosis / Q000453:epidemiology / Q000378:metabolism / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D044382:Population Groups; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism*; D011960:Receptors, Estrogen / Q000378:metabolism*; D011980:Receptors, Progesterone / Q000378:metabolism*; D018426:SEER Program; D013019:South Africa / Q000453:epidemiology; D013997:Time Factors; D064726:Triple Negative Breast Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000378:metabolism / Q000473:pathology; D055815:Young Adult
chemical_list: D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone
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