title: Is breast cancer from Sub Saharan Africa truly receptor poor? Prevalence of ER/PR/HER2 in breast cancer from Kenya.
abstract: OBJECTIVE
  Studies on ER/PR/HER2 in breast cancer from Sub Saharan Africa (SSA) are fraught with inconsistencies in the prevalence of hormone receptor status. In Kenya, ER/PR/HER2 for breast cancers is not part of routine assessment and available in only three to four centers across the country. Variability in methodology and interpretation makes comparison between data difficult. Our aim was to accurately determine the prevalence of ER/PR/HER2 using standardized techniques and double reporting. Prognostic tumor parameters were also correlated with clinical features and receptor status.
  
  
  METHODS
  Consecutive invasive breast cancers (IBC) accrued between September 2011 and December 2012 were analyzed at Aga Khan University Hospital, Nairobi (AKUHN). Tumor blocks were stained for ER/PR/HER2 on an automated platform. Double reporting of ER/PR/HER2 was done using the Allred system and the ASCO/CAP guidelines respectively.
  
  
  RESULTS
  A total of 301 cases of IBC were analyzed for pathology and ER/PR/HER2. The age range of patients was 19-94 years with a median of 47.5 years. Invasive ductal carcinoma (NOS) was the most common histologic type (84.2%). ER positivity was seen in 72.8%, PR in 64.8% and HER2 in 17.6% of all cases. Triple negative breast cancers (TNBC) constituted 20.2% of the cases. There was a significant association between receptor status and histologic grade (p < 0.001) and statistically significant trend of increasing pathological stage of tumor (pT) associated with TNBC (p = 0.020).
  
  
  CONCLUSIONS
  We present a definitive prospective analysis of ER/PR/HER2 from a single center and demonstrate that prevalence of receptor status from SSA is comparable with that in the West.
authors.affiliation: Department of Pathology, Aga Khan University Hospital, P.O. Box 30270-00100 GPO, Nairobi, Kenya. Electronic address: shaheen.sayed@aku.edu.
authors.forename: Shahin
authors.initials: S
authors.lastname: Sayed
authors.affiliation: Department of Pathology, Aga Khan University Hospital, P.O. Box 30270-00100 GPO, Nairobi, Kenya. Electronic address: Zahir.moloo@aku.edu.
authors.forename: Zahir
authors.initials: Z
authors.lastname: Moloo
authors.affiliation: Department of Surgery, Aga Khan University Hospital, P.O. Box 30270-00100 GPO, Nairobi, Kenya. Electronic address: Ronald.wasike@aku.edu.
authors.forename: Ronald
authors.initials: R
authors.lastname: Wasike
authors.affiliation: Department of Surgery, African Inland Church, Kijabe Mission Hospital, P.O. Box 20, KIjabe 00220, Kenya. Electronic address: petersuebird@gmail.com.
authors.forename: Peter
authors.initials: P
authors.lastname: Bird
authors.affiliation: Department of Surgery, St. Mary's Mission Hospital, P.O. Box 3409, Nairobi, Kenya. Electronic address: oigara@yahoo.com.
authors.forename: Raymond
authors.initials: R
authors.lastname: Oigara
authors.affiliation: Division of Anatomical Pathology, Faculty of Health Sciences, University of Cape Town and National Health Laboratory Service - Groote Schuur Hospital, Falmouth Building, Medical School Anzio Road, Observatory, South Africa. Electronic address: Dhiren.govender@uct.ac.za.
authors.forename: Dhirendra
authors.initials: D
authors.lastname: Govender
authors.affiliation: Department of Pathology, Aga Khan University Hospital, P.O. Box 30270-00100 GPO, Nairobi, Kenya. Electronic address: Joshua.chege@aku.edu.
authors.forename: Joshua
authors.initials: J
authors.lastname: Kibera
authors.affiliation: Department of Public Health and Family Medicine, Faculty of Health Sciences, Medical School, University of Cape Town, Anzio Road, Observatory, South Africa. Electronic address: Henri.carrara@gmail.com.
authors.forename: Henri
authors.initials: H
authors.lastname: Carrara
authors.affiliation: University of Alabama at Birmingham Comprehensive Cancer Center, 703 South 19th Street, Birmingham, 3529 AL, USA. Electronic address: mns@uab.edu.
authors.forename: Mansoor
authors.initials: M
authors.lastname: Saleh
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000453:epidemiology / Q000378:metabolism* / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000453:epidemiology / Q000378:metabolism* / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000453:epidemiology / Q000378:metabolism* / Q000473:pathology; D018275:Carcinoma, Lobular / Q000453:epidemiology / Q000378:metabolism* / Q000473:pathology; D005260:Female; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D015995:Prevalence; D011446:Prospective Studies; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism*; D011960:Receptors, Estrogen / Q000378:metabolism*; D011980:Receptors, Progesterone / Q000378:metabolism*; D064726:Triple Negative Breast Neoplasms / Q000453:epidemiology / Q000378:metabolism / Q000473:pathology
chemical_list: D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone
keywords: Breast cancer; Hormone receptors; Sub Saharan Africa