title: Design considerations for identifying breast cancer risk factors in a population-based study in Africa.
abstract: Although breast cancer is becoming more prevalent in Africa, few epidemiologic studies have been undertaken and appropriate methodologic approaches remain uncertain. We therefore conducted a population-based case-control study in Accra and Kumasi, Ghana, enrolling 2,202 women with lesions suspicious for breast cancer and 2,161 population controls. Biopsy tissue for cases prior to neoadjuvant therapy (if given), blood, saliva and fecal samples were sought for study subjects. Response rates, risk factor prevalences and odds ratios for established breast cancer risk factors were calculated. A total of 54.5% of the recruited cases were diagnosed with malignancies, 36.0% with benign conditions and 9.5% with indeterminate diagnoses. Response rates to interviews were 99.2% in cases and 91.9% in controls, with the vast majority of interviewed subjects providing saliva (97.9% in cases vs. 98.8% in controls) and blood (91.8% vs. 82.5%) samples; lower proportions (58.1% vs. 46.1%) provided fecal samples. While risk factor prevalences were unique as compared to women in other countries (e.g., less education, higher parity), cancer risk factors resembled patterns identified elsewhere (elevated risks associated with higher levels of education, familial histories of breast cancer, low parity and larger body sizes). Subjects with benign conditions were younger and exhibited higher socioeconomic profiles (e.g., higher education and lower parity) than those with malignancies, suggesting selective referral influences. While further defining breast cancer risk factors in Africa, this study showed that successful population-based interdisciplinary studies of cancer in Africa are possible but require close attention to diagnostic referral biases and standardized and documented approaches for high-quality data collection, including biospecimens.
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD.
authors.forename: Louise A
authors.identifier: 0000-0003-3853-8562
authors.initials: LA
authors.lastname: Brinton
authors.affiliation: Komfo Anoyke Teaching Hospital, Kumasi, Ghana.
authors.forename: Baffour
authors.initials: B
authors.lastname: Awuah
authors.affiliation: Korle Bu Teaching Hospital, Accra, Ghana.|University of Ghana, Accra, Ghana.
authors.forename: Joe
authors.initials: J
authors.lastname: Nat Clegg-Lamptey
authors.affiliation: Peace and Love Hospital, Kumasi, Ghana.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Wiafe-Addai
authors.affiliation: Komfo Anoyke Teaching Hospital, Kumasi, Ghana.
authors.forename: Daniel
authors.initials: D
authors.lastname: Ansong
authors.affiliation: University of Ghana, Accra, Ghana.
authors.forename: Kofi M
authors.initials: KM
authors.lastname: Nyarko
authors.affiliation: Peace and Love Hospital, Kumasi, Ghana.
authors.forename: Seth
authors.initials: S
authors.lastname: Wiafe
authors.affiliation: Korle Bu Teaching Hospital, Accra, Ghana.
authors.forename: Joel
authors.initials: J
authors.lastname: Yarney
authors.affiliation: University of Ghana, Accra, Ghana.
authors.forename: Richard
authors.initials: R
authors.lastname: Biritwum
authors.affiliation: Westat, Inc, Rockville, MD.
authors.forename: Michelle
authors.initials: M
authors.lastname: Brotzman
authors.affiliation: University of Ghana, Accra, Ghana.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Adjei
authors.affiliation: Komfo Anoyke Teaching Hospital, Kumasi, Ghana.
authors.forename: Ernest
authors.initials: E
authors.lastname: Adjei
authors.affiliation: Komfo Anoyke Teaching Hospital, Kumasi, Ghana.
authors.forename: Francis
authors.initials: F
authors.lastname: Aitpillah
authors.affiliation: Korle Bu Teaching Hospital, Accra, Ghana.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Edusei
authors.affiliation: Korle Bu Teaching Hospital, Accra, Ghana.|University of Ghana, Accra, Ghana.
authors.forename: Florence
authors.initials: F
authors.lastname: Dedey
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD.|Currently at the University of North Carolina at Chapel Hill, Chapel Hill, NC.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Nyante
authors.affiliation: Komfo Anoyke Teaching Hospital, Kumasi, Ghana.
authors.forename: Joseph
authors.initials: J
authors.lastname: Oppong
authors.affiliation: Komfo Anoyke Teaching Hospital, Kumasi, Ghana.
authors.forename: Ernest
authors.initials: E
authors.lastname: Osei-Bonsu
authors.affiliation: Komfo Anoyke Teaching Hospital, Kumasi, Ghana.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Titiloye
authors.affiliation: Korle Bu Teaching Hospital, Accra, Ghana.
authors.forename: Verna
authors.initials: V
authors.lastname: Vanderpuye
authors.affiliation: Peace and Love Hospital, Kumasi, Ghana.
authors.forename: Emma
authors.initials: E
authors.lastname: Brew Abaidoo
authors.affiliation: Komfo Anoyke Teaching Hospital, Kumasi, Ghana.
authors.forename: Bernard
authors.initials: B
authors.lastname: Arhin
authors.affiliation: Komfo Anoyke Teaching Hospital, Kumasi, Ghana.
authors.forename: Isaac
authors.initials: I
authors.lastname: Boakye
authors.affiliation: Peace and Love Hospital, Kumasi, Ghana.
authors.forename: Margaret
authors.initials: M
authors.lastname: Frempong
authors.affiliation: Korle Bu Teaching Hospital, Accra, Ghana.
authors.forename: Naomi
authors.initials: N
authors.lastname: Ohene Oti
authors.affiliation: University of Ghana, Accra, Ghana.
authors.forename: Victoria
authors.initials: V
authors.lastname: Okyne
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD.|Currently at the Usher Institute of Population Health Sciences and Informatics, Edinburgh Cancer Research Centre, Edinburgh, Scotland.
authors.forename: Jonine D
authors.initials: JD
authors.lastname: Figueroa
mesh_terms: D000293:Adolescent; D000328:Adult; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000453:epidemiology*; D016022:Case-Control Studies; D005260:Female; D005869:Ghana / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D016017:Odds Ratio; D010298:Parity; D011159:Population Surveillance / Q000379:methods*; D015995:Prevalence; D012107:Research Design; D018570:Risk Assessment / Q000379:methods / Q000706:statistics & numerical data*; D012307:Risk Factors; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Africa; breast cancer; epidemiology; risk factors