Article

Proliferation in African Breast Cancer: Biology and Prognostication in Nigerian Breast Cancer Material

University of Turku, Turku, Southwest Finland, Finland
Modern Pathology (Impact Factor: 6.19). 08/2002; 15(8):783-9. DOI: 10.1097/01.MP.0000021764.03552.BD
Source: PubMed

ABSTRACT

Three hundred cases of invasive breast carcinoma from the University of Calabar Teaching Hospital, Nigeria were subjected to evaluation of proliferative activity by mitotic counts. The prognostic significance and association with other prognostic factors were evaluated. The mitotic activity was expressed as mitotic activity index (MAI), and standardized mitotic index (SMI). Pearson's correlation and univariate and multivariate Cox's regression were used. The mean follow-up time was 25.9 months. The mean values of SMI and MAI were 42.6 mitotic figures per square millimeter and 30.5 mitotic figures per 10 high-power fields, respectively, and these were much higher than values reported for Europe or other Western countries. The SMI had a positive correlation with tumor size (r = 0.31, P <.0001), histologic grade (r = 0.68, P <.0001), nuclear area (r = 0.45, P <.0001), and negative correlation with fraction of fields with tubular differentiation (FTD; r = -0.56, P = <0.0001). There was no statistically significant difference in the mitotic activity between the postmenopausal and the premenopausal patients. Also, lymph node-positive patients had higher counts than did lymph node-negative patients. Earlier determined grading associated decision thresholds divided the patients into groups of favorable and unfavorable prognosis. However, the statistically optimal thresholds for Nigerian material were different (32 and 92 mitotic figures per square millimeter for SMI). Tumor size of 5 cm, SMI, and MAI were independent prognostic factors. Nigerian breast cancers are high-grade, high-stage, and high-proliferating cancers occurring in a younger population than those of the Western countries. Proliferation is also more active. Evaluation of SMI or MAI can improve the distinction between aggressive and less aggressive variants of breast cancer.

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Available from: Teijo Kuopio, Apr 14, 2014
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    • "Data relating to the clinical stages of breast cancer on first diagnosis showed that 52.35% of the women presented at the advanced stages (III and IV) whiles early stage presentation involved 47.65%. This is consistent with some studies done in Ghana[9][32][33]and Africa[34][35]. Breast cancer mortality was found to be correlated to the stage at diagnosis. Testing equality among the groups, at a p value of 0.000 indicated significance . "

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