Frequency of the basal-like phenotype in African breast cancer

Department of Pathology, Faculty of Medicine, Makerere University, Kampala, Uganda.
Apmis (Impact Factor: 2.04). 12/2007; 115(12):1391-9. DOI: 10.1111/j.1600-0463.2007.00862.x
Source: PubMed


Basal-like breast carcinoma has been recognized as a subtype with specific prognostic implications. However, there is a lack of reports about this category of breast tumors in African women. The aim of this study was to explore the basal-like phenotype in breast cancer patients in an African population, and a registry-based series was included from the well-defined Kyadondo County in Uganda (1.7 millions). We studied a total of 65 archival paraffin blocks of invasive breast cancer using antibodies against cytokeratin 5/6 and P-cadherin, and these markers were expressed in 34% of all cases and in 52% of ER (estrogen receptor)-negative tumors. All basal-like tumors were ER negative (p<0.0005) and PR (progesterone receptor) negative (p=0.002). Basal-like breast carcinomas were of a higher histologic grade (p=0.001), had high mitotic counts (p=0.002), and marked nuclear pleomorphism (p=0.002). P-cadherin-positive tumors had a high Ki-67 proliferative rate (p=0.039). In conclusion, the basal-like phenotype is frequent in this African series of breast cancer and is strongly associated with poor prognostic factors. Our findings might be significant in relation to clinical management of these patients, including novel targeted therapy.

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Available from: Hawa Nalwoga, May 29, 2014
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    • "Genetic, ethnic and racial factors influence breast carcinoma molecular subtypes, possibly by determining intrinsic differences in tumor biology [7]. Basal-like breast carcinomas are more frequent in African Americans (26.5%) and in African women (34%) than Non-African Americans (16.0%) [7,24]. The incidence was lower in studies from Asia, including Korea, China and Japan (14.7%, 12.6% and 8.4%, respectively) [25-27]. "
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    ABSTRACT: Breast carcinomas can be classified into five subtypes based on gene expression profiling or immunohistochemical characteristics. Among these subtypes, basal-like breast carcinomas (BLBCs) are one of the most studied group, due to their poor prognosis. The aim of this study was to investigate the prevalance, morphological and immunohistochemical features of BLBCs, in Turkish population. Five hundred invasive breast carcinomas were reviewed for several morphological features and immunostained for oestrogen and progesterone receptors, c-ERB-B2, cytokeratin5/6, cytokeratin14, vimentin and epidermal growth factor receptor (EGFR). Basal-like breast carcinoma was defined as a triple negative tumor with cytokeratin5/6 and/or EGFR positive. The prevalance of BLBC was 9.6%. All medullary carcinomas and 55.6% of metaplastic carcinomas showed basal-like immunophenotype. Patients with BLBC were younger (p=0.04) and had higher-grade tumors (p<0.0001). Morphologic features associated with BLBC included increased mitosis, nuclear pleomorphism, presence of geographic and/or central necrosis, pushing margin of invasion and stromal lymphocytic response (p<0.0001). Presence of prominent nucleoli and vesicular nuclear chromatin were the cytological features correlated with basal-like phenotype (p<0.0001). On multivariate analyses, BLBCs were associated with high mitotic number (p<0.0001), the presence of vesicular chromatin (p=0.004), high tubular grade (p=0.011), lymphocytic response (p=0.031) and the absence of carcinoma insitu (p=0.039). Vimentin was positive in 53.2% of BLBCs, while cytokeratin14 was less frequently expressed (27.7%). BLBCs have some distinctive, but not pathognomonical, morphological features. Paying attention to these features and adding cytokeratin14 and vimentin to the immunohistochemical panel can help the definitive diagnosis of BLBCs. Virtual slide Http://
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    • "In our Sudanese series, basal CK expression was associated with higher histologic grade and with hormone receptor negative status. This is in agreement with well-established evidence that the expression of basal markers occurs in poorly differentiated hormone receptors-negative BCs, as reported for Caucasian and African American series and also for the Ugandan series [25, 26, 35, 51, 55]. As in other studies, CK17 was more frequently positive than CK5/6 [25]. "
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    • "Hence, apart from methodological discrepancies, biological differences might be present when comparing breast cancers from African and Caucasian populations (Elledge et al, 1994; Ikpatt et al, 2002; Jones et al, 2004; Porter et al, 2004). In line with this, a poorer outcome has been observed in African and African-American patients (Wojcik et al, 1998; Ikpatt et al, 2002) when compared with breast cancers among Caucasians, with differences in the spectrum of tumour characteristics and prognostic features such as the presence of tumour necrosis, low ER positivity rate, high HER2-positive rate, and a high frequency of basal-like features (Mbonde et al, 2001; Ikpatt et al, 2002; Carey et al, 2006; Nalwoga et al, 2006, 2007; Morris et al, 2007; Bird et al, 2008). "
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    ABSTRACT: Putative breast cancer stem cells might express surface markers such as aldehyde dehydrogenase 1 (ALDH1) and BMI-1 proteins. The aim of this study was to explore the expression of these proteins in breast cancers from an African population and their associations with the basal-like phenotype (BLP) and other molecular characteristics. We analysed 192 paraffin-embedded breast carcinoma samples by tissue microarrays and immunohistochemical methods. In total, 88 tumours (48%) expressed ALDH1, whereas 46 (25%) expressed BMI-1 protein. Expression of ALDH1 was associated with high histological grade (P<0.0005), high mitotic count (P<0.0005), high nuclear grade (P<0.0005), oestrogen receptor (ER) negativity (P<0.0005), progesterone receptor (PR) negativity (P=0.009), p53 expression (P=0.034), cytokeratin 5/6 positivity (P=0.008), epidermal growth factor receptor (EGFR) expression (P=0.015) and the BLP (P<0.0005), whereas it was inversely associated with BMI-1 staining (P=0.009). On the other hand, BMI-1 expression was associated with low histological grade (P=0.004) and ER positivity (P=0.001). There was a high prevalence of ALDH1 expression among breast carcinomas and associations with basal markers and features of aggressive tumours. Studies are required to elucidate the importance of these findings for improved understanding of breast cancer biology.
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