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Breast cancer subtypes: implications for the treatment and survival of patients in Africa—a prospective cohort study from Mozambique
BACKGROUND: Data regarding breast cancer epidemiology, treatment and survival in Africa are scarce. We aimed to assess the distribution of breast cancer subtypes in Mozambique and its impact on patients’ treatment and survival. The concordance of biomarker assessment between cytological and histolog...
Autores principales: | , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7537337/ https://www.ncbi.nlm.nih.gov/pubmed/33020218 http://dx.doi.org/10.1136/esmoopen-2020-000829 |
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author | Brandão, Mariana Guisseve, Assucena Bata, Genoveva Alberto, Matos Ferro, Josefo Garcia, Carlos Zaqueu, Clésio Lorenzoni, Cesaltina Leitão, Dina Come, Jotamo Soares, Otília Gudo-Morais, Alberto Schmitt, Fernando Tulsidás, Satish Carrilho, Carla Lunet, Nuno |
author_facet | Brandão, Mariana Guisseve, Assucena Bata, Genoveva Alberto, Matos Ferro, Josefo Garcia, Carlos Zaqueu, Clésio Lorenzoni, Cesaltina Leitão, Dina Come, Jotamo Soares, Otília Gudo-Morais, Alberto Schmitt, Fernando Tulsidás, Satish Carrilho, Carla Lunet, Nuno |
author_sort | Brandão, Mariana |
collection | PubMed |
description | BACKGROUND: Data regarding breast cancer epidemiology, treatment and survival in Africa are scarce. We aimed to assess the distribution of breast cancer subtypes in Mozambique and its impact on patients’ treatment and survival. The concordance of biomarker assessment between cytological and histological samples was also evaluated. METHODS: Prospective cohort study including 210 patients diagnosed between January 2015 and August 2017, followed to November 2019. Clinicopathological characteristics, treatment, 3-year overall survival (OS) and disease-free survival (DFS) were compared across classic tumour subtypes (oestrogen receptor (ER)-positive/human epidermal growth factor receptor 2 (HER2)-negative, HER2-positive and triple-negative breast cancer (TNBC)) and surrogate intrinsic subtypes (St. Gallen classification). Concordance was measured using Cohen’s κ statistics. RESULTS: A total of 51% of patients had ER-positive/HER2-negative tumours, 24% HER2-positive and 25% TNBC. Concordance between cytological and histological samples regarding ER and HER2 status was substantial (κ=0.762 and κ=0.603, respectively). There were no significant differences across subtypes regarding clinical characteristics and treatment, except for HIV positivity and high histological grade (more prevalent among TNBC) or endocrine therapy (higher use among ER-positive/HER2-negative and HER2-positive patients). Three-year OS was 52.5% (95% CI, 44.3% to 60.0%), being higher in ER-positive/HER2-negative (61.1%) compared with HER2-positive (53.2%) and TNBC (31.9%) patients. Adjusted HRs were 1.96 (95% CI, 1.13 to 3.39) among HER2-positive and 3.10 (95% CI, 1.81 to 5.31) among TNBC versus ER-positive/HER2-negative patients. Three-year DFS was 46.6% (95% CI, 38.0% to 54.8%), being lower among TNBC versus ER-positive/HER2-negative patients (HR 2.91; 95% CI, 1.64 to 5.16). Results were similar between surrogate intrinsic subtypes. CONCLUSION: There was a high proportion of HER2-positive and TNBC among Mozambican patients and their survival was poor compared with ER-positive/HER2-negative patients, partly due to the limited treatment options. A systematic assessment of ER, PR and HER2 status is feasible and may help tailoring and optimise the treatment of patients with breast cancer in low-resource settings, potentially leading to survival gains in this underserved population. |
format | Online Article Text |
id | pubmed-7537337 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-75373372020-10-07 Breast cancer subtypes: implications for the treatment and survival of patients in Africa—a prospective cohort study from Mozambique Brandão, Mariana Guisseve, Assucena Bata, Genoveva Alberto, Matos Ferro, Josefo Garcia, Carlos Zaqueu, Clésio Lorenzoni, Cesaltina Leitão, Dina Come, Jotamo Soares, Otília Gudo-Morais, Alberto Schmitt, Fernando Tulsidás, Satish Carrilho, Carla Lunet, Nuno ESMO Open Original Research BACKGROUND: Data regarding breast cancer epidemiology, treatment and survival in Africa are scarce. We aimed to assess the distribution of breast cancer subtypes in Mozambique and its impact on patients’ treatment and survival. The concordance of biomarker assessment between cytological and histological samples was also evaluated. METHODS: Prospective cohort study including 210 patients diagnosed between January 2015 and August 2017, followed to November 2019. Clinicopathological characteristics, treatment, 3-year overall survival (OS) and disease-free survival (DFS) were compared across classic tumour subtypes (oestrogen receptor (ER)-positive/human epidermal growth factor receptor 2 (HER2)-negative, HER2-positive and triple-negative breast cancer (TNBC)) and surrogate intrinsic subtypes (St. Gallen classification). Concordance was measured using Cohen’s κ statistics. RESULTS: A total of 51% of patients had ER-positive/HER2-negative tumours, 24% HER2-positive and 25% TNBC. Concordance between cytological and histological samples regarding ER and HER2 status was substantial (κ=0.762 and κ=0.603, respectively). There were no significant differences across subtypes regarding clinical characteristics and treatment, except for HIV positivity and high histological grade (more prevalent among TNBC) or endocrine therapy (higher use among ER-positive/HER2-negative and HER2-positive patients). Three-year OS was 52.5% (95% CI, 44.3% to 60.0%), being higher in ER-positive/HER2-negative (61.1%) compared with HER2-positive (53.2%) and TNBC (31.9%) patients. Adjusted HRs were 1.96 (95% CI, 1.13 to 3.39) among HER2-positive and 3.10 (95% CI, 1.81 to 5.31) among TNBC versus ER-positive/HER2-negative patients. Three-year DFS was 46.6% (95% CI, 38.0% to 54.8%), being lower among TNBC versus ER-positive/HER2-negative patients (HR 2.91; 95% CI, 1.64 to 5.16). Results were similar between surrogate intrinsic subtypes. CONCLUSION: There was a high proportion of HER2-positive and TNBC among Mozambican patients and their survival was poor compared with ER-positive/HER2-negative patients, partly due to the limited treatment options. A systematic assessment of ER, PR and HER2 status is feasible and may help tailoring and optimise the treatment of patients with breast cancer in low-resource settings, potentially leading to survival gains in this underserved population. BMJ Publishing Group 2020-10-05 /pmc/articles/PMC7537337/ /pubmed/33020218 http://dx.doi.org/10.1136/esmoopen-2020-000829 Text en © Author (s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. Published by BMJ on behalf of the European Society for Medical Oncology. http://creativecommons.org/licenses/by-nc/4.0/ http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, any changes made are indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. |
spellingShingle | Original Research Brandão, Mariana Guisseve, Assucena Bata, Genoveva Alberto, Matos Ferro, Josefo Garcia, Carlos Zaqueu, Clésio Lorenzoni, Cesaltina Leitão, Dina Come, Jotamo Soares, Otília Gudo-Morais, Alberto Schmitt, Fernando Tulsidás, Satish Carrilho, Carla Lunet, Nuno Breast cancer subtypes: implications for the treatment and survival of patients in Africa—a prospective cohort study from Mozambique |
title | Breast cancer subtypes: implications for the treatment and survival of patients in Africa—a prospective cohort study from Mozambique |
title_full | Breast cancer subtypes: implications for the treatment and survival of patients in Africa—a prospective cohort study from Mozambique |
title_fullStr | Breast cancer subtypes: implications for the treatment and survival of patients in Africa—a prospective cohort study from Mozambique |
title_full_unstemmed | Breast cancer subtypes: implications for the treatment and survival of patients in Africa—a prospective cohort study from Mozambique |
title_short | Breast cancer subtypes: implications for the treatment and survival of patients in Africa—a prospective cohort study from Mozambique |
title_sort | breast cancer subtypes: implications for the treatment and survival of patients in africa—a prospective cohort study from mozambique |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7537337/ https://www.ncbi.nlm.nih.gov/pubmed/33020218 http://dx.doi.org/10.1136/esmoopen-2020-000829 |
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