Clinical and Epidemiologic Profile of Breast Cancer in Tanzania

Article type: Research Article

Authors: Burson, Ashley M.^a | Soliman, Amr S.^{a; *} | Ngoma, Twalib A.^b | Mwaiselage, Julius^b | Ogweyo, P.^c | Eissa, Mohab S.^a | Dey, Subhojit^d | Merajver, Sofia D.^e

Affiliations: [a] Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA | [b] Ocean Road Cancer Institute, Dar Es Salaam, Tanzania | [c] Muhimbili National Hospital, Pathology Department, Dar Es Salaam, Tanzania | [d] Indian Institute of Public Health, Public Health Foundation of India, New Delhi, India | [e] Center for Global Health, University of Michigan, Ann Arbor, MI, USA

Correspondence: [*] Corresponding author: Amr S. Soliman, M.D., Ph.D., Department of Epidemiology, University of Michigan School of Public Health, 109 Observatory St., Ann Arbor, MI 48109, USA. Tel.: +1 734 764 5469; Fax: +1 734 764 3192; E-mail: asoliman@umich.edu

Abstract: Purpose:Breast cancer is a highly heterogeneous disease globally. Public health prevention measures require an understanding of the burden of breast cancer and its risk factors. The purpose of this study was to describe the clinical, pathologic, and epidemiologic characteristics of breast cancer patients in Tanzania. Methods:Data was abstracted from the medical records of all breast cancer patients attending Ocean Road Cancer Institute (ORCI) over a 2-year period from July 2007 to June 2009. Tumor tissue paraffin blocks were collected for all patients with available tissues for the determination of estrogen receptor (ER) and progesterone receptor (PR). Data for all patients was analyzed descriptively and by using unconditional logistic regression, by comparing early stage (ES), defined as stages I and II and late stage (LS), defined as stages III and IV patients to obtain odds ratios (ORs), 95% confidence intervals (CIs), and P-values. Results:Among the 488 patients, stage was determined for 356~patients, 90.7% of whom presented in LS. Of the 57 tumor tissues, 49.1% were ER-/PR-. Patients with ulceration (OR = 4.97; 95% CI = 1.07, 23.04; p = 0.04) and peau d'orange (OR = 6.78; 95% CI = 1.48, 31.17; p = 0.01) were more likely to present in LS rather than ES. Male breast cancer accounted for 2.9% of all breast cancers and inflammatory breast cancer (IBC) comprised 4.3–5.5% of cases based on registered t4d diagnosis or the criteria of IBC signs, if t4d was not reported in the medical records. Conclusion:Most breast cancer patients in Tanzania are diagnosed at advanced disease stages with about half of the tumors being ER-/PR-. These data strongly support that reducing barriers to care, down-staging of disease at diagnosis, implementation of clinical guidelines for management of advanced cases, and palliative care are the four most essential factors that need to be addressed to reduce morbidity and mortality from breast cancer in Tanzania. Further research is needed to quantify the magnitude and molecular features of two relatively rare forms of breast cancer that may account for a greater proportion of the burden of breast cancer in Tanzania compared to the USA and Western Europe: male breast cancer and IBC.

Keywords: Breast cancer, epidemiology, Tanzania, Sub-Saharan Africa, male breast cancer, inflammatory breast cancer

DOI: 10.3233/BD-2009-0296

Journal: Breast Disease, vol. 31, no. 1, pp. 33-41, 2010