Inflammatory breast cancer in North Africa: Comparison of clinical and molecular epidemiologic characteristics of patients from Egypt, Tunisia, and Morocco

Article type: Research Article

Authors: Soliman, Amr S.^{a; *} | Kleer, Celina G.^b | Mrad, Karima^c | Karkouri, Mehdi^d | Omar, Sherif^e | Khaled, Hussein M.^e | Benider, Abdel-Latif^f | Ayed, Farhat Ben^g | Eissa, Saad S.^e | Eissa, Mohab S.^a | McSpadden, Erin J.^a | Lo, An-Chi^a | Toy, Kathy^h | Kantor, Elizabeth D.^a | Xiao, Quin^a | Hampton, Claire^a | Merajver, Sofia D.^{h; i}

Affiliations: [a] Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA | [b] Department of Pathology, University of Michigan School of Medicine, Ann Arbor, MI, USA | [c] Department of Pathology, Institute Saleh Azaiz, Tunis, Tunisia | [d] Department of Pathology, Medical School, Hassan the Second University, Casablanca, Morocco | [e] National Cancer Institute of Cairo University, Cairo, Egypt | [f] Ibn Roch Oncology Center, Hassan the Second University, Casablanca, Morocco | [g] Anti-cancer Foundation, Tunis, Tunisia | [h] Department of Medicine, University of Michigan Medical School, Ann Arbor, MI, USA | [i] Center for Global Health, University of Michigan, Ann Arbor, MI, USA

Correspondence: [*] Correspondence to: Amr S. Soliman, Department of Epidemiology, University of Nebraska Medical Center College of Public Health, 984395 Nebraska Medical Center, Omaha, NE 68198-4395, USA. Tel.: +1 402 559 3976; Fax: +1 402 559 7259; E-mail: amr.soliman@unmc.edu

Abstract: Understanding molecular characteristics that distinguish inflammatory breast cancer (IBC) from non-IBC is crucial for elucidating breast cancer etiology and management. We included 3 sets of patients from Egypt (48 IBC and 64 non-IBC), Tunisia (24 IBC and 40 non-IBC), and Morocco (42 IBC and 41 non-IBC). Egyptian IBC patients had the highest combined erythema, edema, peau d'orange, and metastasis among the 3 IBC groups. Egyptian IBC tumors had the highest RhoC expression than Tunisians and Moroccan IBCs (87% vs. 50%, vs. 38.1, for the 3 countries, respectively). Tumor emboli were more frequent in Egyptian IBC than non-IBC (Mean ± SD: 14.1 ± 14.0 vs. 7.0 ± 12.9, respectively) (P < 0.001) and Tunisians (Mean ± SD: 3.4 ± 2.5 vs. 1.9 ± 2.0, respectively) (P < 0.01). There was no difference of emboli in Moroccan tumors (1.7 ± 1.2 vs. 1.8 ± 1.2 for IBC and non-IBC, respectively (P=0.66). This study illustrates that RhoC overexpression and tumor emboli are more frequent in IBC relative to non-IBC from Egypt and Tunisia. Tumors of Moroccans were significantly different from Egyptian and Tunisian tumors for RhoC expression and emboli. Future studies should focus on relating epidemiologic factors and clinical pictures to molecular features of IBC in these and other populations.

Keywords: Inflammatory breast cancer, tumor emboli, RhoC, Egypt, Tunisia, Morocco, North Africa

DOI: 10.3233/BD-2012-000337

Journal: Breast Disease, vol. 33, no. 4, pp. 159-169, 2012