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Published in: BMC Women's Health 1/2011

Open Access 01-12-2011 | Research article

Molecular subtype analysis determines the association of advanced breast cancer in Egypt with favorable biology

Authors: Bodour Salhia, Coya Tapia, Elia A Ishak, Salwa Gaber, Bree Berghuis, Khateeb H Hussain, Rachelle A DuQuette, James Resau, John Carpten

Published in: BMC Women's Health | Issue 1/2011

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Abstract

Background

Prognostic markers and molecular breast cancer subtypes reflect underlying biological tumor behavior and are important for patient management. Compared to Western countries, women in North Africa are less likely to be prognosticated and treated based on well-characterized markers such as the estrogen receptor (ER), progesterone receptor (PR) and Her2. We conducted this study to determine the prevalence of breast cancer molecular subtypes in the North African country of Egypt as a measure of underlying biological characteristics driving tumor manifestations.

Methods

To determine molecular subtypes we characterized over 200 tumor specimens obtained from Egypt by performing ER, PR, Her2, CK5/6, EGFR and Ki67 immunohistochemistry.

Results

Our study demonstrated that the Luminal A subtype, associated with favorable prognosis, was found in nearly 45% of cases examined. However, the basal-like subtype, associated with poor prognosis, was found in 11% of cases. These findings are in sharp contrast to other parts of Africa in which the basal-like subtype is over-represented.

Conclusions

Egyptians appear to have favorable underlying biology, albeit having advanced disease at diagnosis. These data suggest that Egyptians would largely profit from early detection of their disease. Intervention at the public health level, including education on the benefits of early detection is necessary and would likely have tremendous impact on breast cancer outcome in Egypt.
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Literature
1.
go back to reference Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM: Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM: Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer.
2.
go back to reference Dey S, Soliman AS, Hablas A, Seifeldein IA, Ismail K, Ramadan M, El-Hamzawy H, Wilson ML, Banerjee M, Boffetta P, et al: Urban-rural differences in breast cancer incidence in Egypt (1999-2006). Breast. Dey S, Soliman AS, Hablas A, Seifeldein IA, Ismail K, Ramadan M, El-Hamzawy H, Wilson ML, Banerjee M, Boffetta P, et al: Urban-rural differences in breast cancer incidence in Egypt (1999-2006). Breast.
3.
go back to reference Zanetti R, Tazi MA, Rosso S: New data tells us more about cancer incidence in North Africa. Eur J Cancer. 46 (3): 462-466. Zanetti R, Tazi MA, Rosso S: New data tells us more about cancer incidence in North Africa. Eur J Cancer. 46 (3): 462-466.
4.
go back to reference Perou CM, Sorlie T, Eisen MB, van de Rijn M, Jeffrey SS, Rees CA, Pollack JR, Ross DT, Johnsen H, Akslen LA, et al: Molecular portraits of human breast tumours. Nature. 2000, 406 (6797): 747-752. 10.1038/35021093.CrossRefPubMed Perou CM, Sorlie T, Eisen MB, van de Rijn M, Jeffrey SS, Rees CA, Pollack JR, Ross DT, Johnsen H, Akslen LA, et al: Molecular portraits of human breast tumours. Nature. 2000, 406 (6797): 747-752. 10.1038/35021093.CrossRefPubMed
5.
go back to reference Sorlie T, Perou CM, Tibshirani R, Aas T, Geisler S, Johnsen H, Hastie T, Eisen MB, van de Rijn M, Jeffrey SS, et al: Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications. Proc Natl Acad Sci USA. 2001, 98 (19): 10869-10874. 10.1073/pnas.191367098.CrossRefPubMedPubMedCentral Sorlie T, Perou CM, Tibshirani R, Aas T, Geisler S, Johnsen H, Hastie T, Eisen MB, van de Rijn M, Jeffrey SS, et al: Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications. Proc Natl Acad Sci USA. 2001, 98 (19): 10869-10874. 10.1073/pnas.191367098.CrossRefPubMedPubMedCentral
6.
go back to reference Sorlie T, Tibshirani R, Parker J, Hastie T, Marron JS, Nobel A, Deng S, Johnsen H, Pesich R, Geisler S, et al: Repeated observation of breast tumor subtypes in independent gene expression data sets. Proc Natl Acad Sci USA. 2003, 100 (14): 8418-8423. 10.1073/pnas.0932692100.CrossRefPubMedPubMedCentral Sorlie T, Tibshirani R, Parker J, Hastie T, Marron JS, Nobel A, Deng S, Johnsen H, Pesich R, Geisler S, et al: Repeated observation of breast tumor subtypes in independent gene expression data sets. Proc Natl Acad Sci USA. 2003, 100 (14): 8418-8423. 10.1073/pnas.0932692100.CrossRefPubMedPubMedCentral
7.
go back to reference Cheang MC, Chia SK, Voduc D, Gao D, Leung S, Snider J, Watson M, Davies S, Bernard PS, Parker JS, et al: Ki67 index, HER2 status, and prognosis of patients with luminal B breast cancer. J Natl Cancer Inst. 2009, 101 (10): 736-750. 10.1093/jnci/djp082.CrossRefPubMedPubMedCentral Cheang MC, Chia SK, Voduc D, Gao D, Leung S, Snider J, Watson M, Davies S, Bernard PS, Parker JS, et al: Ki67 index, HER2 status, and prognosis of patients with luminal B breast cancer. J Natl Cancer Inst. 2009, 101 (10): 736-750. 10.1093/jnci/djp082.CrossRefPubMedPubMedCentral
8.
go back to reference Carey LA, Perou CM, Livasy CA, Dressler LG, Cowan D, Conway K, Karaca G, Troester MA, Tse CK, Edmiston S, et al: Race, breast cancer subtypes, and survival in the Carolina Breast Cancer Study. JAMA. 2006, 295 (21): 2492-2502. 10.1001/jama.295.21.2492.CrossRefPubMed Carey LA, Perou CM, Livasy CA, Dressler LG, Cowan D, Conway K, Karaca G, Troester MA, Tse CK, Edmiston S, et al: Race, breast cancer subtypes, and survival in the Carolina Breast Cancer Study. JAMA. 2006, 295 (21): 2492-2502. 10.1001/jama.295.21.2492.CrossRefPubMed
9.
go back to reference Nielsen TO, Hsu FD, Jensen K, Cheang M, Karaca G, Hu Z, Hernandez-Boussard T, Livasy C, Cowan D, Dressler L, et al: Immunohistochemical and clinical characterization of the basal-like subtype of invasive breast carcinoma. Clin Cancer Res. 2004, 10 (16): 5367-5374. 10.1158/1078-0432.CCR-04-0220.CrossRefPubMed Nielsen TO, Hsu FD, Jensen K, Cheang M, Karaca G, Hu Z, Hernandez-Boussard T, Livasy C, Cowan D, Dressler L, et al: Immunohistochemical and clinical characterization of the basal-like subtype of invasive breast carcinoma. Clin Cancer Res. 2004, 10 (16): 5367-5374. 10.1158/1078-0432.CCR-04-0220.CrossRefPubMed
10.
go back to reference O'Brien KM, Cole SR, Tse CK, Perou CM, Carey LA, Foulkes WD, Dressler LG, Geradts J, Millikan RC: Intrinsic breast tumor subtypes, race, and long-term survival in the Carolina Breast Cancer Study. Clin Cancer Res. 2010, 16 (24): 6100-6110. 10.1158/1078-0432.CCR-10-1533.CrossRefPubMedPubMedCentral O'Brien KM, Cole SR, Tse CK, Perou CM, Carey LA, Foulkes WD, Dressler LG, Geradts J, Millikan RC: Intrinsic breast tumor subtypes, race, and long-term survival in the Carolina Breast Cancer Study. Clin Cancer Res. 2010, 16 (24): 6100-6110. 10.1158/1078-0432.CCR-10-1533.CrossRefPubMedPubMedCentral
11.
go back to reference Genestie C, Zafrani B, Asselain B, Fourquet A, Rozan S, Validire P, Vincent-Salomon A, Sastre-Garau X: Comparison of the prognostic value of Scarff-Bloom-Richardson and Nottingham histological grades in a series of 825 cases of breast cancer: major importance of the mitotic count as a component of both grading systems. Anticancer Res. 1998, 18 (1B): 571-576.PubMed Genestie C, Zafrani B, Asselain B, Fourquet A, Rozan S, Validire P, Vincent-Salomon A, Sastre-Garau X: Comparison of the prognostic value of Scarff-Bloom-Richardson and Nottingham histological grades in a series of 825 cases of breast cancer: major importance of the mitotic count as a component of both grading systems. Anticancer Res. 1998, 18 (1B): 571-576.PubMed
12.
go back to reference Paik S, Taniyama Y, Geyer CE: Anthracyclines in the treatment of HER2-negative breast cancer. J Natl Cancer Inst. 2008, 100 (1): 2-4. 10.1093/jnci/djm277.CrossRefPubMed Paik S, Taniyama Y, Geyer CE: Anthracyclines in the treatment of HER2-negative breast cancer. J Natl Cancer Inst. 2008, 100 (1): 2-4. 10.1093/jnci/djm277.CrossRefPubMed
13.
go back to reference Paik S, Kim C, Wolmark N: HER2 status and benefit from adjuvant trastuzumab in breast cancer. N Engl J Med. 2008, 358 (13): 1409-1411. 10.1056/NEJMc0801440.CrossRefPubMed Paik S, Kim C, Wolmark N: HER2 status and benefit from adjuvant trastuzumab in breast cancer. N Engl J Med. 2008, 358 (13): 1409-1411. 10.1056/NEJMc0801440.CrossRefPubMed
14.
go back to reference Dey S, Soliman AS, Hablas A, Seifeldin IA, Ismail K, Ramadan M, El-Hamzawy H, Wilson ML, Banerjee M, Boffetta P, et al: Urban-rural differences in breast cancer incidence by hormone receptor status across 6 years in Egypt. Breast Cancer Res Treat. 120 (1): 149-160. Dey S, Soliman AS, Hablas A, Seifeldin IA, Ismail K, Ramadan M, El-Hamzawy H, Wilson ML, Banerjee M, Boffetta P, et al: Urban-rural differences in breast cancer incidence by hormone receptor status across 6 years in Egypt. Breast Cancer Res Treat. 120 (1): 149-160.
15.
go back to reference Anderson BO: Breast cancer hormone receptor status in Egypt: are we asking the questions that matter most?. Breast Cancer Res Treat. 120 (1): 161-163. Anderson BO: Breast cancer hormone receptor status in Egypt: are we asking the questions that matter most?. Breast Cancer Res Treat. 120 (1): 161-163.
16.
go back to reference Ben Abdelkrim S, Trabelsi A, Missaoui N, Beizig N, Bdioui A, Anjorin A, Jomaa W, Mokni M: Distribution of molecular breast cancer subtypes among Tunisian women and correlation with histopathological parameters: a study of 194 patients. Pathol Res Pract. 2010, 206 (11): 772-775. 10.1016/j.prp.2010.07.012.CrossRefPubMed Ben Abdelkrim S, Trabelsi A, Missaoui N, Beizig N, Bdioui A, Anjorin A, Jomaa W, Mokni M: Distribution of molecular breast cancer subtypes among Tunisian women and correlation with histopathological parameters: a study of 194 patients. Pathol Res Pract. 2010, 206 (11): 772-775. 10.1016/j.prp.2010.07.012.CrossRefPubMed
17.
go back to reference Awadelkarim KD, Arizzi C, Elamin EO, Hamad HM, De Blasio P, Mekki SO, Osman I, Biunno I, Elwali NE, Mariani-Costantini R, et al: Pathological, clinical and prognostic characteristics of breast cancer in Central Sudan versus Northern Italy: implications for breast cancer in Africa. Histopathology. 2008, 52 (4): 445-456. 10.1111/j.1365-2559.2008.02966.x.CrossRefPubMed Awadelkarim KD, Arizzi C, Elamin EO, Hamad HM, De Blasio P, Mekki SO, Osman I, Biunno I, Elwali NE, Mariani-Costantini R, et al: Pathological, clinical and prognostic characteristics of breast cancer in Central Sudan versus Northern Italy: implications for breast cancer in Africa. Histopathology. 2008, 52 (4): 445-456. 10.1111/j.1365-2559.2008.02966.x.CrossRefPubMed
18.
go back to reference Onitilo AA, Engel JM, Greenlee RT, Mukesh BN: Breast cancer subtypes based on ER/PR and Her2 expression: comparison of clinicopathologic features and survival. Clin Med Res. 2009, 7 (1-2): 4-13. 10.3121/cmr.2009.825.CrossRefPubMedPubMedCentral Onitilo AA, Engel JM, Greenlee RT, Mukesh BN: Breast cancer subtypes based on ER/PR and Her2 expression: comparison of clinicopathologic features and survival. Clin Med Res. 2009, 7 (1-2): 4-13. 10.3121/cmr.2009.825.CrossRefPubMedPubMedCentral
19.
go back to reference Huo D, Ikpatt F, Khramtsov A, Dangou JM, Nanda R, Dignam J, Zhang B, Grushko T, Zhang C, Oluwasola O, et al: Population differences in breast cancer: survey in indigenous African women reveals over-representation of triple-negative breast cancer. J Clin Oncol. 2009, 27 (27): 4515-4521. 10.1200/JCO.2008.19.6873.CrossRefPubMedPubMedCentral Huo D, Ikpatt F, Khramtsov A, Dangou JM, Nanda R, Dignam J, Zhang B, Grushko T, Zhang C, Oluwasola O, et al: Population differences in breast cancer: survey in indigenous African women reveals over-representation of triple-negative breast cancer. J Clin Oncol. 2009, 27 (27): 4515-4521. 10.1200/JCO.2008.19.6873.CrossRefPubMedPubMedCentral
20.
go back to reference Al Tamimi DM, Shawarby MA, Ahmed A, Hassan AK, AlOdaini AA: Protein expression profile and prevalence pattern of the molecular classes of breast cancer--a Saudi population based study. BMC Cancer. 10: 223. Al Tamimi DM, Shawarby MA, Ahmed A, Hassan AK, AlOdaini AA: Protein expression profile and prevalence pattern of the molecular classes of breast cancer--a Saudi population based study. BMC Cancer. 10: 223.
21.
go back to reference Seedhom A, Kamal N: Factors Affecting Survival of Women Diagnosed with Breast Cancer in El-Minia Governorate, Egypt. International journal of preventatative medicine. 2011, 2 (3): 113-138. Seedhom A, Kamal N: Factors Affecting Survival of Women Diagnosed with Breast Cancer in El-Minia Governorate, Egypt. International journal of preventatative medicine. 2011, 2 (3): 113-138.
22.
go back to reference Lucotte G, Mercier G: Brief communication: Y-chromosome haplotypes in Egypt. Am J Phys Anthropol. 2003, 121 (1): 63-66. 10.1002/ajpa.10190.CrossRefPubMed Lucotte G, Mercier G: Brief communication: Y-chromosome haplotypes in Egypt. Am J Phys Anthropol. 2003, 121 (1): 63-66. 10.1002/ajpa.10190.CrossRefPubMed
23.
go back to reference Luis JR, Rowold DJ, Regueiro M, Caeiro B, Cinnioglu C, Roseman C, Underhill PA, Cavalli-Sforza LL, Herrera RJ: The Levant versus the Horn of Africa: evidence for bidirectional corridors of human migrations. Am J Hum Genet. 2004, 74 (3): 532-544. 10.1086/382286.CrossRefPubMedPubMedCentral Luis JR, Rowold DJ, Regueiro M, Caeiro B, Cinnioglu C, Roseman C, Underhill PA, Cavalli-Sforza LL, Herrera RJ: The Levant versus the Horn of Africa: evidence for bidirectional corridors of human migrations. Am J Hum Genet. 2004, 74 (3): 532-544. 10.1086/382286.CrossRefPubMedPubMedCentral
24.
go back to reference Sabatier R, Finetti P, Cervera N, Lambaudie E, Esterni B, Mamessier E, Tallet A, Chabannon C, Extra JM, Jacquemier J, et al: A gene expression signature identifies two prognostic subgroups of basal breast cancer. Breast Cancer Res Treat. 2011, 126 (2): 407-420. 10.1007/s10549-010-0897-9.CrossRefPubMed Sabatier R, Finetti P, Cervera N, Lambaudie E, Esterni B, Mamessier E, Tallet A, Chabannon C, Extra JM, Jacquemier J, et al: A gene expression signature identifies two prognostic subgroups of basal breast cancer. Breast Cancer Res Treat. 2011, 126 (2): 407-420. 10.1007/s10549-010-0897-9.CrossRefPubMed
25.
go back to reference Bertucci F, Finetti P, Cervera N, Charafe-Jauffret E, Mamessier E, Adelaide J, Debono S, Houvenaeghel G, Maraninchi D, Viens P, et al: Gene expression profiling shows medullary breast cancer is a subgroup of basal breast cancers. Cancer Res. 2006, 66 (9): 4636-4644. 10.1158/0008-5472.CAN-06-0031.CrossRefPubMed Bertucci F, Finetti P, Cervera N, Charafe-Jauffret E, Mamessier E, Adelaide J, Debono S, Houvenaeghel G, Maraninchi D, Viens P, et al: Gene expression profiling shows medullary breast cancer is a subgroup of basal breast cancers. Cancer Res. 2006, 66 (9): 4636-4644. 10.1158/0008-5472.CAN-06-0031.CrossRefPubMed
26.
go back to reference Lubinski J, Gorski B, Huzarski T, Byrski T, Gronwald J, Serrano-Fernandez P, Domagala W, Chosia M, Ucinski M, Grzybowska E, et al: BRCA1-positive breast cancers in young women from Poland. Breast Cancer Res Treat. 2006, 99 (1): 71-76. 10.1007/s10549-006-9182-3.CrossRefPubMed Lubinski J, Gorski B, Huzarski T, Byrski T, Gronwald J, Serrano-Fernandez P, Domagala W, Chosia M, Ucinski M, Grzybowska E, et al: BRCA1-positive breast cancers in young women from Poland. Breast Cancer Res Treat. 2006, 99 (1): 71-76. 10.1007/s10549-006-9182-3.CrossRefPubMed
27.
go back to reference Yin D, Morris C, Allen M, Cress R, Bates J, Liu L: Does socioeconomic disparity in cancer incidence vary across racial/ethnic groups?. Cancer Causes Control. 2010, 21 (10): 1721-1730. 10.1007/s10552-010-9601-y.CrossRefPubMedPubMedCentral Yin D, Morris C, Allen M, Cress R, Bates J, Liu L: Does socioeconomic disparity in cancer incidence vary across racial/ethnic groups?. Cancer Causes Control. 2010, 21 (10): 1721-1730. 10.1007/s10552-010-9601-y.CrossRefPubMedPubMedCentral
Metadata
Title
Molecular subtype analysis determines the association of advanced breast cancer in Egypt with favorable biology
Authors
Bodour Salhia
Coya Tapia
Elia A Ishak
Salwa Gaber
Bree Berghuis
Khateeb H Hussain
Rachelle A DuQuette
James Resau
John Carpten
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Women's Health / Issue 1/2011
Electronic ISSN: 1472-6874
DOI
https://doi.org/10.1186/1472-6874-11-44

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