Pia Eber-Schulz1, Wakuma Tariku2, Christian Reibold1, Adamu Addissie3, Claudia Wickenhauser4, Christine Fathke4, Steffen Hauptmann5, Ahmedin Jemal6, Christoph Thomssen1, Eva Johanna Kantelhardt7,8. 1. Department of Gynecology, Martin-Luther-University, Halle, Germany. 2. Ethiopian Evangelical Church of Mekane Yesus EECMY Aira Hospital, Aira, Ethiopia. 3. School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia. 4. Department of Pathology, Martin-Luther-University, Halle, Germany. 5. Maastricht University Medical Centre, Maastricht, The Netherlands. 6. American Cancer Society, Atlanta, USA. 7. Department of Gynecology, Martin-Luther-University, Halle, Germany. eva.kantelhardt@uk-halle.de. 8. Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University, Saale, Halle, Germany. eva.kantelhardt@uk-halle.de.
Abstract
PURPOSE: To describe the histopathological characteristics and survival of female breast cancer (BC) patients in a rural setting with limited access to adjuvant treatment. METHODS: A prospective study of 107 histologically confirmed BC patients treated with surgery from 2010 to 2016 from rural parts of western Ethiopia. Referral pathology was performed, and active follow-up was conducted. Adjusted cox regression analysis (hazard ratio [HR]) was performed. RESULTS: The median age at diagnosis was 45 (16-83) years; 57% of the patients presented with cT3/4 tumors, 71% with clinically positive lymph nodes, 21% with HER2-overexpression (Dako3+) and 68% with grade 3 tumors. Estrogen and/or progesterone receptor expressions were present in 66% and triple-negative disease in 25%. The estimated 1- and 2-year overall survival probability rates were 78 and 53%, respectively. The 2-year survival for patients with clinically positive lymph nodes was 44% compared to 73% for patients with lymph node-negative disease (HR 2.44; 95% confidence interval [95% CI] 1.19-5.02). The corresponding 2-year survival for patients with cT4 tumors was 25% versus 68% for patients with cT1-2 tumors (cT1-3 vs. cT4 HR 3.86; 95% CI 1.82-13.63). The 2-year survival for patients with hormone receptor-negative disease was 40% compared to 59% for patients with hormone receptor-positive disease (HR 1.92; 95% CI 1.06-3.47). CONCLUSION: The majority of breast cancer patients treated with surgery in rural parts of western Ethiopia are diagnosed at advanced stage and have hormone receptor-positive disease. Nearly half of the patients die within 2 years. These findings underscore the need for provision of adjuvant hormonal therapy and for the establishment of pathology service including hormone receptor testing.
PURPOSE: To describe the histopathological characteristics and survival of female breast cancer (BC) patients in a rural setting with limited access to adjuvant treatment. METHODS: A prospective study of 107 histologically confirmed BC patients treated with surgery from 2010 to 2016 from rural parts of western Ethiopia. Referral pathology was performed, and active follow-up was conducted. Adjusted cox regression analysis (hazard ratio [HR]) was performed. RESULTS: The median age at diagnosis was 45 (16-83) years; 57% of the patients presented with cT3/4tumors, 71% with clinically positive lymph nodes, 21% with HER2-overexpression (Dako3+) and 68% with grade 3 tumors. Estrogen and/or progesterone receptor expressions were present in 66% and triple-negative disease in 25%. The estimated 1- and 2-year overall survival probability rates were 78 and 53%, respectively. The 2-year survival for patients with clinically positive lymph nodes was 44% compared to 73% for patients with lymph node-negative disease (HR 2.44; 95% confidence interval [95% CI] 1.19-5.02). The corresponding 2-year survival for patients with cT4 tumors was 25% versus 68% for patients with cT1-2 tumors (cT1-3 vs. cT4 HR 3.86; 95% CI 1.82-13.63). The 2-year survival for patients with hormone receptor-negative disease was 40% compared to 59% for patients with hormone receptor-positive disease (HR 1.92; 95% CI 1.06-3.47). CONCLUSION: The majority of breast cancerpatients treated with surgery in rural parts of western Ethiopia are diagnosed at advanced stage and have hormone receptor-positive disease. Nearly half of the patients die within 2 years. These findings underscore the need for provision of adjuvant hormonal therapy and for the establishment of pathology service including hormone receptor testing.
Entities:
Keywords:
Africa; Breast cancer; Ethiopia; Prognostic factors; Survival
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