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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 6  |  Issue : 2  |  Page : 121-123

Clinical and pathological presentations of breast cancer among young women in North-Central Nigeria


Department of Surgery, Faculty of Clinical Sciences, University of Abuja, Abuja, Nigeria

Date of Submission30-May-2021
Date of Decision15-Jul-2021
Date of Acceptance02-Sep-2021
Date of Web Publication29-Dec-2021

Correspondence Address:
Dr. Mojirola Ibukun Alegbejo-Olarinoye
Department of Surgery, Faculty of Clinical Sciences, University of Abuja, Abuja
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jmwa.jmwa_10_21

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  Abstract 

INTRODUCTION: Breast cancer in the young is rare. Breast cancer in young women seems to be on the rise in Nigeria. They present within the peak of reproductive years and career. They have more aggressive disease with a worse prognosis. Treatment is based on knowledge of treatment of older women. There are very scanty data on breast cancer in the young in our environment. This study aims to highlight the clinical stage of presentation and histological subtypes among women below 40.
PATIENTS AND METHODS: This is a prospective study done over 2 years. The patients' sociodemographic data, clinical staging and histological diagnosis were noted.
RESULTS: A total of 112 cases of breast cancer were seen, out of which 58 (51.75%) cases were aged below 40 years. Forty patients (68.9%) cases had Stage IV disease, 12 (20.68%) of the cases had Stage III, five (8.62%) had Stage II and one patient had Stage I (1.72%). Out of the 40 who were Stage IV, three were pregnant in the third trimester. Histology was invasive ductal carcinoma for 48 (84.4%) cases, while nine (15.52%) were invasive lobular cancer and one was medullary carcinoma (1.72%). Hormone and immunohistochemistry showed that 30 (51.7%) were triple-negative, 22 (37.93%) were oestrogen receptor and progesterone receptor+ and six (10.34%) were human epidermal growth factor+.
CONCLUSION: More than half of the total cases of breast cancer seen within the period were young women who presented with late stage of the disease with the majority as triple-negative.

Keywords: Aggressive, breast cancer, young women


How to cite this article:
Alegbejo-Olarinoye MI. Clinical and pathological presentations of breast cancer among young women in North-Central Nigeria. J Med Womens Assoc Niger 2021;6:121-3

How to cite this URL:
Alegbejo-Olarinoye MI. Clinical and pathological presentations of breast cancer among young women in North-Central Nigeria. J Med Womens Assoc Niger [serial online] 2021 [cited 2022 Jan 22];6:121-3. Available from: http://www.jmwan.org/text.asp?2021/6/2/121/334057


  Introduction Top


The incidence of breast cancer increases with age. Most women are diagnosed after the age of 40 years.[1] The risk factors, outcomes and tumour pathology are unique in women below 40 years, indicating that breast cancer in young women may be another clear-cut pathologic entity.[2],[3],[4],[5],[6] Treatment of these women is however based on what is done for older women.

When women are diagnosed with breast cancer at a young age, they are likely to have adverse tumour characteristics and a worse prognosis than those diagnosed at an older age.[7],[8],[9],[10],[11],[12],[13],[14]

A diagnosis of breast cancer in young women creates more burden than in the elderly.[5],[15],[16],[17]

Issues relating to fertility, raising children, sexuality, early menopause and earning a living during/after treatment are what most young women with breast cancer have to face.[18]

Treatment is expensive and only available most times in tertiary centres and not in remote areas.

In breast oncology, the term young woman varies, referring to women younger than 35–40 years. There are very scanty data on breast cancer in young women in Nigeria.

This study aims to highlight the clinical stage of presentation and histological subtypes among women below 40 years seen in the hospital.


  Patients and Methods Top


This was a prospective study conducted at a private clinic in Abuja, North-Central Nigeria. Patients who had breast cancer and were less than 40 years were noted over a 2-year period from June 2018 to June 2020. Informed consent was taken from all participants. Details of the patient's socio-demographic data were noted. Clinical staging (based on TNM classification), histological diagnosis and immunohistochemistry were noted after trucut, incision and excision biopsies were done. A pro forma was used to obtain required data from all the study participants during the study period. The pro forma collected data on socio-demographic and disease characteristics. Data were analysed using SPSS Package Version 25 (IBM Corp., Armonk,N.Y., USA) for windows. Data were expressed as frequencies and proportions with some of these presented as tables.


  Results Top


A total of 112 cases of breast cancer were seen, of which 58 (51.75%) cases were aged below 40 years. The median age was 38 years, and the average age was 40 years.

Forty patients (68.9%) cases had Stage IV disease, 12 (20.68%) of the cases had Stage III, five (8.62%) had Stage II disease and one patient had Stage I (1.72%) [Table 1].
Table 1: Distribution of the number of cases and stage of disease at presentation

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Out of the 40 patients who were Stage IV, three were pregnant in the third trimester.

Histology was invasive ductal carcinoma for 48 (82.75%) cases, while nine (15.53%) were invasive lobular cancer and one was medullary carcinoma (1.72%) [Table 2].
Table 2: Histological type of the tumour

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Hormone and immunohistochemistry showed 30 (51.7%) were triple-negative, 22 (37.93%) were oestrogen receptor and progesterone receptor+ and six (10.34%) were human epidermal growth factor+ [Table 3].
Table 3: Hormone/immunohistochemistry

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Patients who presented at Stages III and IV of the disease had modified radical mastectomy while those with Stages I and II had breast-conserving surgery.


  Discussion Top


Young women with breast cancer account for 51.75% of all the female breast cancers in this study. What is noted in developed countries is 5%–10%.[19] This is very high. The reason this study has a high proportion might be because at intervals surgical outreaches were carried out free of charge in the hospital where women had their breast checked and when necessary other investigations were carried out.

68.5% of the patients came in with Stage IV breast cancer. In Nigeria, young women presenting with late breast cancer are common. This is also seen in developed countries.[19]

Invasive ductal carcinoma was the most common histological type, and this is similar to another study in Nigeria;[16] for immunohistochemistry, the most common was triple-negative. [Figure 1], [Figure 2], [Figure 3] shows histological types of breast cancer.
Figure 1: Invasive lobular carcinoma

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Figure 2: Invasive ductal carcinoma

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Figure 3: Medullary carcinoma

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  Conclusion Top


This study has shown a higher number of young females with breast cancer in our environment than in the developed countries and most present at advanced stages of the disease.

There needs to be creation of more awareness of the disease. Gene studies need to be available, so women can have adequate information early and carry out prophylactic measures before the disease even develops.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
American Cancer Society. Breast Cancer Facts & Figures 2009-2010. Atlanta: American Cancer Society, Inc. 2010.  Back to cited text no. 1
    
2.
Althuis MD, Brogan DD, Coates RJ, Daling JR, Gammon MD, Malone KE, et al. Breast cancers among very young premenopausal women (United States). Cancer Causes Control 2003;14:151-60.  Back to cited text no. 2
    
3.
Winchester DP, Osteen RT, Menck HR. The national cancer data base report on breast carcinoma characteristics and outcome in relation to age. Cancer 1996;78:1838-43.  Back to cited text no. 3
    
4.
Anders CK, Hsu DS, Broadwater G, Acharya CR, Foekens JA, Zhang Y, et al. Young age at diagnosis correlates with worse prognosis and defines a subset of breast cancers with shared patterns of gene expression. J Clin Oncol 2008;26:3324-30.  Back to cited text no. 4
    
5.
Nixon AJ, Neuberg D, Hayes DF, Gelman R, Connolly JL, Schnitt S, et al. Relationship of patient age to pathologic features of the tumor and prognosis for patients with stage I or II breast cancer. J Clin Oncol 1994;12:888-94.  Back to cited text no. 5
    
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Colleoni M, Rotmensz N, Robertson C, Orlando L, Viale G, Renne G, et al. Very young women (<35 years) with operable breast cancer: Features of disease at presentation. Ann Oncol 2002;13:273-9.  Back to cited text no. 6
    
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Sabiani L, Houvenaeghel G, Heinemann M, Reyal F, Classe JM, Cohen M, et al. Breast cancer in young women: Pathologic features and molecular phenotype. Breast 2016;29:109-16.  Back to cited text no. 7
    
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Passhak M, Shachar SS, Bar-Sela G, Fried G. Breast cancer in young women aged 35 and under: Patterns of care and outcome. Breast J 2018;24:441-3.  Back to cited text no. 8
    
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Greally M, Kielty J, Watson GA, Das G, Malouf C, McSorley L, et al. Where youth matters – Clinicopathologic characteristics and emerging trends in treatment and outcomes in young Irish women with breast cancer. Ir J Med Sci 2019;188:59-67.  Back to cited text no. 9
    
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de Azambuja E, Holmes AP, Piccart-Gebhart M, Holmes E, Di Cosimo S, Swaby RF, et al. Lapatinib with trastuzumab for HER2-positive early breast cancer (NeoALTTO): Survival outcomes of a randomised, open-label, multicentre, phase 3 trial and their association with pathological complete response. Lancet Oncol 2014;15:1137-46.  Back to cited text no. 10
    
11.
Copson E, Eccles B, Maishman T, Gerty S, Stanton L, Cutress RI, et al. Prospective observational study of breast cancer treatment outcomes for UK women aged 18–40 years at diagnosis: The POSH study. J Natl Cancer Inst 2013;105:978-88.  Back to cited text no. 11
    
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Gnerlich JL, Deshpande AD, Jeffe DB, Sweet A, White N, Margenthaler JA. Elevated breast cancer mortality in women younger than age 40 years compared with older women is attributed to poorer survival in early-stage disease. J Am Coll Surg 2009;208:341-7.  Back to cited text no. 12
    
13.
Chen HL, Zhou MQ, Tian W, Meng KX, He HF. Effect of age on breast cancer patient prognoses: A population-based study using the SEER 18 database. PLoS One 2016;11:e0165409.  Back to cited text no. 13
    
14.
Jayasinghe UW, Taylor R, Boyages J. Is age at diagnosis an independent prognostic factor for survival following breast cancer? ANZ J Surg 2005;75:762-7.  Back to cited text no. 14
    
15.
Gajdosc C, Tartter PL, Bleweiss IJ. Stage 0 to stage 111 breast cancer in young women. J Am Coll Surg 2000;190:525-9.  Back to cited text no. 15
    
16.
Foxcroft LM, Evans EB, Porter AJ. The diagnosis of breast cancer in women younger than 40. Breast 2004;13:297-306.  Back to cited text no. 16
    
17.
Ihemelandu CU, Leffall LD Jr., Dewitty RL, Naab TJ, Mezghebe HM, Makambi KH, et al. Molecular breast cancer subtypes in premenopausal and post menopausal African-American women: Age specific prevalence and survival. J Surg Res 2007;143:109-18.  Back to cited text no. 17
    
18.
Boyages J, Recht A, Connolly JL, Schnitt SJ, Gelman R, Kooy H, et al. Early breast cancer: Predictors of breast recurrence for patients treated with conservative surgery and radiation therapy. Radiother Oncol 1990;19:29-41.  Back to cited text no. 18
    
19.
Ntekim A, Nufu FT, Campbell OB. Breast cancer in young women in Ibadan, Nigeria. Afr Health Sci 2009;9:242-6.  Back to cited text no. 19
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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