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Investigation of breast cancer sub-populations in black and white women in South Africa

Breast Cancer Research and Treatment volume 160, pages 531–537 (2016)Cite this article

Abstract

Purpose

Bimodal age distributions at diagnosis have been widely observed among US and European female breast cancer populations. To determine whether bimodal breast cancer distributions are also present in a sub-Saharan African population, we investigated female breast cancer in South Africa.

Methods

Using the South African National Cancer Registry data, we examined age-at-diagnosis frequency distributions (density plots) for breast cancer overall and by their receptor (oestrogen, progesterone and HER2) determinants among black and white women diagnosed during 2009–2011 in the public healthcare sector. For comparison, we also analysed corresponding 2010–2011 US SEER data. We investigated density plots using flexible mixture models, allowing early/late-onset membership to depend on receptor status.

Results

We included 8857 women from South Africa, 7176 (81 %) with known oestrogen receptor status, and 95064 US women. Bimodality was present in all races, with an early-onset mode between ages 40–50 years and a late-onset mode among ages 60–70 years. The early-onset mode was younger in South African black women (age 38), compared to other groups (45–54 years).

Conclusions

Consistent patterns of bimodality and of its receptor determinants were present across breast cancer patient populations in South Africa and the US. Although the clinical spectrum of breast cancer is well acknowledged as heterogeneous, universal early- and late-onset age distributions at diagnosis suggest that breast cancer etiology consists of a mixture two main types.

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Fig. 1

Abbreviations

AIC:

Akaike information criterion

CI:

Confidence interval

ER:

Oestrogen receptor

FISH:

Fluorescence in situ hybridization

HER2E:

Human-epidermal growth factor-2 enriched (ER−PR−HER2+)

IHC:

Immunohistochemistry

PR:

Progesterone receptor

SA:

South Africa

SEER:

Surveillance, Epidemiology, and End Results

US:

United States

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Funding

The work reported in this paper was undertaken during the tenure of a Postdoctoral Fellowship to Dr Dickens from the International Agency for Research on Cancer, partially supported by the European Commission FP7 Marie Curie Actions – People – Co-funding of regional, national and international programmes (COFUND).

Author information

Affiliations

  1. Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France

    Caroline Dickens, Joachim Schüz & Valerie A. McCormack

  2. Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa

    Caroline Dickens & Raquel Duarte

  3. Division of Cancer Epidemiology and Genetics, National Cancer Institute, Biostatistics Branch, Executive Plaza South Rm 8036, 6120 Executive Blvd, Bethesda, MD, USA

    Ruth M. Pfeiffer & William F. Anderson

  4. National Cancer Registry of South Africa, National Health and Laboratory Services, Johannesburg, South Africa

    Patricia Kellett & Danuta Kielkowski

Authors
  1. Caroline Dickens
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  2. Ruth M. Pfeiffer
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  3. William F. Anderson
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  4. Raquel Duarte
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  5. Patricia Kellett
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  6. Joachim Schüz
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  7. Danuta Kielkowski
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  8. Valerie A. McCormack
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Corresponding author

Correspondence to Caroline Dickens.

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The authors declare that they have no conflicts of interest.

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Dickens, C., Pfeiffer, R.M., Anderson, W.F. et al. Investigation of breast cancer sub-populations in black and white women in South Africa. Breast Cancer Res Treat 160, 531–537 (2016). https://doi.org/10.1007/s10549-016-4019-1

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  • DOI: https://doi.org/10.1007/s10549-016-4019-1

Keywords

  • Breast cancer
  • Receptors
  • Age distributions
  • South Africa