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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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).
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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