Hormonal and Her2 Receptor Immunohistochemistry of Breast Cancers in Ile-Ife, Nigeria

Research Article

Austin J Womens Health. 2015;2(1): 1009.

Hormonal and Her2 Receptor Immunohistochemistry of Breast Cancers in Ile-Ife, Nigeria

Omoniyi-Esan GO¹, Olaofe OO²*, Aremu OA³,Omonisi AE4, Olasode BJ5 and Adisa OA6

¹Department of Morbid Anatomy & Forensic Medicine, College of Health Sciences, Obafemi Awolowo University, Nigeria

²Department of Morbid Anatomy & Forensic Medicine, College of Health Sciences, Obafemi Awolowo University, Nigeria

³Departments of Morbid Anatomy & Forensic Medicine, Obafemi Awolowo University Teaching Hospital, Nigeria

4Departments of Morbid Anatomy & Forensic Medicine, Obafemi Awolowo University Teaching Hospital, Nigeria

5Department of Morbid Anatomy & Forensic Medicine, College of Health Sciences, Obafemi Awolowo University, Nigeria

6Department of Surgery, College of Health Sciences, Obafemi Awolowo University, Nigeria

*Corresponding author: Dr. Olaofe OO, Department of Morbid Anatomy & Forensic Medicine, College of Health Sciences, Obafemi Awolowo University, Nigeria

Received: April 03, 2015; Accepted: May 28, 2015; Published: May 29, 2015

Abstract

Aim: The aim of this study was to assess Estrogen Receptor (ER), Progesterone Receptor (PR) and ErB B2 receptor (Her2) status of Breast cancers in Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria.

Materials and Method: A 5-year prospective study was done of all Breast cancers in Department of Morbid Anatomy and Forensic Medicine, OAUTHC, Ile-Ife, Nigeria, from January 2007 to December 2012.

Results: A total of 136 cases of Breast cancers were seen in the study period. Immunohistochemistry was done on all these cases. The mean age was 50.7±13.5 SD (yrs). The age range was 23-92 yrs. Phenotypic classification based on ER, PR and Her2 immunohistochemistry show 45 cases (33.1%) to be Basal-like (Triple negative), 30 cases (22.1%) are Her2 over expressing, 21 cases (15.4%) are Luminal B type, 20 cases (14.7%) are luminal A type.

Conclusion: A significant number of cases is Estrogen receptor positive; hence in a resource poor setting like ours, the use of anti-estrogens in treatment of breast cancer cases with unknown receptor status may be justified as these drugs are known to be relatively cheap. It is not possible to predict the breast cancer phenotypes by using the age at presentation.

Keywords: Breast Cancer; Hormonal Receptor; Immunohistochemistry

Abbreviations

ER: Estrogen Receptor; PR: Progesterone Receptor; Triple Neg: Triple Negative; OAUTHC: Obafemi Awolowo University Teaching Hospitals Complex; FNAC: Fine Needle Aspiration Cytology

Introduction

Breast cancer is a malignant neoplasm with a huge mental and financial burden in Nigeria [1]. It is known to cause up to 50% of all malignancies in females [2,3]. Breast cancer is known to have a relatively high mortality rate in African women [4,5]. This cancer apart from causing a significant mortality also markedly reduces the quality of life of the patient. Although there is relatively good awareness of breast cancer in some communities in Nigeria, substantial number of people still seems to be ignorant of the disease.

Some molecular studies have been done on breast cancers to identify the genetic or hereditary factors that contribute to the genesis of the disease. Many of these studies have identified a small but significant number of genetic mutations [6-8]. Identification of genetic mutations in families is important in preventive efforts. Despite identification of genetic factors in aetiology of the disease, only a few respondents in a study will agree for a prophylactic mastectomy if necessary [9].

Even though new molecules of clinical significance have been identified in Nigerian women [10], the Estrogen Receptor (ER), Progesterone Receptor (PR) and Her2 receptor statuses are still of utmost clinical significance. The standard treatment protocols in use today revolve around ER, PR, and Her2 receptor expression by the malignant cancer cells. This is used to determine treatment in patients who can afford the related drugs. There have been various efforts to introduce new drugs to treatment of these cases but most new drugs are expensive and hence not readily available.

In many cases of breast cancer in Nigeria, presentation to the hospital is relatively late; hence, the standard therapeutic modified radical mastectomy cannot be used. Chemotherapy is used for these patients [11-14]. It is therefore very important to study the receptor status of breast cancer to know its relationship with clinical data and its possible influence in our resource limited treatment protocol.

Aim

The aim of this study was to assess ER, PR and Her2 receptor status of Breast cancers in Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria and to relate the findings with the age of the patient.

Materials and Methods

A 5-year prospective study was done of all Breast cancers in Department of Morbid Anatomy and Forensic Medicine, OAUTHC, Ile-Ife, Nigeria, from January 2007 to December 2012. The whole population of breast cancer cases seen in this period was included in the study. There was no sampling done. Inclusion criteria were all cases of breast cancer with tissue biopsy and conclusive histological diagnosis. Cases with incomplete data and inadequate tissue biopsy were excluded from the study. Relevant clinical data was extracted from histological request forms and case notes.

The cancer tissues were routinely fixed in buffered formalin. The tissues were further processed in an Automatic tissue Processor. Histologic diagnoses were made from haematoxylin and eosin stained sections obtained from the paraffin wax tissue blocks.

The sections from each representative block were subjected to immunohistochemistry. A standard immunohistochemistry protocol was used. 3-3’Diaminobenzidine tetrahydrochloride was used as chromogen and haematoxylin was used as counter stain. Immunohistochemical staining for estrogen receptor, progesterone receptor and Her2/neu were carried out retrospectively on sections from the processed tissue blocks. A standard positive control was used with each batch to ensure consistency between batches. A negative control was also used for standardization. The standard positive and negative controls were obtained from tissue blocks used for routine procedures in the laboratory.

Data analysis

The results obtained were analyzed using Statistical Package for Social Sciences version 15. The results were presented in charts. Chi square tests were used. The level of statistical significance was put at P = 0.05

Results

A total of 136 cases of Breast cancers were seen in the study period. Immunohistochemistry was done on all these cases. The data on age was available in 131 out of the 136 cases. Most of the cases were from biopsies (85 - 62.5%) while mastectomy accounted for the rest (51 - 37.5%). Females account for the overwhelming majority with 132 cases (97.1%) while males account for 4 cases (2.9%).

The mean age was 50.7±13.5 SD (yrs). The age range was 23-92 yrs. The age group 40-50 years account for the highest number of cases (46 cases- 35.1%) while the 50-60 yrs age-group account for the second highest with 28 cases (21.3%). The distribution of the cases in these age groups and others can be seen in (Figure 1).

Citation: Omoniyi-Esan GO, Olaofe OO, Aremu OA, Omonisi AE, Olasode BJ and Adisa OA. Hormonal and Her2 Receptor Immunohistochemistry of Breast Cancers in Ile-Ife, Nigeria. Austin J Womens Health. 2015;2(1): 1009.