Immunohistochemistry-derived subtypes of breast cancer distribution in four regions of Ethiopia

Esmael Besufikad Belachew; Adey Feleke Desta; Tewodros Yalew Gebremariam; Dinikisira Bekele Deneke; Senait Ashenafi; Melisachew Mulatu Yeshi; Bizunesh Dires Fenta; Alemwosen T/Hayimanot Alem; Addisu Alemu; Abdo Kedir Abafogi; Tigist Desta; Menberework Chanyalew; Daniel Beshah; Lesley Taylor; Marcus Bauer; Dareskedar Tsehay; Selfu Girma; Daniel Seifu Melka; Tesfaye Sisay Tessema; Eva J Kantelhardt; Rawleigh Howe

doi:10.3389/fendo.2023.1250189

Immunohistochemistry-derived subtypes of breast cancer distribution in four regions of Ethiopia

Front Endocrinol (Lausanne). 2023 Nov 9:14:1250189. doi: 10.3389/fendo.2023.1250189. eCollection 2023.

Authors

Esmael Besufikad Belachew^{1

2

3}, Adey Feleke Desta^#², Tewodros Yalew Gebremariam⁴, Dinikisira Bekele Deneke⁴, Senait Ashenafi⁴, Melisachew Mulatu Yeshi⁵, Bizunesh Dires Fenta⁶, Alemwosen T/Hayimanot Alem⁶, Addisu Alemu⁷, Abdo Kedir Abafogi⁸, Tigist Desta³, Menberework Chanyalew³, Daniel Beshah⁹, Lesley Taylor¹⁰, Marcus Bauer^{11

12}, Dareskedar Tsehay³, Selfu Girma³, Daniel Seifu Melka¹³, Tesfaye Sisay Tessema¹⁴, Eva J Kantelhardt^#^{15

16}, Rawleigh Howe^#³

Affiliations

¹ Biology Department, College of Natural and Computational Sciences, Mizan Tepi University, Mizan, Ethiopia.
² Department of Microbial, Cellular and Molecular Biology, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
³ Non-Communicable Diseases (NCD) Research Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia.
⁴ Department of Pathology, School of Medicine, College of Health Sciences, Tikur Anbessa Specialized Hospital and Addis Ababa University, Addis Ababa, Ethiopia.
⁵ Department of Pathology, School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
⁶ Pathology Department, Hawassa Referral Hospital, Hawassa, Ethiopia.
⁷ College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
⁸ Pathology Department, Jimma University Specialized Hospital, Jimma, Ethiopia.
⁹ Department of Diagnostic Laboratory, Tikur Anbessa Specialized Hospital, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
¹⁰ City of Hope National Medical Center, Duarte, CA, United States.
¹¹ Global Health Working Group, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
¹² Institute of Pathology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
¹³ Department of Biochemistry, Division of Basic Sciences, University of Global Health Equity, Kigali, Rwanda.
¹⁴ Institute of Biotechnology, Addis Ababa University, Addis Ababa, Ethiopia.
¹⁵ Department of Gynecology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
¹⁶ Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.

^# Contributed equally.

Abstract

Purpose: Different biological characteristics, therapeutic responses, and disease-specific outcomes are associated with different molecular subtypes of breast cancer (BC). Although there have been different studies on BC in the Ethiopian capital city of Addis Ababa, there have been few studies in other parts of the nation, and none have evaluated biological characteristics in other locations in the context of the extensive ethnic and genetic diversity found in Ethiopia. This study was carried out to evaluate the distribution of immunohistochemistry (IHC) subtypes of BCs throughout four Ethiopian regions.

Methods: A total of 227 formalin-fixed paraffin-embedded (FFPE) tissue blocks were collected from tertiary hospitals in four Ethiopian regions between 2015 and 2021. The IHC staining was performed for subtyping, ER, PR, HER2, and Ki-67 proliferation markers.

Results: The mean age at diagnosis was 43.9 years. The percentage of ER and PR-negative tumors were 48.3% and 53.2%, respectively. The IHC subtypes showed the following distribution: 33.1% triple-negative breast cancer (TNBC), 27.6% luminal B, 25.2% luminal A, and 14.1% HER2 enriched. In multiple logistic regression analysis, grade III and HER2 positivity were associated with larger tumor size, and also originating from Jimma compared to Mekele.

Conclusion: Patients with ER-negative, PR-negative, and TNBC were found in 48.3%, 53.2%, and 33.1% of cases, respectively, showing that half the patients could potentially benefit from endocrine treatment. A considerably high prevalence of TNBC was reported in our study, demanding additional research that includes genetic predisposition factors. Additionally, aggressive tumors were found in a high percentage of younger age groups, which must be considered when planning personalized treatment strategies.

Keywords: Africa; Ethiopia; breast cancer; estrogen receptor; immunohistochemistry; subtype.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Ethiopia / epidemiology
Humans
Immunohistochemistry
Receptor, ErbB-2
Receptors, Estrogen
Triple Negative Breast Neoplasms* / pathology

Substances

Receptor, ErbB-2
Receptors, Estrogen

Grants and funding

This study was funded by Armauer Hansen Research Institute,Addis Ababa University, Mizan Tepi University. Additionally, this study received some funding from Else-Kroener-Foundation through Martin-Luther-University, Halle-Wittenberg, Germany, grant No. 2018_HA31SP and by a Grant from Hospital Partnerships Funding Program through Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) commissioned by the German Federal Ministry for Economic Cooperation and Development (BMZ) No. 81281915.