Breast Cancer in Thailand: A Comprehensive Histopathological Study of Buddhist and Muslim Women. (21st September 2018)

• Record Type: Journal Article
• Authors: Pang, Judy; Carter, Cody; Virani, Shama; Zarins, Katie; Defever, Kali; Khazan, Ana; Colacino, Justin; De Leon, Carlos Mendes; Rozek, Laura; Kleer, Celina
• Is Part Of: American journal of clinical pathology. Volume 150(2018)Supplement 1
• Page Start: S91
• Page End: S92
• Publication Date: 2018-09-21
• Subjects: Diagnosis, Laboratory -- Periodicals; Pathology -- Periodicals; 616.07
• DOI: 10.1093/ajcp/aqy096.222
• Languages: English
• ISSNs: 0002-9173

Abstract

Abstract: Objectives: The incidence of breast cancer in Thailand increased 300% between 1990 and 2010, but the causes are unknown. In this region, the incidence of breast cancer is lower in predominantly Muslim subpopulations compared to Buddhist. The histological features of breast cancers in Thailand have not been fully characterized, and breast carcinomas in Buddhist and Muslim women may exhibit different histological features. Methods: Breast cancer cases diagnosed at Songklanagarind Hospital in Hat Yai, Thailand, in 2004, 2009, 2010, and 2014 were reviewed for existing formalin-fixed, paraffin-embedded blocks. H&E-stained, immunostained, and unstained sections of all available cases were brought to our institution. A comprehensive histopathological study and evaluation of all ER, PR, and HER2 immunostains were carried out by two breast pathologists blinded to clinical and demographic information. Results: We studied 425 cases of invasive carcinoma (369 Buddhist, 55 Muslim). The average age at diagnosis was significantly lower for Muslims than Buddhists, 46.6 versus 52.7 years, respectively ( P = .003). Buddhists more commonly presented at a lower stage (stage 2, 45.6%) than Muslims (stage 3, 36%). Invasive ductal carcinoma (IDC) was the most common type (Buddhist 67%, Muslim 82%), followed by invasive lobular carcinoma (Buddhist 14%, Muslim 9%). In Buddhists, histological heterogeneity was higher than in Muslims, as 17% of IDCs had apocrine, medullary, metaplastic, micropapillary, and papillary areas compared to Muslims, where only micropapillary and metaplastic features were present in 8% of cases. Triple-negative tumors were more common in Muslims compared to Buddhists (30% and 18%, respectively). Conclusion: Age at diagnosis of breast cancer in southern Thailand is significantly younger in Muslim women than Buddhist. Muslims present at a higher stage and have a higher incidence of triple-negative tumors. While tumors in Muslims are histologically homogeneous, tumors in Buddhists exhibit heterogeneity, which may have genetic, biological, and management implications.