Myelodysplasia in Ugandan patients with HIV/AIDS: an autopsy study.

BACKGROUND: Myelodysplasia has been reported to occur quite frequently in the spectrum of HIV/AIDS disease and is thought to be partly responsible for bone marrow failure in these patients. However, the frequency and type of myelodysplasia appear to differ at different stages of the disease in different populations with mechanisms of its development not well understood. OBJECTIVE: To document the pattern of myelodysplasia in Ugandan patients with terminal HIV/AIDS disease. DESIGN: Prospective descriptive study. SETTING: Department of Pathology, Faculty of Medicine, Makerere University College of Health Sciences SUBJECTS: Bone marrow necropsies from patients who died with AIDS disease at Mulago teaching hospital in Kampala, Uganda during a one-year period. RESULTS: Eighty-four (84%) of the 50 cases studied had myelodysplasia with 39 cases having megakaryocytic myelodysplasia. Myelodysplasia involving erythroid cell series occurred in 23 and in 20 of these cases was in combination with megakaryocytic dysplasia. Granulocyte myelodysplastic features were observed in only two cases and these two cases did not have other cell lines involved. CONCLUSION: Myelodysplastic features are common in HIV patients with megakaryocytic and eythroid cell lines being the most affected. This could be due to the direct HIV effect, or the combined effect of opportunistic infections, neoplasms, drugs and HIV itself affecting the haemopoietic stem cell and or its microenvironment.

Expression of aldehyde dehydrogenase 1 (ALDH1) is associated with basal-like markers and features of aggressive tumours in African breast cancer.

BACKGROUND: Putative breast cancer stem cells might express surface markers such as aldehyde dehydrogenase 1 (ALDH1) and BMI-1 proteins. The aim of this study was to explore the expression of these proteins in breast cancers from an African population and their associations with the basal-like phenotype (BLP) and other molecular characteristics. METHODS: We analysed 192 paraffin-embedded breast carcinoma samples by tissue microarrays and immunohistochemical methods. RESULTS: In total, 88 tumours (48%) expressed ALDH1, whereas 46 (25%) expressed BMI-1 protein. Expression of ALDH1 was associated with high histological grade (P<0.0005), high mitotic count (P<0.0005), high nuclear grade (P<0.0005), oestrogen receptor (ER) negativity (P<0.0005), progesterone receptor (PR) negativity (P=0.009), p53 expression (P=0.034), cytokeratin 5/6 positivity (P=0.008), epidermal growth factor receptor (EGFR) expression (P=0.015) and the BLP (P<0.0005), whereas it was inversely associated with BMI-1 staining (P=0.009). On the other hand, BMI-1 expression was associated with low histological grade (P=0.004) and ER positivity (P=0.001). CONCLUSION: There was a high prevalence of ALDH1 expression among breast carcinomas and associations with basal markers and features of aggressive tumours. Studies are required to elucidate the importance of these findings for improved understanding of breast cancer biology.

Trends in the incidence of primary liver cancer in Central Uganda, 1960-1980 and 1991-2005.

Primary liver cancer (PLC) incidence trends from Africa are unknown. Using Kampala Cancer Registry data from 1960 to 1980 and 1991 to 2005, we identified 771 PLCs. Although rates were stable among men, PLC incidence among women increased >50%. Investigations of viral hepatitis, aflatoxin, obesity, and human immunodeficiency virus (HIV) may help to explain the increasing incidence of hepatocellular carcinomas (HCCs).

Lymphomas diagnosed in Uganda during the HIV/AIDS pandemic.

BACKGROUND: There are numerous reports from different countries documenting a change in frequency and profile of lymphomas after the onset of the HIV/AIDS pandemic. In Uganda little is known concerning the distribution of lymphoma subtypes diagnosed at the Department of Pathology, Makerere University College of Health Sciences during this period. OBJECTIVE: To examine the frequency and diagnostic profile of lymphomas diagnosed in Uganda in the HIV/AIDS era. DESIGN: Retrospective study. SETTING: Department of Pathology, Makerere University College of Health Sciences, Kampala, Uganda. SUBJECTS: One thousand and thirteen patients diagnosed with lymphomas in the period 1980-1989. RESULTS: The most common type of non-Hodgkin lymphoma was Burkitt lymphoma (36%). The frequencies of lymphocytic and histiocytic types were 34.5% and 8.2% respectively. CONCLUSION: There was a decrease in histopathologically diagnosed lymphomas in Uganda in the period 1980-1989. Burkitt lymphoma continues to be the most common subtype diagnosed, some major lymphoma subtypes like T-cell and follicular lymphomas were not reported in the country in the HIV/AIDS era.

Burkitt's lymphoma in Uganda: the role of immunohistochemistry in diagnosis.

BACKGROUND: Haematoxylin and eosin staining has remained the standard diagnostic method for Burkitt's lymphoma. Ancillary tests including immunohistochemistry, not widely available in developing countries, are important tools in verifying the diagnosis of lymphomas with equivocal morphological findings. OBJECTIVE: To evaluate the reliability of haematoxylin and eosin staining in the diagnosis of Burkitt's lymphoma using immunohistochemistry as the gold standard. DESIGN: Cross sectional study. SETTING: Department of Pathology laboratory, Makerere University Medical School, Uganda. SUBJECTS: One hundred and thirty eight formalin fixed paraffin embedded biopsies of Burkitt's lymphoma diagnosed from January 2001 to December 2005. RESULTS: Of the 138 tumours, 88.4% were extra-nodal: jaw 36.2%, ovary 21%, gastrointestinal tract 12.3% other abdominal 11.6%. Males (55.8%) predominated. The sensitivity and specificity of haematoxylin and eosin were 93.2% and 50% respectively. The positive and negative predictive values were 91.7% and 55.6%. CONCLUSION: Histology using haematoxylin and eosin staining is sensitive in the diagnosis of Burkitt's lymphoma but not very specific. Immunohistochemical staining with CD20, Ki-67 and bcl-2 is necessary for difficult cases.

c-erbB-2 oncoprotein over-expression in breast cancer and its relationship to histology and grade in a Ugandan population.

OBJECTIVE: To evaluate c-erbB-2 oncoprotein over expression in breast cancer patients of Kyadondo county and also relate this oncoprotein to histological type and grade of the tumour. DESIGN: Cross-sectional study. SETTING: Pathology Department, Faculty of Medicine, Makerere University. SUBJECTS: Seventy two breast cancer patients who were among the 174 entered in survival study had their paraffin breast tissue blocks retrieved from archives of Pathology Department and had their c-erbB-2 determined by peroxidase-labeled streptavidin-biotin immunohistochemical method. RESULTS: c-erbB-2 oncoprotein was over expressed in 33.3% of the tumours and correlated positively with histological grade (p = 0.007). TH oncoprotein over expression was not restricted to any particular histological type and there was no association with age of patient. CONCLUSION: The over expression of c-erbB-2 oncoprotein observed in one third of breast cancer patients of this African population could partly explain the observed poor survival rate reported in this community.

Kaposi's sarcoma-associated herpesvirus and Kaposi's sarcoma in Africa. Uganda Kaposi's Sarcoma Study Group.

BACKGROUND: Endemic Kaposi's sarcoma (KS) is a clinically and epidemiologically distinct human immunodeficiency virus negative form of KS occurring in Africa. Kaposi's sarcoma is now the most frequently reported cancer in some areas of Africa. OBJECTIVE: To determine if a KS-associated herpesvirus (KSHV) is present in both endemic HIV-seronegative and HIV-seropositive KS lesions from African patients. METHODS: Paraffin-embedded tissue specimens from Ugandan patients with KS and non-KS tumor control patients attending a university-based oncology clinic were examined in a blinded case-control study. Tissue DNA specimens were examined for detectable KSHV genome by nested polymerase chain reaction performed at two independent laboratories. RESULTS: We identified KSHV in 17 (85%) of 20 KS tissue specimens from HIV-seronegative patients and 22 (92%) of 24 KS tissue specimens from HIV-infected persons. Kaposi's sarcoma lesions from four HIV-infected persons and four HIV-seronegative persons were positive for KSHV. Unlike previous studies in North America and Europe, three (14%) of 22 non-KS cancer control patients' tissue specimens were also positive for KSHV that resulted in an overall odds ratio of 49.2 (95% confidence interval, 9.1 to 335) for detecting KSHV in KS lesions from patients in Uganda. CONCLUSION: As in North America and Europe, KSHV infection is strongly associated with both HIV-seropositive and HIV-seronegative KS in Africa. However, it is likely that infection with this virus is more highly prevalent in Uganda.

The pathology of severe morbidity and mortality caused by HIV infection in Africa.

PIP: AIDS is the leading cause of death among adults in at least two capital cities in Africa: Abidjan, Cote d'Ivoire, and Kinshasa, Zaire. Knowledge of the causes of morbidity and mortality in HIV-positive people in Africa is, however, less than complete due to limited postmortem diagnostic facilities, difficulties in obtaining consent for postmortem examinations, and a general lack of pathologists. Although HIV affects all organs, either directly or by facilitating opportunistic infections and tumors, pulmonary insufficiency, wasting, cerebral lesions compromising vital centers, and overwhelming toxic systemic infection are the major causes of HIV disease. Virtually every pathological lesion described in developed countries has also been seen in Africa. This paper discusses what is known of the major serious pathologies in sub-Saharan Africa. It is clear that more pathological diagnostic and follow-up data are needed before an accurate picture of the patterns and pathogeneses of the various manifestations of HIV infection in Africa can be drawn. Sections consider HIV-1 and HIV-2 infection, Mycobacterium tuberculosis infection, non-tuberculosis pulmonary disease, diarrhea and the wasting syndrome, neuropathology, specific systemic infections, tumors associated with HIV infection, and pediatric AIDS in Africa.^ieng

AIDS-related cancers in Africa: maturation of the epidemic in Uganda.

BACKGROUND: The AIDS epidemic has passed its peak in Uganda, with possible consequences for the risk of cancers related to infectious agents. OBJECTIVE: To compare the incidence of cancers possibly linked to infections with HIV, before the AIDS epidemic (the 1960s), at its high point (the early 1990s) when HIV-seroprevalence and AIDS notifications peaked, and after the onset of its decline in the later 1990s. METHODS: Analysis of incidence rates of infection-associated cancers in the population of Kyadondo county, in 1960-1971, 1991-1994, and 1995-1997. Comparison with data on prevalence of HIV infection, and notifications of AIDS. RESULTS: The incidence of Kaposi's sarcoma has increased enormously since the 1960s, with a shift to earlier age at onset, and more generalized and nodal disease; there has been little change in the profile during the 1990s. There was a large increase in incidence of squamous cell carcinomas of the conjunctiva, which has continued through the 1990s. Non-Hodgkin's lymphomas showed little increase in incidence until the most recent period, in which the incidence has increased both in children (particularly Burkitt's lymphomas) and adults. Although the incidence of cervical cancer was higher in the 1990s than the 1960s, it seems doubtful that this is related to HIV infection. Certain other cancers which have been linked to AIDS in western populations (Hodgkin's disease, anal carcinoma, childhood leiomyosarcoma) show no changes in risk. CONCLUSION: The AIDS epidemic has dramatically changed the profile of cancer in Uganda. Trends in the AIDS-related cancers are consistent with current knowledge concerning the mechanisms behind the increased risk. The incidence of certain cancers with a viral aetiology (liver, cervix, penis, Hodgkin's disease) appears not to have been influenced by AIDS.

Non-Hodgkin lymphoma in Uganda: a case-control study.

BACKGROUND: Lymphomas are a relatively common complication of AIDS in western countries, but little is known of the impact of the AIDS epidemic in Africa on the risk of these tumours. OBJECTIVE: To investigate the types of non-Hodgkin lymphoma (NHL) occurring in Kampala, Uganda, their association with Epstein-Barr virus (EBV), and how their risk is modified by HIV and other variables. METHODS: A case-control study comparing NHL cases with age/sex-matched controls. Lymphoma cases included 50 histologically diagnosed adults (31 with validation and phenotyping) and 132 histologically diagnosed children (61 with validation and phenotyping). Controls were adults with cancers unrelated to HIV and children with non-infectious diseases. RESULTS: Most (90%) childhood lymphomas were EBV-positive Burkitt's lymphoma (BL), with no association with HIV. Adult lymphoma cases were mainly BL (mostly EBV positive) or diffuse B cell lymphomas (71%). Only a weak association was found with HIV infection; a more precise estimate was obtained with the total series (OR 2.2, 95% CI 0.9-5.1) than validated/phenotyped cases (OR 2.1, 95% CI 0.3-6.7). Higher socioeconomic status adults, who travelled away from home, or had a history of sexually transmitted diseases, appeared to have a moderately increased risk of lymphoma. CONCLUSION: Childhood lymphomas were predominantly endemic BL, the risk of which was not modified by HIV. In adults, the risk associated with HIV was much lower in Uganda than in western countries, possibly because of the poor survival of immunosuppressed HIV-positive individuals. Future studies will require careful attention to subtyping of lymphomas, to investigate the possible differences between them.

Risk factors for Kaposi's sarcoma in HIV-positive subjects in Uganda.

BACKGROUND: Kaposi's sarcoma (KS) is associated epidemiologically with HIV infection and with human herpesvirus 8 (HHV-8 or KSHV). Both KS and HIV infection are common in Uganda. We conducted a case-control study of 458 HIV-seropositive. Ugandan adults with KS and 568 HIV-seropositive subjects without KS to examine risk factors for HIV-associated KS. METHODS: We recruited newly diagnosed adult KS cases from five hospitals in Kampala, Uganda and controls from a large referral clinic for HIV infection at Mulago Hospital. All cases and controls were counselled and tested for HIV and answered an interviewer-administered questionnaire about their home, socio-economic conditions, lifestyle and sexual behaviour before they became ill. Only HIV-seropositive subjects were included in the analysis. RESULTS: There were 295 males and 163 females with KS and 227 male and 341 female controls. Age distribution was similar but there was a higher proportion of cases (45%) than controls (29%) residing in rural regions of Uganda. KS cases were more likely than controls to have a higher level of education (X2 for trend, 4.8; P = 0.03), to have occupations associated with affluence [chi 2 for heterogeneity, 17.3 on 5 degrees of freedom (df); P = 0.004] and to come from larger settlements [adjusted odds ratio (OR) for settlements of > 1000 versus 10-99 houses, 1.8; 95% confidence interval (CI), 1.1-3.0]. Cases were more likely than controls to have high household income (chi 2 for trend, 32.6; P < 0.001) and other markers of urban or rural wealth such as owning several cows (chi 2 for trend, 9.5; P = 0.002). Cases were more likely to travel away from home (adjusted OR, 1.6; 95% CI, 1.1-2.3) and more likely to have spent increasing time in contact with water (chi 2 for trend, 12.3; P < 0.001). Few indices of sexual behaviour were related to risk of KS, including reported number of sexual partners. Cases were more likely than controls to be married to one rather than several spouses (adjusted OR, 1.6; 95% CI, 1.2-2.2) and to have reported a history of sexually transmitted diseases (STD) (adjusted OR, 1.6; 95% CI, 1.2-2.3). CONCLUSIONS: Among HIV-infected subjects, KS cases are characterized by better education and greater affluence, compared with controls. Urban address, travel away from home, exposure to water, monogamous marriage and self-reported STD were also more frequent among KS cases than controls. The higher socio-economic status of persons with HIV and KS may be a marker for enhanced exposure to a possibly sexually transmitted agent, or for a delayed exposure to a childhood infection. The risk posed by exposure to water among KS cases requires further study.

PIP: The risk factors for Kaposi's sarcoma in HIV-infected persons were investigated in a case-control study conducted in Kampala, Uganda, in 1994-96. Cases included 458 HIV-positive Ugandans with newly diagnosed Kaposi's sarcoma, while the control group was comprised of 568 seropositive subjects without Kaposi's sarcoma. Men and women with Kaposi sarcoma were significantly more likely than controls to have a higher educational level, have prestigious professional or military jobs, to come from large settlements (over 1000 houses), to have a high household income, to travel away from home more than seven nights per year, and to have spent increasing time in contact with water. In addition, cases were more likely than controls to be married to one rather than several spouses and to have a history of a sexually transmitted disease. Indices of sexual behavior, including reported number of sexual partners and condom use, were unrelated to Kaposi's sarcoma risk. The higher socioeconomic status of HIV-infected persons with Kaposi's sarcoma may be a marker for enhanced exposure to a sexually transmitted agent such as human herpes virus-8 or for delayed exposure to a childhood infection. The puzzling association between exposure to water and Kaposi's sarcoma warrants further investigation.

Human papillomaviruses and cancer in Uganda.

In a case-control study in Uganda, we examined associations between different cancer sites or types in relation to antibodies against human papillomaviruses (HPV)-16, -18 and -45. For each cancer site or type, the control group comprised all other cancers excluding those known, or thought to be associated with HPV infection (cancers of the uterine cervix, penis and eye). Among controls the seroprevalence of antibodies was 11% (68/616) against HPV-16, 5% (29/605) against HPV-18 and 6% (35/605) against HPV-45. Antibodies against HPV-16 were significantly associated with only two cancers: uterine cervix [prevalence of antibodies 27% (51/191); odds ratio (OR) 2.0, 95% confidence interval (CI) 1.2-3.1, P=0.01] and penis [prevalence of antibodies 27% (4/15); OR 6.4, 95% CI 1.7-24.3, P=0.01]. For both cancers, the risk increased with increasing anti-HPV-16 antibody titre (Ptrend=0.01 for each). No cancer site or type was significantly associated with antibodies against HPV-18 and -45.

Pattern of cancer in Mbarara, Uganda.

OBJECTIVE: To determine the pattern of cancer in Mbarara region. DESIGN: Retrospective descriptive study. SETTING: Mbarara University of Science and Technology (MUST), Mbarara, southwestern Uganda. SUBJECTS: A total of 585 cancer patients diagnosed between 1995 and 1999 formed the basis of the analysis. RESULTS: The most frequent cancers observed among males in their descending order were Kaposis sarcoma (KS), stomach, Non Hodgkin Lymphoma (NHL), prostate and penis while in females cancer of cervix, breast, NHL, stomach and KS were found most frequent. CONCLUSION: This pattern was different from that of Kyadondo county, Uganda in which stomach and penila cancer were found to be rare whereas oesophageal cancer was one of the commonest cancer in Kyadondo but rare in Mbarara. These differences which are discussed in detail could be attributed to both environmental and genetic factors.

Frequency of Helicobacter pylori in gastroscopic biopsy of Ugandan Africans.

A total of 56 patients who presented for gastroscopy from 1993 to 1995 in Mulago Hospital had their gastroscopic biopsy specimens examined for Helicobacter pylori (H. pylori). H. pylori was demonstrated in 14 (25%) of the patients. There was no sex difference in those with H. pylori infections and the bacteria were only found in those above 22 years of age. Fifty six percent of those with the infection in which ethnicity was mentioned were Nyankole although they formed only 21% of the study group. In all positive cases, H. pylori was found in the antrum with accompanying chronic atrophic gastritis.

Mucin secretion by gastric carcinoma cells: PAS alcian blue stain study.

Thirty cases of gastric cancer were studied. Slides were stained with PAS Alcian Blue. The staining characteristics of the mucin were correlated with gross characteristics of the tumours and histological types. Due to the few cases studied, there was no observed statistical significance between the various mucin staining characteristics with the histological type, sex site of tumour and ethnicity. In 84% of cases the tumour cells secreted either neutral or mixed mucins. Acid mucins were demonstrated in 5 cases only. Neutral mucin is normally secreted by gastric epithelium and neck cells of gastric glands. The observation in this study suggests that those tumours which secrete neutral and mixed mucin probably arise from gastric epithelium, neck cells of gastric glands or colonic metaplasia. In those cases where the tumour produces acid mucin it is possible the tumour arose from areas of intestinal metaplasia.

Scleroma in Uganda: a review of 85 cases.

Biopsy and autopsy protocols revealed that between 1972 and 1981, 85 cases of scleroma were diagnosed in Uganda. The disease was found to affect females more than males, and was found to be more common in the middle aged. Scleroma occurred in the nose in 96% of cases and presented commonly at a late stage. The disease was found commonly among the tribes of south western Uganda and Itesot in the east. Possible factors associated with the distribution of this disease in Uganda are discussed.

Haematoxylin and eosin staining in the diagnosis of Hodgkin's disease in Uganda.

BACKGROUND: Whereas immunohistochemical methods have been widely used for the diagnosis and classification of Hodgkin's disease in the developed countries, there are very few reports of their use in the developing countries where haematoxylin and eosin is the mainstay of diagnosis of Hodgkin's disease. Yet the diagnostic accuracy of haematoxylin and eosin has not been assessed in Uganda. OBJECTIVE: To determine the reliability of haematoxylin and eosin staining in the diagnosis of Hodgkin's disease using immunohistochemistry as the reference standard. DESIGN: Laboratory based cross sectional study. SETTING: Makerere University Medical School, Department of Pathology. METHODOLOGY: Two hundred and forty formalin fixed, paraffin embedded biopsies seen in the Makerere University, Department of Pathology from 1980-2000 were studied. The tissue sections, were assessed and subjected to immunohistochemical methods using monoclonal antibodies including leucocyte common antigen, LCA (CD45), antibodies to Reed-Sternberg cells (CD15, CD30) and antibodies to B cells (CD20). The sensitivity, specificity, positive predictive value and negative predictive value were assessed. The overall Kappa score was used to assess the agreement between the two diagnostic tests. RESULTS: Of the 240 biopsies, 171(71.3%) were confirmed as Hodgkin's disease by immunohistochemistry. Using haematoxylin and eosin (H&E), only 131 of the 171 cases of Hodgkin's disease were detected. The mean age of the 171 cases was 26.1 (SD 16.2) years, with a mode of 20.0 and median of 22.5 years. The 15-24 year age group was the most affected (47.2%). There were more males (65.9%) than females and most were Baganda the dominant tribe in the central region. The sensitivity, specificity, positive and negative predictive values of haematoxylin and eosin were 76.61%, 92.75%, 96.32% and 61.53% respectively. The agreement between the two tests was 81.25% with an overall measure of agreement, Kappa, of 0.602. CONCLUSION: Haematoxylin and eosin has relatively high efficacy in the diagnosis of Hodgkin's disease. Use of haematoxylin and eosin is still recommended for the diagnosis of Hodgkin's disease, reserving the expensive immunohistochemistry for difficult cases.

Comparison of immunohistochemical and modified Giemsa stains for demonstration of Helicobacter pylori infection in an African population.

BACKGROUND: Modified Giemsa staining has been favoured by many researchers because it is easy to perform but, like many other stains, demonstration of the bacteria depends on its morphology. It has been arged in some research circles that some of the organisms in the gastric mucosa may not be true H.pylori. Immunohistochemical techniques have been developed and make use of anti H.pylori antibody, which reacts, with somatic antigens of the whole bacteria and have been found to correlate well with the presence of the bacteria. OBJECTIVE: To ascertain the efficacy of modified Giemsa stain in an African setting where H.Pylori seems quite prevalent. STUDY DESIGN: A laboratory-based study of two diagnostic tests in which modified Giema stain was compared with immunohistochemistry. METHODS: A total of 48 consecutive autopsy cases with no upper gastro intestinal diseases had their gastric mucosa stained for demonstration of H.pylori using both modified Giemsa and immunohisto chemical staining techniques. RESULTS: Twenty-seven cases of H.pylori were demonstrated by both techniques and 14 cases were not identified by the two staining methods. In 2 cases immunostain could not demonstrate the bacteria but they were identified with modified Giemsa stain while in 5 cases the bacteria were identified by immunostain but not with modified Giemsa stain. The sensitivity of modified Giemsa stain was 85% (CI 66.5-98.8) while the specificity was 89% (CI 60.4 - 97.8). The positive predictive value of modified Giemsa stain was 93% CI 75 - 98.8%) while the negative predictive value was 74% (CI 48.6 - 89.9). The kappa statistic comparing the 2 stains was 0.69 (p value 0.00001) giving a good agreement between the two tests. CONCLUSION: With the above results the modified Giemsa stain, which is readily available in most African laboratories, is recommenced for diagnosis of H.pylori, a prevalent infection in Africa.

Takayasu's arteritis (pulseless disease) in Uganda.

We report herein the case of a 23 year old woman who was referred to Mulago National Referral and Faculty of Medicine Makerere University Teaching Hospital because of sudden collapse, left sided weakness and headache for management. The patient underwent a battery of investigations but died five days after admission. The post mortem findings were extensive infarction the right cerebrum extending from parietal to occipital lobes. There was thickening of the wall and complete obliteration of right common carotid artery. The left common carotid artery was severely stenosed with marked thickening of the wall. The subclavian artery was thickened and completely obliterated. Microscopically there was intimal thickening by fibrous connective tissue and infiltrate of chronic inflammatory cells in the walls of the three affected branches of the oarta. These gross microscopic features were compatible with Takayasu's arteritis (TA).

Difference in Risk Factors for Breast Cancer by ER Status in an Indigenous African Population.

Introduction. Breast cancer is the commonest cancer among women globally. In Uganda, it is on the rise, projected at a 4.5% annual ASR increase (age standardized incidence rate). The reasons for this steep increase are not fully established. In the recent past, gene profiling in tumor tissues suggests that breast cancers are divided into subtypes dependent on the presence or absence of oestrogen receptor, progesterone, and human epidermal growth factor receptor 2 (HER 2). These subtypes do have distinctive clinical outcomes and perhaps risk factors from past studies. There is paucity of data on hormonal receptor status and the traditionally known risk factors in sub-Saharan Africa. The purpose of this study therefore was to establish the differences between ER status and the traditionally known risk factors for breast cancer in Uganda. Methods. An observational analytical hospital, based study, carried out at Makerere University, College of Health Sciences. Formalin fixed and paraffin imbedded sections were prepared for haemotoxylin and eosin (H&E) stains and immunohistochemistry (IHC). Ethical approval was obtained. Results. A total of 113 women were recruited. Mean age was 45 years (SD14). There were no significant differences in selected risk factors (setting, age, contraceptive use, parity, breast feeding, or menarche) by ER status although ER negative tumors had significantly higher grade tumors (by a factor of two) compared to ER positive tumors. Conclusion. There were no significant differences among risk factors by ER status contrary to what several other studies suggest. The manifestation of breast cancer in Africa warrants further extensive inquiry.