Demographics of breast cancer in a small cohort of women in the Caribbean

ABSTRACT

OBJECTIVES: To address the prevalence and spectrum of breast cancer (BRCA1 and BRCA2) mutations in the Caribbean population. DESIGN AND METHODS: Demographic and clinical pathologic data was collected from 347 women of Afro-Caribbean decent. The cohort included women with breast cancer from the following countries the Cayman Islands, Jamaica, Barbados, Dominica, Trinidad & Tobago and Haiti. RESULTS: The mean age of onset in the cohort was 48.1 yrs. with a mean body mass index (BMI) of 27.7. 70% of breast cancer cases were estrogen receptor-positive (ER+) (n=241) and in Jamaica 27% (n=105) of breast cancer cases were human epidermal growth factor receptor 2 positive (Her2+). Total Abdominal Hysterectomy Bilateral Salpingo Oophorectomy (TAH-BSO) delayed invasive breast cancer from 48 to 53 years (p=0.005). Parity was a significant factor (p<0.0001), which delayed age of onset by 8 yrs. Additionally, pregnancy alone delayed age of onset (p<0.005) by 8 yrs. Only three women out of 347 were found to have a mutation. CONCLUSIONS: This population-based study provided an insight into pattern of risk factors – both genetic and environmental of breast cancer incidence and subtype across the Caribbean. In conclusion 1) genetic causes of breast cancer appeared rare outside of the Bahamas, 2) fertility factors appeared important in the development of breast cancer, 3) TAH-BSO was common as both a form of contraception and because of the high incidence of fibroids, it may be protective, 4) BMI may impact on breast cancer development and 5) screening mammography was rare and the vast majority was diagnostic in nature.