Prevalence and type of anaemia in receptor negative breast cancer
Date
2016-10-25
Authors
Maraj, Amisha
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Abstract
Background
Breast cancer is the most common cancer in women worldwide, with an incidence of
approximately one million cases every year and is the main cause of cancer related
deaths in women [1-3]. Breast cancers which are considered to be aggressive are triple
negative breast cancers [4]. Triple negative breast cancer is known to have a worse
prognosis and is associated with lympho-vascular invasion, higher recurrence rate and
metastasis [4]. The reason behind this aggressiveness is not completely understood.
Anaemia is common in breast cancer patients and may be a result of the disease
process, complication of treatment or pre-existing co-morbidities [5-8]. Clinically
significant anaemia is defined as a Haemoglobin level less than 10g/dL, and is
accompanied by the symptoms and signs of anaemia such as fatigue, dizziness and
pallor [9]. This degree of anaemia can result in a delay of initiating therapy as well as
delay to correct the anaemia before initiating treatment such as neoadjuvant
chemotherapy and surgery [10]. Furthermore, patients with anaemia with an Hb<10g/dL
are known to blunt response to chemotherapy and radiotherapy due to tissue hypoxia
[6]. The aim of this study is to determine the prevalence and type of anaemia in patients
with triple negative breast cancer at Charlotte Maxeke Johannesburg Academic
Hospital.
Aim
To determine the prevalence and type of anaemia in patients with triple negative breast
cancer at Charlotte Maxeke Johannesburg Academic Hospital.
Objectives
1. To study the demography of patients presenting with breast cancer.
2. To determine the prevalence of triple negative breast cancer.
3. To determine prevalence and type of anaemia in patients with breast cancer
and whether this is affected by receptor status.
Method
This was a retrospective review of records of patients from the Breast and Endocrine
Unit at Charlotte Maxeke Johannesburg Academic Hospital over 2002-2012 (11 year
period). Once ethical approval was granted, data was obtained from the National
Health Laboratory Services records of all breast cancer patients for the period 2002-
2012 (11 year period) at Charlotte Maxeke Johannesburg Academic Hospital.
Patients demography, histological subtypes and profile was recorded as well as
haemoglobin and mean corpuscular volume (Appendix 1).
The data was recorded in Excel spreadsheets and the proportion of triple negative
breast cancer patients with or without anaemia at the time of diagnosis (within 3
months) was compared using the chi-squared statistical tests to determine if a
correlation exists. Age categories were expressed using the data sets of average
(including standard deviation) and range. Gender was calculated as percentages
and expressed as a ratio.
Results
Records of 520 patients were found; of which 94 patients were excluded. The
average age was 55± 13.3 years (range 18-91). The female to male ratio was 109:1.
Fifty two patients had triple negative breast cancer (TNBC) and 374 patients had
receptor positive breast cancer (RPBC). Of these, only 246 patients had a
haemoglobin level matched at time of diagnosis (within 3 months) that is 29 patients
in the TNBC group and 217 patients in the RPBC group. Approximately 26%
(65/246) of patients with haemoglobin level matched at time of diagnosis (within 3
months) had anaemia at the time of presentation.
Anaemia was found to be more significant and prevalent in the TNBC group as
55.2% (16/29) of the TNBC group had anaemia whereas 22.6% (49/217) of the
RPBC group patients were found to have anaemia at presentation. In the TNBC
group, 16 of 29 patients had anaemia and microcytic and normocytic anaemia were
equally common. Whereas, in the RPBC group, 49 of 217 patients had anaemia and
normocytic anaemia was the most common i.e. 51% (25/49 patients).
Conclusion
Anaemia was found to be more common in patients with TNBC compared to RPBC.
The predominant types of anaemia found in TNBC patients are microcytic and
normocytic and may suggest different mechanisms. Within the TNBC group,
microcytic and normocytic and macrocytic anaemia were 7/16 (43.75%); 7/16
(43.75%); and 2/16 (12,5%) respectively. Whereas, within the RPBC group,
microcytic and normocytic and macrocytic anaemia were 22(44,89%); 25 (51.02%)
and 2 (0.4%) respectively.
Description
This research report was compiled to meet the requirements for a Master of
Medicine in Surgery degree. The research report was submitted to the Department
of Surgery at the University of the Witwatersrand.
Johannesburg, 2015