Ashdin Publishing African Journal of Pathology and Microbiology Vol. 4 (2015), Article ID 235899, 5 pages doi:10.4303/ajpm/235899 ASHDIN publishing Research Article Triple-Negative Breast Cancer among Ghanaian Women Seen at Korle-Bu Teaching Hospital E. M. Der, 1,2 R. K. Gyasi, 1 Y. Tettey, 1 T. M. Bayor, 3 and L. Newman 4 1 Department of Pathology, Medical School, University of Ghana, P.O. Box 4236, Korle-Bu, Accra, Ghana 2 Department of Pathology, School of Medicine and Health Sciences, University for Development Studies, P.O. Box TL 1883, Tamale, Ghana 3 Department of Horticulture, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana 4 Breast Care Center, Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI 48109, USA Address correspondence to E. M. Der, maadelle@yahoo.com Received 3 December 2014; Revised 26 March 2015; Accepted 31 March 2015 Copyright © 2015 E. M. Der et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background. Women with African ancestry in the United States and in continental Africa have been found to have exception- ally increased frequencies of triple-negative breast cancer (TNBC), prompting speculation that this risk may have an inherited basis and may at least partially explain breast cancer outcome disparities related to racial/ethnic identity. Our goal was to evaluate the breast cancers diagnosed in one of the largest health care facilities in western Africa, and to compare the frequencies as well as risk factors for TNBC versus non-TNBC. Methods. We reviewed all breast cancer cases that had immunohistochemistry (Novolink Detection system), in 2010. Results. The overall study population of 223 breast cancer cases was relatively young (median age 52.4 y), and most had palpable tumors larger than five centimeters in diameter. More than half were TNBC (130 cases, 58.3%). We observed similar frequencies of young age at diagnosis, stage at diagnosis, and tumor grade among cases of TNBC compared to cases of non-TNBC. Conclusion. Ghanaian breast cancer patients tend to have an advanced stage distribution and relatively young age at diagnosis. The triple-negative molecular marker pattern is the most common seen among these women, regardless of age, tumor grade, and stage of diagnosis. Additional research is necessary regarding the causes of TNBC, so that we can elucidate the reasons for its increased prevalence among women with African ancestry. Keywords triple-negative breast cancer; Ghana; immunohistochem- istry; young; high grade 1. Introduction Breast cancer is a common cause of cancer mortality among women in Ghana [1], motivating a call for increased breast health awareness in this country. Developing countries, how- ever, have limited financial resources to support population- based tumor registries. While estimates of population-based cancer incidence and mortality rates exist, their accuracy can be questioned, and most studies related to specific cancer patterns are therefore based upon reports from single insti- tutions. Breast cancers have traditionally been categorized as invasive tumors with or without a noninvasive (in situ) component. Advances in the technology of genetic profiling for invasive breast cancer have furthermore led to improved understanding regarding the existence of a spectrum of tumor subtypes associated with varying degrees of malignant virulence, and the basal subtype is widely-acknowledged as having the most inherently aggressive behavior. In clinical practice, we typically rely on immunohistochemistry (IHC) to detect patterns of expression for three molecular markers as a surrogate strategy to characterize the cancers of newly-diagnosed patients. Tumors that are negative for the estrogen receptor (ER), the progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER2/neu) are commonly called triple-negative breast cancer (TNBC). Triple-negative status tends to be an adverse prognostic feature, because the micrometastatic potential of these tumors cannot be controlled with either targeted endocrine therapy or targeted anti-HER2/neu therapy, and also because there is a strong correlation between TNBC and the basal breast cancer subtype. In developed countries and among women of White/European American and European background TNBC accounts for 10–20% of all breast cancers [1,2,3, 4]. TNBC is more prevalent among breast cancer patients that are diagnosed at young ages, patients with hereditary susceptibility derived from BRCA-1 mutations, and African American patients [4, 5]. Frequencies of TNBC is approx- imately twofold higher for African American compared to White American and European breast cancer patients, and recent studies [6,7,8] have demonstrated that one-third to more than half of sub-Saharan African breast cancer patients have triple-negative disease. The higher proportion of TNBC among African American and African women has prompted speculation that shared African ancestry might be associated with a heritable marker of TNBC risk. However, robust data on the breast cancer burden in