Background: Breast cancer remains intractable and the leading cause of cancer related death among women. The appearance of breast tumour and its progression poses great clinical unpredictability before and after diagnosis, therapy and appearance of recurrent secondary deposits. Various immunological changes occur during breast tumourigenesis, and can be of value in the surveillance of the diseases. In our environment, there is scanty information on the value of these immunological factors especially immunoglobulins in screening and surveillance of breast cancer—hence the need for this study. Methodology: A total of 59 females (mean age = 48.7 ± 8.7 yrs) with clinically and pathologically confirmed breast cancer were prospectively recruited alongside with 20 patients with benign breast tumour representing patients’ control group and 20 apparently healthy age and sex-matched control subjects (mean age = 47.5 ± 13.4 yrs). Breast cancer patients were further grouped into early stage breast cancer (N = 25) and advanced stage breast cancer (N = 34). Patients were subjected to standard treatment modalities and pre- and post-treatment samples collected at intervals. Samples were assayed for IgG & IgM by immunoenzymatic methods and IgA by immunoturbidimetric method. Questionnaires and measurements were used to obtain necessary demographic and anthropologic information from the subjects. Results: Results showed that in all stages of breast cancer and treatment groups, the mean serum IgG, IgM and IgA levels respectively were not significantly raised (P > 0.05) when compared. Results also showed that majority (59%) of the patients presented at advanced stage of the disease. Low level of education and low income were among the prevailing risk factors. Majority (63%) of the cases had body mass index suggesting obesity (>30 kg/m2). Conclusion: Results suggest that serum immunoglobulin (IgG, IgM and IgA) levels are of limited value in surveillance of breast cancer in our environment. Based on our findings, it could also be concluded that low levels of education and low income are among the risk factors. Advocacy and evidence based policies aimed at prevention and early detection of the disease should be prioritized.
KeywordsBreast TumourImmunoglobulinsTreatment and Disease Surveillance
Easton, D.F. (2005) Study Shows Women of African Ancestry Diagnosed with More Virulent form of Breast Cancer. The University of Chicgo Chronicle, 24, 1-3.
Fregene, A. and Newman, L.A. (2005) Breast Cancer in Sub-Saharan Africa. How Does It Relate to Breast Cancer in African-American Women. Cancer, 103, 1540-1550. https://doi.org/10.1002/cncr.20978
Kruger, W.M. and Apffelstaedt, J.P. (2007) Young Breast Cancer Patients in the Developing World: Incidence, Choice of Surgical Treatment and Genetic Factors. South African Family Practice, 49, 18-24. https://doi.org/10.1080/20786204.2007.10873634
Atoyebi, O.A., Atimomo, C.E., Adesanya, A.A., Beredugo, B.K. and da Rocha-Afodu, J.T. (1997). An Appraisal of 100 Patients with Breast Cancer Seen at Lagos University Teaching Hospital. Nigerian Quarterly Journal of Hospital Medicine, 7, 104-108.
Anyanwu, S.N. (2000) Breast Cancer in Eastern Nigeria: A Ten Year Review. West African Journal of Medicine, 19, 120-125.
Adetifa, F.A. and Ojikutu, R.K. (2009) Prevalence and Trends in Breast Cancer in Lagos State, Nigeria. An International Multi-Disciplinary Journal, Ethiopia, 3, 1-15.
Adisa, C.A., Eleweke, N., Alfred, A.U., Cambell, M.J., Sharma, R., Nseyo, O., Tandon, V., Mukhfar, R., Greninger, A., Di Risi, J. and Esserman, L.J. (2012) Biology of Breast Cancer in Nigerian Women: A Pilot Study. Annals of African Medicine, 11, 169-175. https://doi.org/10.4103/1596-3519.96880
Hansen, M.H., Nielsen, H. and Ditzel, H.J. (2001) The Tumor-Infiltrating B Cell Response in Medullary Breast Cancer Is Oligoclonal and Directed against the Autoantigen Actin Exposed on the Surface of Apoptotic Cancer Cells. Proceedings of the National Academy of Sciences of the United States of America, 98, 12659-12664. https://doi.org/10.1073/pnas.171460798
Zheng, H., Li, M., Ren, W., Zeng, L., Liu, H.D., et al. (2007) Expression and Secretion of Immunoglobulin Alpha Heavy Chain with Diverse VDJ Recombinations by Human Epithelial Cancer Cells. Molecular Immunology, 44, 2221-2227. https://doi.org/10.1016/j.molimm.2006.11.010
Cazet, A., Julien, S., Bobowski, M., Burchell, J. and Delannoy, P. (2010) Tumour-Associated Carbohydrate Antigens in Breast Cancer. Breast Cancer Research, 12, 204. https://doi.org/10.1186/bcr2577
Edge, S.B., Byral, D.R., Compton, C.C., Fritz, A.G., Greene, F.L. and Trotti, A. (2010) AJCC Cancer Staging Manual. 7th Edition, Springer, New York, 49-56.
Anderson, K.S. and LaBaer, J. (2005) The Sentinel within: Exploiting the Immune System for Cancer Biomarkers. Journal of Proteome Research, 4, 1123-1133. https://doi.org/10.1021/pr0500814
Isik, A., Peker, K., Firat, D., Yilmaz, B., Sayer, I., Idiz, O., Caker, C., Demirylmaz, I. and Yilmaz, I. (2014) Impotance of Metastatic Lymph Node Reaction in Non-Metastatic, Lymph Node-Invaded Colon Cancer: A Clinical Trial. Medical Science Monitor, 20, 1369-1375. https://doi.org/10.12659/MSM.890804
Isik, A., Okan, I., Firat, D., Yilmaz, B., Akcakava, A. and Sahin, M. (2014) A New Prognostic Strategy for Gastric Carcinoma: Albumin Level and Metastatic Lymph Node Ratio. Minerva Chirurgica, 69, 147-153.
Chukwurah, E.F., Emele, F.E., Iyare, F.E., Nwigwe, C.G. and Ogbodo, S.O. (2016) Evaluation of Circulating Immune Complexes in Patients with Malignant and Pre-Malignant Disease Conditions of the Breast in South-Eastern Nigeria. Journal of Disease and Global Health, 5, 211-217.
Emele, F.E. and Chukwurah, E.F. (2017) Evaluation of Serum Cancer Antigens (CA 15-3 and CA 27.29) and Circulating Immune Complexes as Important Tools in the Management of Breast Cancer in Nigeria. The Journal of Immunology, 198, 76.1.
Chukwurah, E.F., Emele, F.E. and Iyare, F.E. (2018) Breast Cancer in Nigerian Women: Evaluating the Utility of Circulating Immune Complexes and Cancer Antigens (CA 15-3 and CA 27.29) in Disease Surveillance. Research Journal of Immunology, 11, 7-14.
Chen, Z., Qiu, X. and Gu, J. (2009) Immunoglobulin Expression in Non-Lymphoid Lineage and Neoplastic Cells. American Journal of Pathology, 174, 1139-1148. https://doi.org/10.2353/ajpath.2009.080879
Wang, J., Lin, D., Peng, H., Huang, Y., Huang, J. and Gu, J. (2013) Cancer-Derived Immunoglobulin G Promotes Tumor Cell Growth and Proliferation through Inducing Production of Reactive Oxygen Species. Cell Death and Disease, 4, e945. https://doi.org/10.1038/cddis.2013.474
Alsabti, E.A. (1979) Serum Immunoglobulins in Breast Cancer. Journal of Surgical Oncology, 11, 129-133. https://doi.org/10.1002/jso.2930110206
Kemp, T.J., Safaeian, M., Miner, S., Williams, M.C., Rodrignez, A.C., Herrco, R., Hildesheim, A. and Pinta, L.A. (2012) Oral Immunoglobulin Levels Are Not a Good Surrogate for Cervical Immunoglobulin Levels. Frontiers in Oncology, 2, 61. https://doi.org/10.3389/fonc.2012.00061
Raina, A., Krasinska, A.M., Greer, J.R., Lamb, J., Fink, E., Moser, A.J., Zeh, H.J., Slivka, A. and Whitcomb, D.C. (2008) Serum Immunoglobulin G Fraction 4 Levels in Pancreatic Cancer: Elevation Not Associated with Autoimmune Pancreatitis. Archives of Pathology & Laboratory Medicine, 132, 48-53.
Ipp, T., Macnab, G.M., Geddes, E.W. and Keo, M.C. (1975) Serum Immunoglobulin Levels in Primary Liver Cancer: Relationship to Underlying Cirrhosis and Hepatitis-B (Surface Antigenemia). British Journal of Cancer, 32, 509-511. https://doi.org/10.1038/bjc.1975.253
Neuchrist, C., Kornfehl, J., Grasl, M., Lassman, N., Kraft, D. and Ehrenberger, K. (1994) Distribution of Immunoglobulin in Squamous Cell Carcinoma of Head and Neck. International Archives of Allergy & Immunology, 104, 97-100.
Khana, S. and Karjodkar, F.R. (2006) Circulating Immune Complexes and Trace Elements (Copper, Iron and Selenium) as Markers in Oral Precancer and Cancer: A Randomised Controlled Clinical Trial. Head and Face Medicine, 2, 33. https://doi.org/10.1186/1746-160X-2-33
Roberts, M.M., Bass, E.M., Wallace, I.J. and Stevenson, A. (1993) Local Immunoglobulin Production in Breast Cancer. British Journal of Cancer, 27, 269-275. https://doi.org/10.1038/bjc.1973.33
Roberts, M.M., Bathgate, E.M. and Stevenson, A. (1975) Serum Immunoglobulin Levels in Patients with Breast Cancer. Cancer, 36, 221-224. https://doi.org/10.1002/1097-0142(197507)36:1 3.0.CO;2-P
Wang, D.Y., Goodwin, P.O., Bulbrook, R.D., Hayward, J.L., Abe, O., Utsunomiya, J. and Kumaoka, S. (1977) Possible Relationship of Plasma IgA, IgG and IgM to Breast Cancer in British and Japanese Women. European Journal of Cancer, 13, 1405-1409. https://doi.org/10.1016/0014-2964(77)90153-0
Petrakis, L., Doherty, M., Lee, R., Mason, L., Pawson, S, Hunt, T.K. and Schweitzer, R. (1977) Immunoglobulin Levels in Breast Fluids of Women with Breast Cancer. Clinical Immunology & Immunopathology, 7, 386-393. https://doi.org/10.1016/0090-1229(77)90073-3
Norum, L.F., Erikstein, B. and Nustad, K. (2001) Elevated CA 125 in Breast Cancer—A Sign of Advance Disease. Tumour Biology, 22, 223-228. https://doi.org/10.1159/000050620
Park, B.W., Oh, J.W., Kim, J.H., Park, S.H., Kim, K.S., Kim, J.H. and Lee, C.S. (2007) Preoperative CA 15-3 and CEA Serum Levels as Predictor of Breast Cancer. Annals of Oncology, 19, 675-681. https://doi.org/10.1093/annonc/mdm538
Charlotte, W., Bo, B., Ola, B., Dorthe, G. and Bo, J. (2013) Primary Breast Cancer Tumours Contain High Amounts of IgA1 Immunoglobulin: An Immunohistochemical Analysis of a Possible Carrier of the Tumour-Associated Tn Antigen. PLoS ONE, 8, e61749.
Rajendran, R., Sugathan, C.K., Remani, P., Ankathil, R. and Vijayakumar, T. (1986) Cell Mediated and Humoral Immune Responses in Oral Submucous Fibrosis. Cancer, 58, 2628-2631. https://doi.org/10.1002/1097-0142(19861215)58:12 3.0.CO;2-Z
Yang, B., Ma, C., Chen, Z., Yi, W., McNutt, M., Wang, Y., Korteweg, C. and Gu, J. (2013) Correlation of Immunoglobulin G Expression and Histological Subtype and Stage in Breast Cancer. PLoS ONE, 8, e58706. https://doi.org/10.1371/journal.pone.0058706
Schauenstein, E., Rabi, H., Steinschifter, W., Hirschmann, C., Estelberger, W. and Schauenstein, K. (1997) Selective Decrease of Serum Immunoglobulin G1 as a Marker of Malignant Transformation in Colorectal Tissue. Cancer, 79, 1486-1486. https://doi.org/10.1002/(SICI)1097-0142(19970415)79:8 3.0.CO;2-D
Ahmed, H.U., Zacharakis, E., Dudderidge, T., Armitage, J.N., Scott, R., Calleary, J., Illing, R., Kirkham, A., Freeman, A., Ogden, C., Allen, C. and Emberton, M. (2009) High-Intensity-Focused Ultrasound in the Treatment of Primary Prostate Cancer: The First UK Series. British Journal of Cancer, 101, 19-26. https://doi.org/10.1038/sj.bjc.6605116
Kronberger, L., Steinschifter, W., Weblacher, M., Estelberger, W., Liebmann, P.M., Rabi, H., Smola, M., Lax, S.F., Mischinger, H.J. and Schauenstein, E. (2000) Selective Decrease of Serum Immunoglobulin G1 as Marker for Early Stages of Invasive Breast Cancer. Breast Cancer Research and Treatment, 64, 193-199. https://doi.org/10.1023/A:1006450205698
Chukwurah, E.F., Uro-Chukwu, H.C. and Uneke, C.J. (2017) Assessment of the Knowledge, Attitude and Practice of Breast Cancer Screening among Female Undergraduate Students of Ebonyi State University. Congress Oral Communication Abstracts: 41st West African College of Physicians Annual Congress, Dakar Senegal.
Adebamowo, C.A. and Adekunle, O.O. (1999) Case-Control Study of the Epidemiological Risk Factors for Breast Cancer in Nigeria. British Journal of Surgery, 86, 665-668. https://doi.org/10.1046/j.1365-2168.1999.01117.x
Rambau, P.F., Chalya, P.L., Manyama, M.M. and Jackson, K.J. (2011) Pathological Features of Breast Cancer Seen in North-Western Tanzania: A Nine Years Retrospective Study. British Medical Council Research Notes, 4, 214.
Palmer, J.R., Wise, L.A., Horton, N.J., Adams-Campbell, L.L. and Rosenberg, L. (2003) Dual Effect of Parity on Breast Cancer Risk in African-American Women. Journal of the National Cancer Institute, 95, 478-483. https://doi.org/10.1093/jnci/95.6.478
Puri, S., Mangat, C., Bhatia, V., Kalia, M., Sehgel, A. and Kaur, A.P. (2009) Awareness of Risk Factors and Aspects of Breast Cancer among North Indian Women. The Internet Journal of Health, 8, 112.
Adebamowo, C., Ogundiran, T.O., Adenipekun, A.A., Oyesegun, R.A., Campbell, O.B., Akang, E.E., Rotimi, C.N. and Olopade, O.I. (2003) Waist-Hip-Ratio and Breast Cancer in Urbanize d Nigerian Women. Breast Cancer Research, 5, 18-24. https://doi.org/10.1186/bcr567
Chen, Y., Thompson, W., Semenciw, R. and Mao, Y. (1999) Epidemiology of Contralateral Breast Cancer. Cancer Epidemiology, Biomarkers and Prevention, 8, 855-861.
Pakseresht, S., Ingle, G.K., Bahadur, A.K., Ramteke, V.K., Singh, M.M., Garg, S., and Agarwal, P.N. (2009) Risk Factors with Breast Cancer among Women in Delhi. Indian Journal of Cancer, 46, 132-138.
Afonso, N. (2009) Women at High Risk for Breast Cancer—What the Primary Care Provider Needs to Know. The Journal of the American Board of Family Medicine, 22, 43-50. https://doi.org/10.3122/jabfm.2009.01.070188
American Institute for Cancer Research (2007) Guidelines for Cancer-Prevention: Healthy Living for Cancer Prevention. http://www.aicr.org
Ogundiran, T.O., Huo, D., Adenipekun, A., Cambell, O., Oyesegun, R., Akang, E., Adebamowo, C. and Olapede, O.I. (2010) Case Control Study of Breast Size ND Breast Cancer Risk in Nigerian Women. American Journal of Epidemiology, 172, 682-690. https://doi.org/10.1093/aje/kwq180
Berstad, P., Coates, R.J., Bernstein, L., Suzanne, G., Folger, S.G., Malone, K.E., Marchbanks, P.A., Weiss, L.K., Liff, J.M., McDonald, J.A., Strom, B.L., Simon, M.S., Deapen, D., Press, M.F., Burkman, R.T., Spirtas, R. and Ursin, G. (2010) A Case-Control Study of Body Mass Index and Breast Cancer Risk in White and African-American Women. Cancer Epidemiology, Biomarkers and Prevention, 19, 1532-1544. https://doi.org/10.1158/1055-9965.EPI-10-0025
Wrensch, M., Chew, T., Farren, G., Barlow, J., Belli, F., Clarke, C., Erdmann, C.A., Lee, M., Moghadassi, M., Perkin-Mentzer, R., Quesenberry, C.P., Saunders-Mason, V., Spence, L., Suzuki, M. and Gould, M. (2003) Risk Factors for Breast Cancer in a Population with High Incidence Rates. Breast Cancer Research, 5, 88-102. https://doi.org/10.1186/bcr605
Hussain, S.K., Altieri, A., Sundquist, J. and Hemminki, K. (2008) Influence of Education Level on Breast Cancer Risk and Survival in Swedish between 1990 and 2004. International Journal of Cancer, 122, 165-169. https://doi.org/10.1002/ijc.23007
Gibson, L.J., Héry, C., Mitton, N., Gines-Bautista, A., Parkin, D.M., Ngelangel, C., and Pisani, P. (2010) Risk Factors for Breast Cancer among Filipino Women in Manila. International Journal of Cancer, 126, 515-521. https://doi.org/10.1002/ijc.24769
Celik, S. and Aksoy, G. (2007) Identification of Risk Factors for Breast Cancer for Women in Istanbul. The Open Nursing Journal, 1, 6-12. https://doi.org/10.2174/1874434600701010006
Saweer, A.A.L., Yacoub, F. and Mohammed, N. (2003) The Prevalence of Risk Factors among Women Diagnosed with Breast Cancer. Bahrain Medical Bulletin, 25, 1-7.
Ayoade, B.A., Tade, A.O. and Salami, B.A. (2012) Clinical Features and Pattern of Presentation of Breast Diseases in Surgical Outpatient Clinic of a Suburban Tertiary Hospital in South-West Nigeria. Nigerian Journal of Surgery, 18, 13-16.