In developed countries, breast cancer treatment has become much more effective due to advances in molecular subtyping to help guide treatment decisions. A presentation at the 2022 American Society of Clinical Oncology (ASCO) Annual Meeting discussed barriers to subtyping in low- and middle-income countries (LMIC), including high costs and lack of personnel and infrastructure for immunohistochemistry (IHC).
“There are barriers to availability of this resource in LMIC, which contributes to global inequalities in breast cancer management and outcomes,” wrote the authors, led by Clement Adebayo Adebamowo, of the Department of Epidemiology and Public Health and Greenebaum Comprehensive Cancer Center at the University of Maryland School of Medicine in Baltimore. “Alternative methods that are more objective, cost less, and require less infrastructure and skilled personnel will improve access and reduce disparities.”
To elucidate the variance of subtyping in women with breast cancer in LMIC, researchers presented data from the African Female Breast Cancer Epidemiology (AFBRECANE) study. They compared the sensitivities and specificities of estrogen receptor and progesterone receptor subtyping between IHC and Cepheid GeneXpert RNA STRAT4 biomarker assay. The assay is an alternative to IHC, considered the gold standard for molecular subtyping. The study included 1,000 cases of breast cancer at 5 clinical sites in Nigeria.
The study did not find a great deal of agreement between the 2 methods, confirming the authors’ claims that LMIC need more accurate, sustainable, objective methods to improve diagnosis, treatment, and prognostication in breast cancer.