Apoptosis in breast cancer: Nigerian vs. Finnish material.

Objective: To evaluate apoptotic activity in breast cancer from Nigerian (n = 300) and Finnish (n=285) women.
Study Design: Apoptotic bodies were expressed as square millimeters of neoplastic tissue (apoptotic index [AI]). The standardized mitotic index (SMI) and mitotic activity index (MAI) estimated proliferation.
Results: The mean (+/- SD) AI was higher in Nigeria (9.6+/-14.8/mm2) than in Finland (5.2+/-6.1/ mm2). In both populations, AI values were higher in premenopausal than postmenopausal women, in lymph node positive than lymph node negative tumors and in larger than smaller tumors. However, the differences were not statistically significant. Increasing histologic grade was associated with increasing AI values (Nigeria, P =.012; Finland, P= .0001). AI in infiltrating ductal carcinomas were higher than in special types of breast cancer (Nigeria, P = .0700; Finland, P = .0168). As a continuous variable, AI was a significant prognosticator (Nigeria, P = .0125, Finland, P = .0466). Increasing AI appeared to be associated with tumor progression and dedifferentiation. The higher SMI/AI in Nigeria (9.2) than in Finland (4.5) reflects higher proliferative activity in the Nigerian material. In multivariate analysis of AI, SMI, MAI and tumor size, the proliferative indices (SMI and MAI) and tumor size only were significant independent prognosticators.
Conclusion: In Nigerian and Finnish material, AI has limited prognostic value as a tool in grading breast cancer. The higher mean SMI/AI in Nigerian cancer suggests a shift in the proliferation/cell death balance, which may be associated with a later phase of the cancer progression cascade.