Receptor-defined subtypes of breast cancer in indigenous populations in Africa: a systematic review and meta-analysis.

BACKGROUND: Breast cancer is the most common female cancer in Africa. Receptor-defined subtypes are a major determinant of treatment options and disease outcomes but there is considerable uncertainty regarding the frequency of poor prognosis estrogen receptor (ER) negative subtypes in Africa. We systematically reviewed publications reporting on the frequency of breast cancer receptor-defined subtypes in indigenous populations in Africa. METHODS AND FINDINGS: Medline, Embase, and Global Health were searched for studies published between 1st January 1980 and 15th April 2014. Reported proportions of ER positive (ER+), progesterone receptor positive (PR+), and human epidermal growth factor receptor-2 positive (HER2+) disease were extracted and 95% CI calculated. Random effects meta-analyses were used to pool estimates. Fifty-four studies from North Africa (n=12,284 women with breast cancer) and 26 from sub-Saharan Africa (n=4,737) were eligible. There was marked between-study heterogeneity in the ER+ estimates in both regions (I2>90%), with the majority reporting proportions between 0.40 and 0.80 in North Africa and between 0.20 and 0.70 in sub-Saharan Africa. Similarly, large between-study heterogeneity was observed for PR+ and HER2+ estimates (I2>80%, in all instances). Meta-regression analyses showed that the proportion of ER+ disease was 10% (4%-17%) lower for studies based on archived tumor blocks rather than prospectively collected specimens, and 9% (2%-17%) lower for those with ≥ 40% versus those with <40% grade 3 tumors. For prospectively collected samples, the pooled proportions for ER+ and triple negative tumors were 0.59 (0.56-0.62) and 0.21 (0.17-0.25), respectively, regardless of region. Limitations of the study include the lack of standardized procedures across the various studies; the low methodological quality of many studies in terms of the representativeness of their case series and the quality of the procedures for collection, fixation, and receptor testing; and the possibility that women with breast cancer may have contributed to more than one study. CONCLUSIONS: The published data from the more appropriate prospectively measured specimens are consistent with the majority of breast cancers in Africa being ER+. As no single subtype dominates in the continent availability of receptor testing should be a priority, especially for young women with early stage disease where appropriate receptor-specific treatment modalities offer the greatest potential for reducing years of life lost. Please see later in the article for the Editors' Summary

Islamic Banks and Financial Stability: An Empirical Analysis

Islamic banking, Financial stability, G21,

Potential biomedical reuse of vegetative residuals from mycorrhized grapevines subjected to warming

Grapevine leaves are widely discarded in open fields despite their known antioxidant properties. We tested the cytotoxicity of leaf extracts from three clones (CL-260, CL-1048, CL-8) of Vitis vinifera L. cv. Tempranillo against four human cancer cell lines: colon, HT-29; breast, MCF-7; lung HTB-54; and lymphoblastic leukemia, CCRF-CEM. Grapevines were cultivated at either ambient (24/14 °C) or elevated (28/18 °C) day/night temperatures, and inoculated (+M) or not (-M) with arbuscular mycorrhizal fungi (AMF). Cytotoxicity was analysed by MTT assays. Elevated air temperatures enhanced the cytotoxicity of leaf extracts from CL-260 against HT-29, CCRF-CEM and HTB-54 and that from CL-8 against MCF-7. Mycorrhization improved the cytotoxicity of leaf extracts from CL-1048 against HT-29, CCRF-CEM, HTB-54 and MCF-7. The cytotoxic activities of CL-260 against HTB-54 and CL-1048 against HT-29 were correlated, respectively, with total phenols and total antioxidant capacity. We conclude that the predicted increase in air temperature for the future climate and the mycorrhizal association of grapevines may enhance the cytotoxicity of leaves, which strengthens the potential application of these agricultural residuals for biomedicine. However, the clonal diversity in the response to AMF and air temperature highlights the importance of choosing the most adequate clone for a concrete environmental scenario.Spanish Ministry of Economy and Competency [AGL2014-56075-C2-1-R] and European Project INNOVINE Call FP7-KBBE-2011-6, Proposal No. 311775. N Torres was the recipient of a FPU grant of the Spanish Ministry of Education, Culture and Sport [FPU2014].Peer reviewe