Assessing the Impact of Improved Pre-analytic Tissue Handling on Immunohistochemistry and Breast Cancer Molecular Subtypes in Ghana: A Cross-Sectional Study

Background Breast cancer is a major cause of morbidity and mortality among Ghanaian women, and the higher reported rates of triple-negative breast cancer (TNBC) are associated with worse outcomes. It is established that quality preanalytics has a positive effect on the outcome of immunohistochemistry. Enhanced preanalytic tissue handling may reduce the reported prevalence of TNBC and result in the correct management of breast cancer patients. This study assessed the impact of improved preanalytic processes on diagnostic outcomes in 4,000 breast biopsies. Methods Pathologists Without Borders partnered with Precision Medicine for Aggressive Breast Cancers to provide 10% neutral buffered formalin, offer training in tissue handling, and instruct providers in core needle biopsy. We retrospectively analyzed all core biopsies diagnosed as breast cancer over four years. Results A total of 4,000 cases were included (mean age, 52.7 ± 13.4 years). Male breast cancer accounted for 1.6% of cases (n = 65). In all tumors, 49.1% were estrogen receptor-negative (n = 1,965), 61.8% were progesterone receptor–negative (n = 2,470), and 63.3% were human epidermal growth factor receptor 2–negative (n = 2,532), yielding a TNBC rate of 29.2%. TNBC was most prevalent in patients aged 40–59 years and in those younger than 30 years. Conclusion We identified a 29.2% TNBC rate, which is lower than previously reported. These findings support established reports of the importance of optimized preanalytic procedures to improve diagnostic accuracy. The variation in TNBC rates with age suggest a need for age-specific breast cancer screening and treatment strategies in Ghana.