Colorectal cancer in South Africa: A heritable cause suspected in many young black patients
Colorectal carcinoma (CRC) has a low incidence amongst the black African population. Largely unrecognised in the scientific literature is that a disproportionately large number of young black patients (<50 years old) present with CRC.
To analyse these tumours which we propose may link them to morphological features associated with known genetic pathways.
Retrospective review of South African patients histologically diagnosed as CRC in the Division of Anatomical Pathology, National Health Laboratory Service (NHLS) and University of the Witwatersrand (1732 patients, 1990 – 2003). Histology was fully reviewed in 609 patients (1997 – 2002) and all specimens from patients under the age of 50 years were subjected to immunohistochemistry for mismatch repair proteins, as well as APC and p53 proteins.
Most young patients (<50 years) were black (41% vs 10% white; p ≤ 0.001). Blacks had predominantly proximal tumours, significantly more poorly differentiated and/or mucinous tumours (p = 0.006) and loss of mismatch repair protein expression was more evident than in whites.
It seems likely that CRC in young blacks develop through the accumulation of mutations, most likely through mismatch repair deficiency or promoter methylation, which in turn is linked to a poor differentiation and a mucinous architecture.
Leandra Cronje, Division of Anatomical Pathology, School of Pathology and HE Griffin Cancer Research Group, University of the Witwatersrand and National Health Laboratory Service
Alan Paterson, Division of Anatomical Pathology, School of Pathology and HE Griffin Cancer Research Group, University of the Witwatersrand and National Health Laboratory Service
Piet Becker, Biostatistics Unit, Medical Research Council of South Africa
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Date published: 2009-02-03
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