Neville Jankey

HTLV-I AND TROPICAL SPASTIC PARAPARESIS

Furthermore, we have shown that platelets prepared from patients admitted with the provisional diagnosis of acute myocardial infarction (AMI) tend to aggregate after heparin challenge in vitro. This was observed whether AMI was confirmed or not, provided patients had a history of, for example, myocardial infarction or peripheral vascular disease. The figures for samples producing more than 50% aggregation after the addition of heparin in vitro

Relationship of Ethnicity and Histologic Type of Breast Carcinoma in a West Indian Population

To the Editor: Breast cancer and ethnicity have been studied mainly in first-world countries including the United States (1,2) and the United Kingdom (3) as it relates to incidence, prevalence, and survival in mainly white and black races. However, there is a paucity of data from the third world including the West Indies. Trinidad & Tobago is an island located in the southernmost part of the Caribbean Sea adjacent to the South American coast. It has a very diverse racial mixture of persons of African (43%) and East Indian descent (41%), which accounts for most of the population. These persons are fourth-generation descendants of East Indian and African laborers who were brought here in the late 1800s from the African and Indian continents to work on plantations. Fifteen percent of the populace consists of persons of mixed descent and Caucasians, while Chinese and Arabs account for less than 1%. It is thus an excellent location for studying the relationship of ethnicity and breast cancer. A 2-year retrospective analysis of breast carcinomas at the General Hospital, Port-of-Spain, Trinidad, West Indies, was conducted. Data were collected from the operating theater books and pathology records focusing on age, ethnicity, and histologic type of breast carcinoma in order to establish the relationship between these parameters. The results showed Afro-Caribbean women were the most commonly affected group (54% of cases), with Indo-Caribbean women accounting for 35% of cases. Mixed races accounted for 11%. The most common age group affected were those patients 53 to 59 years of age. Invasive ductal carcinoma (IDC) was the most commonly occurring histologic type (70% of 299 cases in 2 years), with invasive lobular carcinoma (ILC) accounting for 17%. Afro-Caribbean women were twice as likely to develop IDC and ILC compared to Indo-Caribbean women. Medullary, papillary, and mucinous adenocarcinoma types occurred 4%, 2%, and 3% of the time, respectively, and there were some other rare histologic types accounting for less than 4% of cases. These included squamous, tubular, and comedo carcinomas, sarcoma, mesenchymal chondrosarcoma, and a very rare case of carcinoma occurring in a phyllodes tumor. Most of the data from the United States focuses on comparing the similarities and differences in histology, biology, and survival of blacks and whites with breast cancer (1,2) and in the United Kingdom the focus has been mainly on incidence (3). It is well documented that survival after breast cancer diagnosis is significantly worse among African American women and that the age of diagnosis is significantly younger (4,5). In summary, the data presented is far from complete; however, it still provides information previously unavailable in such a diverse racial mixture in the third-world island population of Trinidad & Tobago. Two points are highlighted from this data: There is clearly a greater chance of AfroCaribbean women developing breast cancer than other races; and there is an unusually high incidence of ILC (17%) in the Trinidad population compared with global data (<4%). We propose a more detailed and thorough analysis in relation to this topic, focusing more on genetic studies to determine the cause of this trend.