Table of Contents  
Year : 2017  |  Volume : 27  |  Issue : 2  |  Page : 33-36

Assessment of some biomarkers of inflammation in breast cancer patients in Benin City, Nigeria

1 Department of Surgery, Central Hospital, University of Benin Teaching Hospital, Benin City, Nigeria
2 Department of Chemical Pathology, University of Benin Teaching Hospital, Benin City, Nigeria

Date of Web Publication23-May-2019

Correspondence Address:
Dr. Idemudia Joseph Osagie
Department of Chemical Pathology, University of Benin Teaching Hospital, Benin City
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/njss.njss_2_14

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Introduction: Inflammation has been shown to play a major role in the pathogenesis of most malignancies including breast cancer. The inflammatory basis of breast cancer has not been evaluated in our environment. Objective: The purpose of this study is to determine the level of some biomarkers of systemic inflammation in patients with breast cancer compared to those of apparently healthy subjects without the disease in Benin City, Nigeria. Methodology: This is a case control study conducted in Benin City, Edo State, Nigeria. Breast cancer patients from Central hospital, Benin City and controls from the general population had their venous blood sampled and analyzed for Erythrocyte Sedimentation Rate (ESR) and C-Reactive Proteins (CRP) levels using standardized laboratory methods. Data were analyzed using SPSS (version 17). Results: Results showed a statistical significant increase (P < 0.05) in both ESR and CRP levels of patients with breast cancer compared to the control. There is also a significant positive correlation (P < 0.001) between ESR and CRP in the study population. Conclusion: These findings support the fact that inflammation is a risk factor for the development of breast cancer and this association might be of clinical significance as these inflammation markers might be of prognostic value.

Keywords: Breast cancer, C-reactive protein, erythrocyte sedimentation rate, inflammation Breast cancer, C-reactive protein, erythrocyte sedimentation rate, inflammation

How to cite this article:
Ofunre E, Kenneth A, Osagie IJ. Assessment of some biomarkers of inflammation in breast cancer patients in Benin City, Nigeria. Niger J Surg Sci 2017;27:33-6

How to cite this URL:
Ofunre E, Kenneth A, Osagie IJ. Assessment of some biomarkers of inflammation in breast cancer patients in Benin City, Nigeria. Niger J Surg Sci [serial online] 2017 [cited 2023 Mar 28];27:33-6. Available from:

  Introduction Top

Breast cancer is the most common type of cancer in women and the leading cause of cancer-related death worldwide.[1] The exact cause of breast cancer is not completely known; it represents a complex interplay of genetic susceptibility and environmental factor, and inflammation has been shown to increase the risk of cancer.[2],[3],[4] The inflammatory response promotes carcinogenesis by damaging DNA, stimulating angiogenesis and cell proliferation, and inhibiting apoptosis.[5],[6]

Erythrocyte sedimentation rate (ESR) is a simple inexpensive index of measurement of chronic inflammation frequently ordered in clinical medicine.[7],[8],[9] In cancer management, a high ESR has been found to correlate with the prognosis of breast cancer and other types of cancer such as Hodgkin's disease, gastric carcinoma, renal cell carcinoma, chronic lymphocytic leukemia, colorectal cancer, and prostate cancer.[10],[11],[12] The diagnostic use of ESR has been generally replaced by the measurement of C-reactive protein (CRP).

CRP is a classical positive acute-phase protein displaying rapid and pronounced rise of its plasma concentration in response to acute inflammation, infection, and tissue damage.[13],[14] CRP is produced by the liver, predominantly under transcriptional control by the cytokine interleukin-6 originating from the site of pathology.[15]

Serum CRP has been shown to parallel carcinogenesis possibly as an expression of the host defense reaction or as paraneoplastic syndrome.[16],[17] Previous epidemiologic studies have reported that elevated CRP levels may be associated with a poor prognosis of several types of solid cancers,[18] including endometrial,[19] cervical,[20] colorectal, pancreatic, hepatocellular, esophageal, renal cell, bladder, prostate, ovarian, and non-small cell lung cancer.[21],[22] Breast cancers are characterized by significant histological inflammation; emerging evidence suggests that inflammatory pathways also play an important role in breast cancer progression.[23],[24],[25],[26],[27],[28] Hence, the aim of the present study was to measure the levels of inflammatory markers in breast cancer patients by measuring their ESR and CRP levels compared to those without the disease (control).

  Patients and Methods Top

A total of sixty female participants from Central Hospital, Benin City, were recruited for this study between July 1, 2011 and October, 31, 2012, a period of 15 months. Thirty of these women (50%) had breast cancer and were of both pre- and post-menopausal age groups. The other thirty participants (50%) were age-matched apparently healthy women who served as control. The study was approved by the Ethics Committee of Central Hospital, Benin City, and participation was voluntary.

Biochemical assay was done at the Department of Chemical Pathology, University of Benin Teaching Hospital.

Sample collection and preparation

Venous blood was obtained from participants into an anticoagulant bottle containing ethylenediaminetetraacetic acid (EDTA) for ESR evaluation, and also into a sterile plain bottle, which was allowed to clot and retract, and then the serum was harvested after centrifugation at 3000 rpm for 15 min for CRP evaluation. The venous blood samples were collected after the patients were diagnosed with breast cancer before the commencement of chemotherapy.

ESR level was evaluated in the whole blood in the EDTA bottle immediately, while the harvested sera were stored frozen at –20°C until CRP analysis was carried out.

Biochemical analysis

Determination of erythrocyte sedimentation rate

ESR was determined using the Westergren method,[7],[29] which measures the distance that erythrocytes have sediment after 1 h in a vertical column of anticoagulated blood under the influence of gravity.

Determination of C-reactive protein levels

CRP levels were determined using the immunoturbidimetric method.[30] In this method, CRP sample binds to specific anti-CRP antibodies, which have been adsorbed to latex particles, and the agglutination measured spectrophotometrically is proportional to the quantity of CRP in the sample.

Data analysis

Data analysis was conducted using the general linear model of SAS 2004 model version 9.1.3 Inc. Cary, North Carolina, USA. All results were expressed as mean ± standard error of mean. Multiple group comparison was performed by one-way ANOVA followed by Duncan test. Pearson's correlation coefficient was employed to ascertain the association between various inflammatory markers.

  Results Top

The mean age of the participants with breast cancer was 55 ± 1.6 years (range: 45–65), while that of the controls was 51 ± 1.4 years (range: 42–66) as shown in [Table 1]. ESR of the participants with breast cancer was 47.50 ± 7.269 mm/h (range: 14–130) and this was statistically significant (P < 0.05) when compared to that of the controls which was 6.867 ± 0.525 mm/h (range: 3–13). CRP level of participants with breast cancer was 73.763 ± 1.331 mg/dL (59.860–82.760) and that of the controls was 8.955 ± 0.657 mg/dL (5.460–13.920) and this disparity was statistically significant (P < 0.05).
Table 1: The mean age, erythrocyte sedimentation rate, and C-reactive proteins levels of breast cancer patients and those without the disease (control)

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There is also a significant positive correlation (P < 0.001) between ESR and CRP levels (r = 0.6004) in all the participants as shown in [Table 2]. [Figure 1] showed remarkable differences in the levels of the inflammatory biomarkers(ESR and CRP) in patients with breast cancer and those without breast cancer (control subjects).
Table 2: Correlation coefficients of C-reactive proteins and erythrocyte sedimentation rate in breast cancer patients and controls

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Figure 1: Histogram comparing levels of erythrocyte sedimentation rate and C-reactive protein of breast cancer patients with normal controls

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  Discussion Top

The findings in this study showed statistically significant elevation of ESR levels of patients with breast cancer compared to that of the controls. High ESR levels have been found to correlate with overall poor prognosis for different types of cancer including breast. European studies of patients with Hodgkin's disease have suggested that an elevated ESR may still be an excellent predictor of early relapse, especially if the value remained elevated after chemotherapy or failed to drop to a normal level within 6 months after therapy.[9],[11]

Findings from this study also showed statistically significantly elevated CRP levels in breast cancer patients compared to the controls; this is probably due to the rise in the plasma concentration of interleukin-6 which is produced predominantly by macrophages during inflammation.[14] High serum CRP might reflect a high metastatic potential as inflammatory cytokines in general and CRP in particular are known to promote metastatic spread by stimulating angiogenesis, increasing vascular permeability, and acting as an endothelial cell mitogen.[31] Results from prospective epidemiologic studies are conflicting, with some other studies showing an association between elevated CRP levels and poor prognosis[32],[33] and others showing no such association.[34],[35] The largest study so far comprised 700 women treated successfully for early-stage breast cancer and found to have elevated levels of CRP measured 2½ years from the time of diagnosis with reduced disease and overall survival.[32]

Studies carried out by Allin and Nordestgaard suggest that invasive breast cancer patients with elevated CRP levels at diagnosis had a 1–7-fold increased risk of death from breast cancer compared to patients with low CRP levels at diagnosis.[36] Promising data on the prognostic significance of serum CRP in various malignancies have been reported.[37] Studies carried out by Akanni et al. at Osogbo, Nigeria, reported a rise in CRP levels in patients with chronic myeloid leukemia; they concluded that CRP could be a useful factor in determining disease progression or monitoring the effectiveness of treatment in leukemic patients.[38]

Studies conducted by Jo et al. in Abeokuta, South Western Nigeria, reported that patients with high CRP also had significantly elevated ESR, a finding which is in keeping with our studies.[39]

  Conclusion Top

Our study confirms the importance of ESR and CRP in breast cancer management. ESR and CRP levels are not routinely measured when planning breast cancer treatment, and the need for baseline determination of these inflammatory markers cannot be underestimated as they might help surgeons know about the patients' prognosis and so guide treatment decision.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

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  [Figure 1]

  [Table 1], [Table 2]

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