Wallgren and associates published on all the cases reported to the Swedish Cancer Registry in the 1985-1968 period as breast carcinomas in women under 30 years of age [1]. On retrospective analysis of the microscopic slides, it was expressly stated that “75 were accepted as carcinoma.” Therefore, the purpose of this paper is to compare some of their results with those diagnosed personally as carcinomas on the strength of my long experience [2]. Moreover, imitating the Birmingham type of histopathology data pool over a period of 30 years, the data were specifically collected from the Ibos or Igbos, who constitute one of the major ethnic groups in Nigeria, West Africa. In this context, the ethnology of the Swedes is such that they are “notably homogenous” [3-5].

During the period from 20^th February, 1970, to 19^th February, 2000, I was solely in charge of a Reference Pathology Laboratory located in Enugu, the former capital of the Eastern Region of Nigeria. Sixtyeight doctors working among the Igbos in 44 hospitals situated in 20 towns sent to me surgical specimens with the required adequate clinical records. Since I kept duplicate copies of their data and my findings, it was possible to compare them with the Swedish materials as regards age, pregnancy status, and histologic appearances, remembering that “carcinoma” simpliciter is unlikely to have changed as a diagnosis during these decades. Moreover, the major interest in Sweden was not on histologic classification but on survival rate itself, whereas the Nigerian patients were not followed up.

There were 122 patients aged up to 29 years Table 1. The youngest was aged 18 years in both series. Those aged from 25-29 years numbered 92, i.e., 75%, thereby preponderating as in Sweden’s 87%. Sixteen Nigerian patients were pregnant or lactating, i.e., 12.3%, in contrast with Sweden, whose figures stood at roughly 20%. Considering the pathological diagnosis, the general run of ductal, lobular, mucinous, comedo, medullary, undifferentiated, and multiform carcinomas could be identified. What stood out was the single case of adenocystic carcinoma which appeared in only the Nigerian cohort Figure 1.

Table 1: Age distribution of patients under 30 years in Sweden and Nigeria.

Figure 1: Typical microscopic appearance of adenocystic carcinoma in an Ibo woman.

Detected patterns portrayed in the present study are truly representative of the local carcinomas. This is because of the representative nature of my materials, seeing that 68 doctors working in 44 hospitals situated in 20 towns submitted the accrued specimens. In fact, I have argued in a Doctorate Thesis based on Igboland that my histopathology data pool is so deep that what is fished from it is necessarily representative of the epidemiology of this ethnic group! [6].

Group in terms of epidemiology is often based on age characteristics. Unfortunately, this yardstick is often variable. Thus, “young women” were here presented as those aged below 30 years. In the recent available literature, this was also the cut-off age [7]. Elsewhere, the figures have varied so much that Gabriel and Domchek lamented as follows: “The definition of a ‘young woman’ in the field of breast oncology varies, with most referring to women under either age 35 or 40 years as ‘young’ [8].” To be specific, the data are “27-45 years,” [9] “under 36,” [10] “under 40,” [11,12] “aged 40 and younger,” [13] and “aged 41-47” [14]. Be that as it may, much as one would have wished for a gold standard, the message is that health education for self examination must start early.

Early such detection must be pursued worldwide. It was singularly canvassed as a global initiative especially in Limited-Resource Countries [15]. Indeed, as United States authors [16] put it, “Because most women initially consult their gynecologist about breastrelated complaints, their role in the diagnostic process needs to be reemphasized.” Perhaps, the women groups have divergent degrees of rapport with their diagnosticians. To emphasize with the review of Anderson, [17] “Uncertainties persist about management and prognosis of mammary cancers that occur during and after pregnancy and during lactation.” In this context, as was summarized recently [18] using data without any age limits, “Breast Cancer during Pregnancy (BCP) is relatively rare and is associated with controversies about its biology and prognosis.” Accordingly, in all probability, world-wide epidemiology may contribute positively in resolving such controversies [19]. Incidentally, the single case of adenocystic carcinoma in the Nigerian series is reminiscent of the interesting appearance of this particular carcinoma in an albino in whom skin lesion coexisted with other forms of carcinoma [20].

A persuasive premise is that the cancer category of yester years is still useful in the promotion of reliable researches on the worldwide epidemiology of breast cancer [21]. This assertion is made in spite of the fact that, nowadays, leading researchers [22,23] are churning out several molecular classifications! Accordingly, the present paper provides some interesting highlights on the comparative epidemiology of breast carcinoma among Swedish and Nigerian women under 30 years of age, e.g., the youngest were both teenagers.