{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T16:31:26Z","timestamp":1787761886182,"version":"build-2784847793"},"reference-count":39,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T00:00:00Z","timestamp":1768521600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T00:00:00Z","timestamp":1768521600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl Journal of Cancer"],"published-print":{"date-parts":[[2026,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Breast cancers are heterogeneous and largely classified using immunohistochemistry of estrogen receptor expression. However, research suggests RNA\u2010based subtyping, including intrinsic (luminal vs. non\u2010luminal) and TP53\u2010based subtypes, may offer additional etiologic insight. TP53 mutant tumors, often more aggressive and non\u2010luminal, are common among women of African descent. We examined possible heterogeneity for RNA\u2010based luminal\/non\u2010luminal and TP53 subtypes among women of west African ancestry. We analyzed 595 invasive breast cancer cases and 2096 controls in the Ghana Breast Health Study. RNA was extracted from formalin\u2010fixed paraffin\u2010embedded tumor samples and profiled via nCounter\u00ae Breast Cancer 360\u2122. Tumors were classified as luminal (\n                    <jats:italic>N<\/jats:italic>\n                    \u2009=\u2009278) vs. non\u2010luminal (\n                    <jats:italic>N<\/jats:italic>\n                    \u2009=\u2009282) and TP53 wildtype\u2010like (\n                    <jats:italic>N<\/jats:italic>\n                    \u2009=\u2009324) vs. mutant\u2010like (\n                    <jats:italic>N<\/jats:italic>\n                    \u2009=\u2009271) using the PAM50 assay and a validated RNA signature, respectively. Case\u2013control odds ratios and 95% confidence intervals were estimated using polytomous logistic regression. Etiologic heterogeneity was assessed in case\u2010only analyses. Higher parity was more protective for luminal than non\u2010luminal tumors (\n                    <jats:italic>p<\/jats:italic>\n                    \u2010heterogeneity\u2009=\u2009.05). Older age at menarche and alcohol use \u22656\u2009months were associated with elevated risk of luminal, but not non\u2010luminal tumors (\n                    <jats:italic>p<\/jats:italic>\n                    \u2010heterogeneity\u2009=\u2009.01). Similar trends were observed for TP53 wildtype\u2010like tumors, though not statistically significant. Cross\u2010classification of PAM50\/TP53 showed that higher parity, older age at menarche, and alcohol use \u22656\u2009months were more strongly associated with luminal\/TP53 wildtype\u2010like than other subtypes. RNA\u2010based breast cancer subtyping suggests TP53 refines breast cancer etiologic heterogeneity in a sub\u2010Saharan African population. The high prevalence of aggressive, mostly TP53\u2010mutant tumors in this population underscores the need for further studies to clarify etiologic heterogeneity.\n                  <\/jats:p>","DOI":"10.1002\/ijc.70332","type":"journal-article","created":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T19:25:29Z","timestamp":1768591529000},"page":"2890-2899","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Etiology of gene expression\u2010based subtypes of breast cancer in the Ghana Breast Health Study"],"prefix":"10.1002","volume":"158","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7831-6660","authenticated-orcid":false,"given":"Amber N.","family":"Hurson","sequence":"first","affiliation":[{"name":"Division of Cancer Epidemiology and Genetics, National Cancer Institute National Institutes of Health  Rockville Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ebonee N.","family":"Butler","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Gillings School of Global Public Health University of North Carolina  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alina M.","family":"Hamilton","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Gillings School of Global Public Health University of North Carolina  Chapel Hill North Carolina USA"},{"name":"Lineberger Comprehensive Cancer Center University of North Carolina  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khushali K.","family":"Shah","sequence":"additional","affiliation":[{"name":"Division of Cancer Epidemiology and Genetics, National Cancer Institute National Institutes of Health  Rockville Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryan Aapentuo","family":"Sienso","sequence":"additional","affiliation":[{"name":"Department of Public Health Tamale Teaching Hospital  Tamale Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace Adjoa","family":"Ocansey","sequence":"additional","affiliation":[{"name":"Department of Public Health Ashaiman Municipal Hospital, Ghana Health Service  Accra Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheba Mary Pognaa","family":"Kunfah","sequence":"additional","affiliation":[{"name":"Ghana HUB of NIHR Global Surgery  Tamale Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernard","family":"Petershie","sequence":"additional","affiliation":[{"name":"Kwame Nkrumah University of Science and Technology  Kumasi Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaitlin E.","family":"White","sequence":"additional","affiliation":[{"name":"Division of Cancer Epidemiology and Genetics, National Cancer Institute National Institutes of Health  Rockville Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence","family":"Edusei","sequence":"additional","affiliation":[{"name":"Korle Bu Teaching Hospital  Accra Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ernest","family":"Adjei","sequence":"additional","affiliation":[{"name":"Komfo Anoyke Teaching Hospital  Kumasi Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florence","family":"Dedey","sequence":"additional","affiliation":[{"name":"Department of Surgery, College of Health Sciences University of Ghana Medical School  Accra Ghana"},{"name":"Department of Surgery Korle Bu Teaching Hospital  Accra Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Verna","family":"Vanderpuye","sequence":"additional","affiliation":[{"name":"National Centre for Radiotherapy and Nuclear Medicine Korle Bu Teaching Hospital  Accra Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joe\u2010Nat","family":"Clegg\u2010Lamptey","sequence":"additional","affiliation":[{"name":"Department of Surgery, College of Health Sciences University of Ghana Medical School  Accra Ghana"},{"name":"Department of Surgery Korle Bu Teaching Hospital  Accra Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel","family":"Yarney","sequence":"additional","affiliation":[{"name":"National Centre for Radiotherapy and Nuclear Medicine Korle Bu Teaching Hospital  Accra Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Biritwum","sequence":"additional","affiliation":[{"name":"Department of Community Health, College of Health Sciences University of Ghana School of Public Health  Accra Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kofi M.","family":"Nyarko","sequence":"additional","affiliation":[{"name":"Disease Control and Prevention Department Ghana Health Service  Accra Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francis","family":"Aitpillah","sequence":"additional","affiliation":[{"name":"Kwame Nkrumah University of Science and Technology  Kumasi Ghana"},{"name":"Komfo Anoyke Teaching Hospital  Kumasi Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph K.","family":"Oppong","sequence":"additional","affiliation":[{"name":"Komfo Anoyke Teaching Hospital  Kumasi Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ernest","family":"Osei\u2010Bonsu","sequence":"additional","affiliation":[{"name":"National Radiotherapy and Nuclear Medicine Centre Komfo Anokye Teaching Hospital  Kumasi Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Ansong","sequence":"additional","affiliation":[{"name":"Komfo Anoyke Teaching Hospital  Kumasi 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Nkrumah University of Science and Technology  Kumasi Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Montserrat","family":"Garcia\u2010Closas","sequence":"additional","affiliation":[{"name":"The Institute of Cancer Research  London UK"},{"name":"Cancer Epidemiology and Prevention Research Unit Institute of Cancer Research and Imperial College  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3728-6535","authenticated-orcid":false,"given":"Mustapha","family":"Abubakar","sequence":"additional","affiliation":[{"name":"Division of Cancer Epidemiology and Genetics, National Cancer Institute National Institutes of Health  Rockville Maryland 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