A cross-sectional study conducted at the Cape Coast Teaching Hospital in Ghana has found that breast cancer patients who have undergone chemotherapy show markedly different blood profiles compared with patients who have not yet received treatment and with healthy women. The study, which included 120 participants, also examined whether routinely measured inflammatory blood indices could help distinguish between hormone receptor subtypes of breast cancer, but found only limited and largely exploratory associations on that front.
The research, published in Discover Medicine, compared three groups: chemotherapy-naïve breast cancer patients, chemotherapy-experienced patients who had completed at least one cycle of treatment, and apparently healthy controls. Purposive sampling was used to recruit 35 chemotherapy-naïve patients, 43 chemotherapy-experienced patients and 42 healthy controls. The median age of all participants was 44 years, with an interquartile range of 35 to 55 years.
The haematological differences associated with chemotherapy exposure were substantial. Chemotherapy-experienced patients had significantly lower red blood cell counts, haemoglobin concentrations, haematocrit and lymphocyte counts than the other groups, with p-values ranging from 0.008 to below 0.001. They also showed higher red cell distribution width and a higher monocyte-to-lymphocyte ratio. These patterns are consistent with the well-documented myelosuppressive effects of cytotoxic chemotherapy, which suppresses bone marrow activity and disrupts normal haematopoiesis, leading to anaemia and depletion of circulating immune cells.
Particularly notable was the behaviour of platelet-related measures. Although absolute platelet counts did not differ significantly between the groups, platelet morphological indices did. Platelet distribution width, mean platelet volume and platelet-large cell ratio were all significantly reduced in the chemotherapy-experienced group, with p-values of 0.004 or lower. The researchers suggest that chemotherapy may influence megakaryocyte maturation and platelet production dynamics before overt thrombocytopenia develops, meaning these indices could potentially serve as early indicators of treatment-related haematological stress, although their clinical relevance requires further investigation.
The treatment context of the cohort helps explain the observed changes. Chemotherapy was the predominant treatment modality among participants on active treatment, accounting for 78.3 percent, followed by surgery at 14.5 percent. Paclitaxel was the dominant single-agent regimen, used in 93 percent of patients receiving single-agent chemotherapy, with capecitabine accounting for the remainder. Among the small number of patients on combination regimens, the AC and TC protocols were each used in 40 percent of cases. Most patients with documented cycle information had completed between one and four cycles, suggesting many were assessed during relatively early phases of treatment exposure. Because detailed information on cumulative doses and the timing of blood collection relative to treatment cycles was not available for all patients, the contribution of specific regimens to the observed changes could not be directly evaluated.
The second part of the study explored whether complete blood count-derived inflammatory indices, including the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic immune-inflammation index and aggregated index of systemic inflammation, were associated with oestrogen receptor, progesterone receptor and HER2 status. These analyses were restricted to the 52 of 78 breast cancer patients for whom immunohistochemistry results were available in medical records, a constraint the authors repeatedly flag as a major limitation.
In unadjusted comparisons, some differences emerged across receptor-defined groups. Platelet counts were higher in ER-positive patients compared with ER-negative patients, and in PR-positive compared with PR-negative patients. PR-positive patients additionally showed elevated plateletcrit, aggregated index of systemic inflammation and systemic immune-inflammation index. HER2-positive patients had higher haemoglobin levels than HER2-negative patients. However, the authors caution against interpreting these findings as evidence of an independent relationship between receptor expression and platelet-mediated inflammation, noting that ER and PR are frequently co-expressed and that receptor-specific differences may reflect broader hormone receptor biology rather than an isolated effect of a single receptor.
The multivariable regression analysis reinforced this caution. Across all three receptor outcomes, neither age, chemotherapy exposure nor the haematological biomarkers were independently associated with receptor status, with all p-values exceeding 0.05. The neutrophil-to-lymphocyte ratio showed non-significant increases in the odds of ER-negative and PR-negative disease, but the wide confidence intervals indicated substantial uncertainty in these small subgroups. The authors conclude that CBC-derived inflammatory markers should currently be regarded as exploratory indicators of the interaction between tumour and host inflammatory response, rather than independent predictors or clinically useful surrogates of ER, PR or HER2 status.
Predictive modelling offered modest, mixed signals. A combined model incorporating clinical variables and biomarkers achieved the highest area under the curve for ER-negative disease at 0.679 and for HER2-positive disease at 0.644, while performing similarly to a biomarker-only model for PR-negative disease at 0.646. Adding biomarkers to the clinical model significantly improved discrimination, as measured by the integrated discrimination improvement index, for ER-negative and PR-negative disease, but the corresponding net reclassification improvements were not statistically significant, and DeLong’s tests showed the AUC differences between models were not significant for any outcome. The combined models achieved higher specificity than clinical models alone, at the cost of reduced sensitivity. The authors emphasise that the modest overall performance is insufficient for clinical application and that these markers should not be considered a replacement for immunohistochemical receptor testing.
The study has several limitations that shape how its findings should be read. Its cross-sectional design precludes any assessment of temporal relationships between chemotherapy exposure, inflammatory changes and receptor status. Hormone receptor data were missing for 26 of the 78 patients, which may have introduced selection bias and reduced statistical power. Blood samples were collected during routine clinic visits without standardisation relative to chemotherapy cycles, and potential confounders such as nutritional status, comorbidities and menopausal status were not comprehensively assessed. As a single-centre study using purposive sampling with measurements at a single time point, generalisability is limited. The authors call for larger, multicentre, longitudinal studies with complete receptor profiling, serial biomarker measurements and external validation to determine whether these low-cost blood indices have reproducible clinical value, particularly in resource-limited settings where access to molecular diagnostics is constrained.
Subject of Research: Haematological and inflammatory blood markers in Ghanaian breast cancer patients by chemotherapy exposure and hormone receptor status
Article Title: Haematological and systemic inflammatory markers associated with chemotherapy exposure and hormone receptor status in Ghanaian patients with breast cancer
Article References: Duneeh, R. V., Ablordey, K., Sackey, B., Adankwah, E., Afriyie, E. Y., Kwablah, G. J., Agyemang, V., Kwadzokpui, P. K., Klugah, M. A., Amponsah, F. A., & Addai-Mensah, O. (2026). Haematological and systemic inflammatory markers associated with chemotherapy exposure and hormone receptor status in Ghanaian patients with breast cancer. Discover Medicine, 3(1), Article 150. https://doi.org/10.1007/s44337-026-00719-0
Image Credits: AI Generated
DOI: 10.1007/s44337-026-00719-0
Keywords: breast cancer, chemotherapy, complete blood count, inflammatory markers, hormone receptors, Ghana, haematology, cross-sectional study, NLR, AISI, Haematological, systemic
News Source: Nathaniel Bowman. (October 30, 2026). Blood markers shift with chemotherapy in Ghanaian breast cancer patients. Scienmag.
