METHODS
The Ahmadu Bello University Teaching Hospital (ABUTH) is a 700-bed Teaching
hospital located in Shika, a semi-urban area of Zaria in Kaduna State, Northern
Nigeria. It is a centre of excellence for oncology and provides services to
patients from all over the country but mainly within the North western region of
Nigeria.
This is a descriptive study in nature using retrospective review of existing
records from 2001-2005. Histologically confirmed cases of breast cancer that
received at least one form of treatment and had at least one follow up visit
were included. A total of 103 records met the criteria and were retrieved.
Data was retrieved from the surgery/pathology register and linked with the main
central patient records. This was entered and analysed using the statistical
package for social science (SPSS Version 11.5) software.
Survival analysis was carried out using the actuarial method and survival time was
defined as time from commencement of treatment to death. Survival curves for the
estimates were compared with across relevant characteristics using the Wilcoxon
(Gehan) test.
RESULTS
Patients were predominantly Hausa speaking females 99 (96.1%) and all were
married. The mean age of patients was 44.5±13 years and most 58 (57.4%) were
within the age range of 30-49 years. Most patients treated were premenopausal 62
(62.6%) and were presented late with advanced breast cancer disease 64 (62.1%).
Approximately half 48 (46.6%) of the patients were presented with stage III
disease, while only 12 (11.7%) had stage I. (Table 1)
The cancers affected mostly the left breast 64 (62.1%). The upper outer quadrant
of the breast 48 (60.7%) was mostly involved followed by the areola in 43
(41.7%) cases either singly or in combination. Only 11 (14.1%) patients had the
whole breast involved and there was no bilateral affectation at presentation.
Invasive ductal carcinoma was the predominantly histological presentation 85
(82.5%) followed by medullary carcinoma 6 (5.8%) and invasive lobular carcinoma
5 (4.9%). (Table 2)
The overall survival rate beyond 3 years was observed in 70.4% of patients,
(Fig. 1). There was no mortality experienced by patients with early breast
cancer, contrary to 24.5% probability of survival beyond 30 months in patients
with advanced disease (p=0.0001), (Fig. 2). Postmenopausal patients had better
survival beyond 36 months (70.6%) compared to premenopausal (68.5%) patients,
(p=0.46). (Fig. 3)
DISCUSSION
Breast cancer management has been a major challenge to physicians in developing
countries, principally due to the lack of advanced technology and late
presentation of patients to the hospital. age at onset of breast cancer
among black women are poorly understood but could probably be connected to the aggressive nature
of the disease.15
This study showed that most (62.1%) of the patients presented with advanced disease
commonly with Manchester Stage III 48(46.6%). The findings are similar to
several other centres in Nigeria.12,14,16-19 Other researchers are of
the opinion that several factors could be responsible for the presentation with
advance disease. Principally among them perhaps are incisions by other
traditional healers, ignorance, poverty and the aggressive
characteristics of breast cancers in
black populations.12,15
This study also showed that invasive ductal carcinoma was the most common 85
(82.5%) histological type followed by Medullary carcinoma 6 (5.8%). Although the
grading was not specified, other researchers have also found invasive ductal
carcinoma occurring most commonly.4,13,14,16 The left breast was
mostly affected 57 (62.0%) with the upper outer quadrant mostly involved 48
(61.6%) either singly or in combination with other parts of the breast. This is in contrast to a previous
study conducted in this centre where the right breast was reported to be the
most commonly affected, but similar to the results reported by Adesunkanmi at
Ile-Ife, Nigeria.12,19 The upper outer quadrant is also reported to
be commonly involved in African and European studies.4,12,20 This may
probably be due to the association of the upper outer quadrant with the axillary
tail which is a channel for drainage of lymph to the axillary lymph nodes and
may carry micro-metastasis more than the other quadrants of the breast.
The overall survival rate of 70.4% at
36 months is low compared to the survival rate of breast cancer patients managed
in developed countries which is 95% and above.3 This poor outcome is
similar to that report by Anyanwu in Nnewi, Nigeria.21 This perhaps
could be due to late presentation because of ignorance and lack of screening
services.
CONCLUSION
The patients managed are relatively young premenopausal women who were mostly
presented with advanced breast cancer.
The overall survival rate was low and survival was better among patient with
early breast cancer than those with advanced disease. There is need to improve
public enlightenment of breast cancer and set up screening centres to encourage
early presentations.
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