Mastectomy for management of breast cancer in Ibadan, Nigeria

Translating Evidence into Practice: A Review of Clinical Practice and Outcomes following the Adoption of an Early Post-Mastectomy Discharge Protocol in a Nigerian Hospital

Introduction

In Nigeria, mastectomy is the most common surgical treatment for breast cancer. Patients are often kept on admission for days until wound drains are removed. An early discharge programme was piloted in a Nigerian hospital in 2017 with very satisfactory outcomes. The impact of this evidence on clinical practice and surgical outcomes was evaluated over 5 years.

Methods

From a prospectively maintained institutional database, the details of patients who underwent mastectomy between 2018 and 2022 were obtained. The duration of post-operative stay was obtained and analysed per year to determine the trend. Post-operative surgical complications such as seroma, haematoma, flap necrosis, and surgical site infection were analysed.

Results

Overall, 147 patients (69%) had early discharge during the review period. Twenty-two patients (10.3%) were discharged within 24 h of surgery, 61 patients (28.6%) were discharged within 24-48 h, and 64 patients (30%) were discharged between 48 and 72 h. There was a steady increase in the adoption of the early discharge protocol over time with a 50% adoption rate in 2018 and 95% in 2022. The mean duration of hospital stay declined steadily from 3.9 days in 2018 to 2.2 days in 2022. Early discharge did not result in any compromise to post-operative outcomes.

Conclusion

This study demonstrates the sustainability of early post-mastectomy discharge in a resource-limited setting with very satisfactory outcomes. It also provides a unique example of how locally generated evidence can guide local practice. We consider these findings generalisable in other Nigerian hospitals and low- and middle-income countries with similar contexts.

Comparing the effectiveness of full-vacuum and half-vacuum drainage in reducing seroma after modified radical mastectomy: a meta-analysis

INTRODUCTION

Owing to limited outpatient support for drain management, delayed discharge after mastectomy is more prevalent in developing countries. Utilising half-vacuum (HV) suction drains for routine drainage after mastectomy could lead to a reduced incidence of seroma and a shorter hospital stay. This systematic review and meta-analysis compared the outcomes of HV against full-vacuum (FV) suction drains in patients who underwent modified radical mastectomy for breast cancer.

METHODS

Differences between the two groups in length of hospital stay, total volume of drain effluent and incidence of seroma were assessed. RevMan 5.4 was used to calculate the odds ratio (OR) and relative risk (RR) for dichotomous data, and the mean difference (MD) for continuous data.

RESULTS

Nine randomised controlled trials were included in this review. Using HV drains reduced both the mean length of hospital stay (MD: -2.30 days, 95% confidence interval [CI]: -4.10 to -0.49 days, I2=97%) and the mean total volume of effluent (MD: -132.61ml, 95% CI: -207.32ml to -57.91ml, I2=88%) compared with FV drains. However, there was no statistically significant difference in incidence of seroma between the two groups (RR: 0.67, 95% CI: 0.30 to 1.46, I2=65%). Likewise, there was no difference in rate of seroma occurrence on sensitivity analysis (OR: 1.29, 95% CI: 0.72 to 2.33, I2=74%).

CONCLUSIONS

There was no difference in the incidence of seroma between HV and FV suction drainage. Conversely, a reduction in the length of hospital stay and the total volume of drain effluent was observed for mastectomy patients with a HV drain.

Immunohistochemical Profiling of HER-2/neu, Steroid Hormone Receptors and KI-67 Biomarkers in A Cohort of Nigerian Women with Breast Cancer

Background

Progressive improvement in the accuracy of profiling of hormone receptors in breast cancer provides the basis for targeted endocrine therapy, a major pillar of multimodal breast cancer treatment. However, the disparity in findings from comparatively smaller sample-sized studies in West Africa has led to somewhat conflicting conclusions and recommendations.

Objectives

This study investigates the immunohistochemical (IHC) profile of breast cancer specimens for estrogen receptor (ER), progesterone receptor (PR), human epidermal receptor-2 (HER2)/neu, and Ki-67 in a tertiary hospital in Ibadan, Nigeria over 12 years.

Materials and Methods

We reviewed 998 IHC reports, documented clinicopathologic parameters, computed patterns of biomarkers, and stratified them based on the American Society of Clinical Oncology/College of American Pathologists recommendations. Descriptive analysis including frequency, mean, and median were generated from the data extracted.

Results

Out of the 998 cases, 975 (97.7%) were females and 23 (2.3%) were males. The mean age was 48.84 ± 11.99 years. Open biopsies were the most common types of specimens (320, 41.6%): lumpectomy and incisional biopsy of ulcerated, fungating or unresectable tumours. In those cases, 246 (32.0%) were samples of breast-conserving or ablative surgical extirpation (mastectomy/wide local excision/quadrantectomy), and 203 (26.4%) were obtained by core needle biopsies. Invasive ductal carcinoma was the most common histopathological type (673, 94.5%). The majority of graded tumours were intermediate grade (444, 53.5%). Four hundred and sixty-nine (48.4%) were ER positive, 414 (42.8%) were PR positive, and 180 (19.4%) were HER2/neu positive. Three hundred and thirty-four (34.0%) were triple-negative. Eighty-nine cases had Ki-67 staining done, and of these 61 (68.5%) had positive nuclear staining.

Conclusion

Steroid hormone receptors and HER-2/neu proportions in our cohort are likely to be more representative than the widely varied figures hitherto reported in the sub-region. We advocate routine IHC analysis of breast cancer samples as a guide to personalized endocrine therapy.

Utilization and predictors of postmastectomy radiation receipt in an Oncology Center in Zimbabwe

PURPOSE

Few sub-Saharan African studies have ascertained utilization for postmastectomy radiation (PMRT) for breast cancer, the second most common cancer among African women. We estimated PMRT utilization and identified predictors of PMRT receipt in Zimbabwe.

METHODS

Retrospective patient cohort included non-metastatic breast cancer patients treated from 2014 to 2019. PMRT eligibility was assigned per NCCN guidelines. Patients receiving chemotherapy for non-metastatic disease were also included. The primary endpoint was receipt of PMRT, defined as chest wall with/without regional nodal radiation. Predictors of receiving PMRT were identified using logistic regression. Model performance was evaluated using the c statistic and Hosmer-Lemeshow test for goodness-of-fit.

RESULTS

201 women with localized disease and median follow-up of 11.4 months (IQR 3.3-17.9) were analyzed. PMRT was indicated in 177 women and utilized in 59(33.3%). Insurance coverage, clinical nodal involvement, higher grade, positive margins, and hormone therapy receipt were associated with higher odds of PMRT receipt. In adjusted models, no hormone therapy (aOR 0.12, 95% CI 0.043, 0.35) and missing grade (aOR 0.07, 95% CI 0.01, 0.38) were associated with lower odds of PMRT receipt. The resulting c statistic was 0.84, with Hosmer-Lemeshow p-value of 0.93 indicating good model fit.

CONCLUSION

PMRT was utilized in 33% of those meeting NCCN criteria. Missing grade and no endocrine therapy receipt were associated with reduced likelihood of PMRT utilization. In addition to practice adjustments such as increasing hypofractionation and increasing patient access to standard oncologic testing at diagnosis could increase postmastectomy utilization.

Socio-demographic, pattern of presentation and management outcome of breast cancer in a semi-urban tertiary health institution

Introduction

breast cancer is the most common malignancy in females worldwide and a major cause of cancer-related deaths in both developing and developed countries. The objective of this study was to determine the socio-demographics, pattern of presentation and management outcome of breast cancer patients.

Methods

clinical records of confirmed breast cancer patients between January 2011 and December 2015 at the Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria were reviewed.

Results

eighty two breast cancer patients were seen. Their ages ranged from 26-95 years (mean 48.9 ± 14.9 years, median 47.5 years). Eighty one (98.8%) were females and the majority (65.4%) were premenopausal. The peak age of incidence was in the 4^th decade. All patients presented with breast lump with mean duration of 9.49±6.1 months and size ranging from 2 to 16cm (mean 7.9±3.4 cm). Ten (12.2%) patients presented early, 61 (74.4%) were locally advanced while 11 (13.4%) had distant metastases. Fifty one (62.2%) patients had mastectomy. Only 38 (46.3%) patients completed six courses of chemotherapy. None had immunohistochemistry but they all routinely took tamoxifen. Only 4 (4.9%) had radiotherapy. Nineteen (23.2%) died within a year of presentation. The follow-up period ranged between 1 and 44 months (mean, 10.3 months). Thirty one (37.8%), 19 (23.2%) and 8 (9.8%) patients were seen during the first, second and third year of follow up respectively.

Conclusion

breast cancer mostly affects young premenopausal women presenting in advanced stage in our setting. The generally poor outcome is not unconnected with late presentation and inadequate diagnostic and treatment facilities.

Impact of axillary node-positivity and surgical resection margins on survival of women treated for breast cancer in Ibadan, Nigeria

Introduction

Oncologic surgical extirpation, the mainstay of loco-regional disease control in breast cancer, is aimed at achieving negative margins and lymph node clearance. Even though axillary lymph nodal metastasis is a critical index of prognostication, establishing the impact of lymph node ratio (LNR) and adequate surgical margins on disease-specific survivorship would be key to achieving longer survival. This study examines the prognostic role of pN (lymph nodes positive for malignancy), LNR and resection margin on breast cancer survival in a tertiary hospital in Ibadan, Nigeria.

Methods

We conducted a longitudinal cohort study of 225 patients with breast carcinoma, documented clinico-pathologic parameters and 5-year follow up outcomes - distant metastasis and survival. Chi-square test and logistic regression analysis were used to evaluate the interaction of resection margin and proportion of metastatic lymph nodes with patients' survival. The receiver operating characteristic curve was plotted to determine the proportion of metastatic lymph nodes which predicted survival. The survival analysis was done using Kaplan-Meier method.

Results

Sixty (26.7%) patients of the patients had positive resection margins, with the most common immuno-histochemical type being Lumina A. 110 (49%) patients had more than 10 axillary lymph nodes harvested. The mean age was 48.6 ± 11.8 years. Tumour size (p = 0.018), histological type (p = 0.015), grade (p = 0.006), resection margin (p = 0.023), number of harvested nodes (p < 0.01), number of metastatic nodes (p < 0.001) and loco-regional recurrence (p < 0.01) are associated with survival. The overall 5-year survival was 65.3%.

Conclusion

Unfavourable survival outcomes following breast cancer treatment is multifactorial, including the challenges faced in the multimodal treatment protocol received by our patients.

Life Without a Breast: Exploring the Experiences of Young Nigerian Women After Mastectomy for Breast Cancer

PURPOSE

The majority of women managed for breast cancer in Nigeria are relatively young, many in their forties. Mastectomy, the most common surgical treatment, raises psychosocial concerns. Understanding these concerns may help address the fears of women who refuse treatment and aid in the care of those who have had mastectomy.

METHODS

Using qualitative methods, we purposively sampled women 45 years of age and younger who underwent mastectomy for breast cancer at a Nigerian teaching hospital. One-on-one in-depth interviews were conducted using an unstructured interview guide. Data were transcribed verbatim and analyzed to identify themes and subthemes.

RESULTS

The study identified six major themes on the impact of mastectomy on psychosocial lives of women, namely decision for mastectomy, postmastectomy transition, body image changes, relationship with husband and sexual life, coping with life postmastectomy, and social support.

CONCLUSION

Our findings highlight the importance of addressing individual patient's psychosocial needs and preferences when discussing breast cancer treatment with young women. The experiences of women described in this study reveal several useful themes for planning treatment protocols and postmastectomy care.

Presentation, diagnosis and management of locally advanced breast cancer: Is it different in low/middle income countries?

Background and Objective:

Breast cancer incidence is increasing and it is highest in low income countries. The main challenge is regarding awareness, screening, late presentation and its management in a third-world country. Our objective was to share the experience faced in various presentations, diagnosis and management of locally advanced breast cancer (LABC) in a third world country and discuss if they are different with respect to developed countries.

Methods:

It is a retrospective case series study performed at Jinnah Postgraduate Medical Centre Karachi, from January 2015 to December 2017, over period of three years. Data was collected from the record maintained by authors about patients presenting in breast clinic. Patients of breast cancer were managed in breast clinic over 3 years. Our study included patients who presented with LABC based on their clinical presentation confirmed by histopathological diagnosis and followed by surgical management. Statistical analysis for students t-test was performed using SPSS (version 20.0). A p-value less than 0.05 was considered statistically significant.

Results:

One hundred twelve patients presented with LABC over period of 3 years. All but two were female. Mean age was 52 years (range 26-78 years), SD 18.96. On presentation size of tumor was 5cm & more in 103 (91.9%) patients. Involvement of axilla was in 86 (76.7%). Chest wall was involved in 22 (19.6%). Total T3 and T4 were 71 (63.3%) and 41 (36.6%) respectively Diagnosis of all patients was confirmed by histopathology. Neoadjuvant was given to all patients to downstage the tumor. ER/PR was positive in 46(41.1%), HER-2/neu positive in 31 (27.6%). On staging breast carcinoma was metastatic in 13(11.6%) with liver, lung and bone in 4 (3.5%), 3 (2.7%) and 6 (5.3%) respectively. Breast conservation was done in 6 (6.1%) patients, Modified Radical Mastectomy was done in 86 (86.9%), Radical Mastectomy in 3 (3.03%), Toilet Mastectomy in 4 (4.045) and 13 (11.6%) patients were not operated.

Conclusion:

In our series 65% of all breast cancers are LABC at presentation. In low/middle income countries high percentage of LABC at presentation result in high metastatic disease, poor prognosis and limits conservation of breast. Awareness and education can improve outcomes.

Safety and feasibility of early postmastectomy discharge and home drain care in a low resource setting

BACKGROUND

Early postmastectomy discharge with a drain in place is standard practice in most developed countries. Its feasibility has not been evaluated in low resource settings like Nigeria.

METHODS

Consenting patients undergoing mastectomy were discharged on the third postoperative day and assessed as outpatients for wound complications as well as their experience at home. Wound outcomes were compared with patients who had traditional long stay.

RESULTS

Forty-five of the 58 patients who had a mastectomy during the study period participated in the early discharge program (77.6%). Of these, four patients (8.9%) had drain malfunction, seroma occurred in eight patients (17.8%), eight patients (17.8%) had wound infection, and six patients (13.3%) had flap necrosis. There was no readmission. Compared with long stay patients, postoperative stay was significantly shorter (3 vs 11 days; P < 0.01) with significant cost savings, while complication rates were not statistically different. All the patients in the early discharge group were confident operating their drains and preferred early discharge. Being around relatives, reduced cost, and fear of the hospital environment were common reasons cited for their preference.

CONCLUSION

Our results support the implementation of an early postmastectomy discharge program in a low resource setting.

Neoadjuvant chemotherapy among patients treated for nonmetastatic breast cancer in a population with a high HIV prevalence in Johannesburg, South Africa

Background

Neoadjuvant (primary) chemotherapy (NACT) is the standard of care for locally advanced breast cancer. It also allows for the short-term assessment of chemotherapy response; a pathological complete responses correspond to improved long-term breast cancer outcomes. In sub-Saharan Africa, many patients are diagnosed with large nonresectable tumors. We examined NACT use in breast cancer patients who visited public hospitals in Johannesburg, South Africa.

Methods

We assessed demographic characteristics, tumor stage and grade, hormone receptor status, and human immunodeficiency virus (HIV) status of female patients diagnosed with nonmetastatic invasive carcinoma of the breast at Chris Hani Baragwanath Academic Hospital between January 1, 2009, and December 31, 2011. The patients received neoadjuvant, adjuvant, or no chemotherapy. Trastuzumab was unavailable. We developed logistic regression models to analyze the factors associated with NACT receipt in these patients.

Results

Of 554 women with nonmetastatic breast cancer, the median age at diagnosis was 52 years (range: 28–88 years). Only 5.8% of patients were diagnosed with stage I disease; 49.3% and 44.9% were diagnosed with stages II and III, respectively. Most patients had hormone-responsive tumors: luminal A, 38.1%; luminal B₁ (human epidermal growth factor receptor 2 [HER2]-negative and high grade), 12.5%, and luminal B₂ (HER2-positive any grade), 11.6%; 11.6% had a HER2-enriched tumor and 20.6% a triple-negative tumor. Eighty (14.4%) patients were HIV-positive. In total, 195 patients (35.2%) received NACT, 264 (47.7%) patients received adjuvant chemotherapy, and 95 patients (17.1%) received no chemotherapy, including 62 (11.2%) patients who received only hormonal therapy. Of patients receiving NACT, 125 (64.1%) were evaluable for clinical response. Eighty (64.0%) patients had a clinically significant response; 19 (15.2%) patients had a stable disease, and 26 (20.8%) patients had a progressive disease. Multivariate analysis showed age <40 years and disease stage to be independently associated with the receipt of NACT.

Conclusion

Most women receiving NACT with available response data showed a clinical benefit. Stage III disease at diagnosis and age <40 years were predictors of neoadjuvant versus adjuvant chemotherapy treatment.

Evolutionary aspects of non-metastatic breast cancer after primary treatment in a sub-Saharan African setting: a 16-year retrospective review at the Douala general hospital, Cameroon

BACKGROUND

Breast cancer has a high case fatality rate in sub-Saharan Africa, and this is chiefly because of late detection and inadequate treatment resources. Progressive renovations in diagnostic and management modalities of non-metastatic breast cancer (NMBC) have been noted in the region but there is paucity of data describing the clinical progress of patients with NMBC. This study sought to determine the rates of local relapse, distant metastasis and sequelae and the time span from initial treatment to the occurrence of these adverse events among patients with NMBC.

METHODS

This was a retrospective review of medical records of patients with histologically confirmed NMBC at the department of radiation therapy and oncology of the Douala General Hospital in Cameroon from the January 1997 to December 2012 period. Clinicopathological and treatment characteristics as well as occurrences of adverse events were studied.

RESULTS

A total of 260 cases were reviewed of which 224/260 (86.2%) had invasive ductal carcinoma. Surgery was performed on 258/260 cases (99.2%) with 187/258 (72.5%) being modified radical mastectomies. Various treatment combinations were used in up to 228/260 patients (87.5%) while surgery alone was the treatment in the remaining 32 cases (12.5%). Metastasis occurred in 142/260 cases (54.6%) of which 68/142 (26.2%) were local relapses and 74/142 (28.5%) were distant metastases. Among the cases of distant metastasis, 9.2% were bone, 8.5% lungs, 6.9% nodal, and 5.4% brain. Metastasis to multiple organs was noted in 4.7% of these cases. The median periods of occurrence of local relapse and distant metastases were 13 and 12 months respectively. Sequelae occurred in 26/260 cases (10%) and were noted after an average of 30 months. The main sequelae were lymphoedema (6.5%) and lung fibrosis (1.5%). At the end of the period under review, 118/260 patients (45.4%) were alive and disease-free with a median follow up time of 24 months.

CONCLUSIONS

Adverse events were frequent among patients who received primary treatment for NMBC. Available cancer therapeutic modalities ought to be supplemented with efficient strategies of follow-up and monitoring so as to optimize the care provided to these patients and improve on their survival.

Quality of Breast Cancer Treatment at a Rural Cancer Center in Rwanda

PURPOSE

As breast cancer incidence and mortality rise in sub-Saharan Africa, it is critical to identify strategies for delivery of high-quality breast cancer care in settings with limited resources and few oncology specialists. We investigated the quality of treatments received by a cohort of patients with breast cancer at Butaro Cancer Center of Excellence (BCCOE), Rwanda's first public cancer center.

PATIENTS AND METHODS

We reviewed medical records of all female patients diagnosed with invasive breast cancer at BCCOE between July 2012 and December 2013. We evaluated the provision of chemotherapy, endocrine therapy, surgery, and chemotherapy dose densities. We also applied modified international quality metrics and estimated overall survival using interval-censored analysis.

RESULTS

Among 150 patients, 28 presented with early-stage, 64 with locally advanced, and 53 with metastatic disease. Among potentially curable patients (ie, those with early-stage or locally advanced disease), 74% received at least four cycles of chemotherapy and 63% received surgery. Among hormone receptor-positive patients, 83% received endocrine therapy within 1 year of diagnosis. Fifty-seven percent of potentially curable patients completed surgery and chemotherapy and initiated endocrine therapy if indicated within 1 year of biopsy. Radiotherapy was not available. At the end of follow-up, 62% of potentially curable patients were alive, 24% were dead, and 14% were lost to follow-up.

CONCLUSION

Appropriate delivery of chemotherapy and endocrine therapy for breast cancer is possible in rural sub-Saharan African even without oncologists based on site. Performing timely surgery and ensuring treatment completion were key challenges after the opening of BCCOE. Further investigation should examine persistent quality gaps and the relationship between treatment quality and survival.

Men Have a Higher Incidence of Seroma after Breast Cancer Surgery

Background and Objectives:

Male breast cancer (MBC) is rare. While surgical treatment may result in several complications in women, little is known about how it affects men. The objective of this study was to compare the incidence of postoperative wound complications between men and women after breast cancer surgery.

Methods:

This cohort study included all male patients enrolled for breast cancer surgical treatment at the Brazilian National Cancer Institute, between 1999 and 2013. Each was matched with three female breast cancer patients. Parameters analyzed were necrosis, seroma and infection. Odds ratios (OR) were generated and statistical significance was considered at p<0.05.

Results:

We included in this study 71 men and 213 women with an average age of 63.5 (±12.0). The incidences of complications in men and women were: necrosis, 32.8% and 37.8% (p=0.477); seroma, 80.6% and 59.4% (p=0.003); and surgical site infection, 14.8% and 18.2% (p=0.54). After adjustment, men had a 3 times greater risk of developing seroma compared to women (OR=3.0; IC95%=1.4-6.4; p=0.004). No statistically significant differences was detected in the incidences of wound infection and necrosis.

Conclusion:

Men have a greater risk of developing seroma after surgery for breast cancer than women, whereas infection and necrosis occur at similar frequencies in both genders.

An update on the management of breast cancer in Africa

Background

There is limited information about the challenges of cancer management and attempts at improving outcomes in Africa. Even though South and North Africa are better resourceds to tackle the burden of breast cancer, similar poor prognostic factors are common to all countries. The five-year overall Survival rate for breast cancer patients does not exceed 60% for any low and middle-income country (LMIC) in Africa. In spite of the gains achieved over the past decade, certain characteristics remain the same such as limited availability of breast conservation therapies, inadequate access to drugs, few oncology specialists and adherence to harmful socio-cultural practices. This review on managing breast cancer in Africa is authored by African oncologists who practice or collaborate in Africa and with hands-on experience with the realities.

Methods

A search was performed via electronic databases from 1999 to 2016. (PubMed/Medline, African Journals Online) for all literature in English or translated into English, covering the terms “breast cancer in Africa and developing countries”. One hundred ninety were deemed appropriate.

Results

Breast tumors are diagnosed at earlier ages and later stages than in highincome countries. There is a higher prevalence of triple-negative cancers. The limitations of poor nursing care and surgery, inadequate access to radiotherapy, poor availability of basic and modern systemic therapies translate into lower survival rate. Positive strides in breast cancer management in Africa include increased adaptation of treatment guidelines, improved pathology services including immuno-histochemistry, expansion and upgrading of radiotherapy equipment across the continent in addition to more research opportunities.

Conclusion

This review is an update of the management of breast cancer in Africa, taking a look at the epidemiology, pathology, management resources, outcomes, research and limitations in Africa from the perspective of oncologists with local experience.

Primary surgical treatment of locally advanced breast cancer in low resource settings

•Optimum management of locally advanced breast cancer is multidisciplinary.•Neoadjuvant chemotherapy is mainstay of management.•Primary surgical treatment may be acceptable in selected patients.

Single-shot lamina thoracic paravertebral block with ketofol for modified radical mastectomy

We describe the use of single-shot lamina thoracic paravertebral block (TPVB) with sedation for a 56-year-old female patient who had modified radical mastectomy with axillary clearance. Two years ago, she suffered vocal cord palsy post thyroidectomy, which was managed with tracheostomy. The tracheostomy tube was removed 8 months later, leaving the patient with persistent hoarseness of voice and left vocal cord palsy. She declined general anesthesia and consented for TPVB. The surgery lasted 95 minutes and was successfully completed with TPVB. Her vital signs were stable during the operation. She had low pain scores, minimal opioid use, early alimentation, and no postoperative nausea and vomiting and was discharged early. We present the anesthetic management of this case in our setting, where TPVB under ultrasound guidance and modern drug-delivery systems for sedation are unavailable.

Surgical Management of Breast Cancer in Africa: A Continent-Wide Review of Intervention Practices, Barriers to Care, and Adjuvant Therapy

Breast cancer has emerged as a leading cancer among women in Africa, necessitating improved understanding of its management across the continent. Although previous studies have described regional trends in therapy, this review aims to summarize continent-wide management and focus specifically on surgical interventions. Current literature shows that the rates of surgery, chemotherapy, and radiation therapy vary across different countries and institutions, indicating the need for greater use of standardized cancer treatment guidelines. Surgery, primarily modified radical mastectomy, is the most common form of therapy described. When chemotherapy is offered, the limited availability and cost of treatment lead to high rates of interruption and premature termination of cycles. Few patients have access to radiation or hormonal therapy because these treatments are not available in many countries. Significant delays in seeking treatment are common and contribute to patients presenting with advanced disease. Although limited infrastructure favors surgical management, interventions to improve early detection behavior, provide timely referrals to medical care, and initiate early treatment with access to clinically justified neo-adjuvant and adjuvant therapy are key to improving prognosis.

OUTCOME OF LAPAROTOMY FOR PERITONITIS IN 302 CONSECUTIVE PATIENTS IN IBADAN, NIGERIA

BACKGROUND

Peritonitis is a life-threatening condition and requires urgent surgical management. Despite improvements in the care of patients with peritonitis, its management is still challenging and associated with significant morbidity and mortality. The aim of this study was to determine factors influencing the outcome in patients managed for peritonitis in a tertiary health institution in Nigeria.

METHOD

A retrospective study involving 302 patients managed for peritonitis over a 3- year period. The biodata, clinical findings, diagnosis, pre-operative care, mode of anaesthesia, cadre of the surgeon, intraoperative findings, postoperative care, and the outcomes were retrieved from their records.

RESULTS

Three hundred and two patients were operated on for peritonitis during the period. The mean age of the patients was 48 ± 12 years. Twenty (6.6%) patients had other co-morbidities, with hypertension being the most frequent. Ruptured appendicitis was the most common cause of peritonitis, 83(27.5). Twenty-eight (9.2%) patients had complications, 19 patients (6.5%) required intensive care unit admission, 25 patients (8.4%) required a second exploratory laparotomy. The mortality rate was 2.4%. There was a statistically significant association between an adverse outcome and presentation with shock, anaemia, jaundice and oliguria.

CONCLUSION

The factors influencing outcome are similar to those of other Africa countries. However, the mortality rate in our study is lower. Peri-operative specific organ support and prompt surgical intervention should be instituted to improve outcome. We suggest a prospective study to elucidate the effect of these factors, and to determine the predictive power of the various scoring systems.

A Review on Breast Cancer Care in Africa

BACKGROUND

The global incidence of breast cancer (BC) is rising, especially in low- and middle-income countries. The purpose of this review is to summarize existing publications on BC care in Africa.

PATIENTS AND METHODS

A systematic search in MEDLINE and smaller databases was carried out to identify African studies on BC treatment, and an additional PubMed search was performed for relevant topics on BC care.

RESULTS

A total of 219 publications, mainly from North and West Africa, were found by systematic search. We also selected articles on BC epidemiology, risk factors, clinical presentation, and cancer control in Africa.

CONCLUSIONS

Publications on BC treatment are mostly from hospital case series. Evidence on treatment from prospective randomized trials that address the specific characteristics of African patients is lacking. The epidemiologic data shows rising incidences in Africa. The prevalence of risk factors is changing by age group, geographic region, and over time. The clinical picture of BC differs from that of Western countries due to the high proportion of young patients (on account of the African population with a high proportion of young people) and late presentation. Global collaborative efforts are needed to address the rising need for improved BC care in Africa.

Breast cancer survival experiences at a tertiary hospital in sub-Saharan Africa: a cohort study

BACKGROUND

Cancer of the breast is a major health burden and the most common cancer among women worldwide. Though its incidence is fourfold greater in high-income countries, in sharp contrast, mortality rates are greatest among the low-income countries. Early detection linked to appropriate treatment is the most effective strategy to improve survival. The purpose of this study therefore was to establish the survival experiences of women with breast cancer at a Ugandan hospital.

METHODS

This study is an observational analytical study. It involved 262 women during the periods 2004 to 2007 and 2010 to 2012. Kaplan Meier method and Cox regression were used to calculate breast cancer mortality and cumulative survival experiences.

RESULTS

Sixty-three out of 262 (23%) deaths were observed; mean age was 45 years, and 91 observations ended on or before follow-up. Luminal B median survival was months. The 5-year cumulative survival was 51.8 %. There were no stage I and II deaths. There were no differences in survival by phenotype adjusted for age, but there were differences for stage IV (p=0.05).

CONCLUSIONS

The cumulative 5-year survival was 51.8 %. The burden of advanced disease and associated mortality were high, and a significant number of patients were lost to follow-up after their first contact.