Descriptive Epidemiology of Cancers in Togo from 2009 to 2016

Gastric cancer in Sub-Saharan Africa - a systematic review of primary data

Introduction

Gastric cancer (GC) is the third leading cause of global cancer-related mortality. Despite the shifting burden of GC to low-and middle-income countries, the data regarding incidence, treatment, and outcomes in these settings are sparse. The primary aim of this systematic review was to aggregate all available data on GC in sub-Saharan Africa (SSA) to describe the variability in incidence across the region.

Methods

Studies reporting population-based primary data on GC in SSA were considered. The inclusion was limited to primary studies published between January 1995 and March 2022 which comprised of adult patients in SSA with GC. Studies without accessible full text in either French or English language were excluded. Unadjusted GC incidence rates with their standard errors for each study were recalculated from the crude numerators and denominators provided in individual studies.

Results

A total of 5,626 articles were identified in the initial search, of which, 69 studies were retained. Reported incidence rates ranged from a high of 5.56 GC cases per 100,000 in Greater Meru Kenya to a low of 0.04 GC cases per 100,000 people in Benin City Nigeria. The overall crude pooled incidence was 1.20 GC cases per 100, 000 (95%CI 1.15-1.26) with a variability of 99.83% (I2 p < 0.001). From the 29 high-quality population-based registry studies the crude pooled incidence was 1.71 GC cases per 100,000 people (95%CI 1.56-21.88) with a variability of 99.60%.

Conclusion

This systemic review demonstrates that GC incidence is highly variable across SSA. The limited data on GC treatment, mortality, and survival presents a significant challenge to providing a complete epidemiologic description of the burden of GC in SSA. There is a need for further robust data collection, exploration, and research studies on cancer care in SSA, with continued assessment of primary data availability.

Factors associated with vulvar cancer from 2005 to 2021 in Togo, sub-Saharan Africa

BACKGROUND

vulvar cancer, once predominantly diagnosed in older women, is increasingly being diagnosed in younger individuals, due to Human Papillomavirus (HPV) infection. Our study aimed to describe the epidemiological and histopathological aspects of vulvar cancer in Togo and its associated factors.

METHODS

This was a cross-sectional study, conducted on vulvar cancer cases histologically diagnosed at the Pathological Laboratory of Lomé over a period of 17-years (2005-2021). Parameters investigated included age, occupation, risk factors, sample nature, macroscopic tumor aspects, histological types, therapeutic intervenions, and prognostic outcomes.

RESULTS

A total of 32 cases of vulvar cancer were collected, yieding an annual frequency of 1.88 cases. The average age of the patients was 48±14.12 years with extremes of 27 years and 82 years. Housewives accounted for the largest proportion of cases (37.5%). Among the 32 cases, 27 had identifiable risk factors, with HPV infection being the most prevalentr (33.3%). The ulcero-budding aspect was most frequently observed, and squamous cell carcinoma was the most common histological type, with the majority being well differentiated (89.3%). Statistically significant associations were found between risk factors and histological types, risk factors and degrees of differentiation, as well as between histological types and good differentiation of vulvar cancers. The 3-year survival was estimated at 78.13%.

CONCLUSION

The incidence of vulvar cancer is increasing in Togo, particularly among young, primarily due to HPV infection.

Factors associated with late diagnosis of breast cancer in women in Togo, Sub-Saharan Africa

BACKGROUND

Breast cancer is the most frequently diagnosed cancer in women worldwide. The objective of this study was to identify factors associated with late diagnosis of breast cancer in Togolese women.

METHODS

We conducted a prospective cross-sectional study with descriptive and analytical purposes on cases of breast cancer in women in 2021, in Togo. The patients included in this study were women followed in the gynecology department for stages III and IV breast cancer.

RESULTS

We included 62 cases of breast cancer. The average age of the patients was 38.6 ± 12.5 years with extremes of 17 and 76 years. The breast nodule was the most common reason for consultation in 75.8% of cases. The histological types diagnosed were invasive carcinoma of non-specific type (58; 93.55%), mucinous carcinoma (3; 4.84%) and lobular carcinoma (1; 1.61%). For the stage of the cancer, 43 patients were stage III (69.4%) and 19 stage IV (30.6%). In multivariate analysis, the factors associated with late diagnosis of breast cancer were: fear of diagnosis (aOR = 1.29; p = 0.0014), long delay in diagnosis (aOR = 2.62; p = 0.0001) and failure to perform breast self-examination (aOR = 1.68; p = 0.0022).

CONCLUSION

The fear of the diagnosis, the absence of self-examination of the breasts and the use of traditional treatment and self-medication in first intention constituted the essential factors of the late diagnosis of breast cancer. Strategies should be put in place at the national level to impact on these factors for an early diagnosis of breast cancer.

Histo-Molecular Profile of Breast Cancer in Young Women in Togo

Introduction:

The frequency of breast cancer in young women, corresponding to women under 40 years of age; varies from 5% to 7% in developed countries. The objective of this study was to contribute to the improvement of the management of breast cancer in young women in Togo, by establishing the molecular classification of these cancers.

Methodology:

This was a retrospective descriptive and analytical study from January 2010 to December 2020.

Results:

About 35 cases of breast cancer were identified in women under 40 years of age. The average age was 35.4 ± 3.5 years. The right breast was affected in 18 cases (51.43%). Histologically, 30 cases (85.72%) were invasive carcinoma of no special type (NST), 2 cases (5.71%) were invasive lobular carcinoma and micro-papillary carcinoma respectively, and 1 case (2.86%) was tubular carcinoma. There were 6 cases (17.1%) of grade I, 25 cases (71.4%) of grade II, and 4 cases (11.4%) of grade III. Molecularly, there were 20 cases (57.1%) of triple-negative subtype, 6 cases (17.1%) of Luminal B subtype, 05 cases (14.3%) of HER2-enriched subtype and 4 cases (11.4%) of Luminal A subtype.

Conclusion:

Breast cancers of young Togolese women express very weakly hormone receptors, with a predominance of a triple negative subtype.

High RPS27A Expression Predicts Poor Prognosis in Patients With HPV Type 16 Cervical Cancer

In recent years, the incidence and the mortality rate of cervical cancer have been gradually increasing, becoming one of the major causes of cancer-related death in women. In particular, patients with advanced and recurrent cervical cancers present a very poor prognosis. In addition, the vast majority of cervical cancer cases are caused by human papillomavirus (HPV) infection, of which HPV16 infection is the main cause and squamous cell carcinoma is the main presenting type. In this study, we performed screening of differentially expressed genes (DEGs) based on The Cancer Genome Atlas (TCGA) database and GSE6791, constructed a protein–protein interaction (PPI) network to screen 34 hub genes, filtered to the remaining 10 genes using the CytoHubba plug-in, and used survival analysis to determine that RPS27A was most associated with the prognosis of cervical cancer patients and has prognostic and predictive value for cervical cancer. The most significant biological functions and pathways of RPS27A enrichment were subsequently investigated with gene set enrichment analysis (GSEA), and integration of TCGA and GTEx database analyses revealed that RPS27A was significantly expressed in most cancer types. In this study, our analysis revealed that RPS27A can be used as a prognostic biomarker for HPV16 cervical cancer and has biological significance for the growth of cervical cancer cells.

Prostate cancer screening: A survey of medical students' knowledge in Lome, Togo, and associated determinants in a resource-limited African context

OBJECTIVES

The aims of this study were to assess the knowledge of medical students in Lomé about these means of screening for prostate cancer in a context of limited resources and controversy about prostate cancer screening, and to identify the determinants associated with these results.

METHODS

This was a prospective descriptive and cross-sectional study conducted in the form of a survey of medical students regularly enrolled at the Faculty of Health Sciences of the University of Lomé for the 2019-2020 academic years.

RESULTS

Of the 1635 eligible students, 1017 correctly completed the form, corresponding to a rate of 62.20%. The average age was 22 ± 3.35 years. The sex ratio (M/F) was 2.5. Undergraduate students were the most represented (53.69%). Students who had not received any training on prostate cancer were the most represented (57.13%). Only 12.88% of the students had completed a training course in urology. Concerning the prostate-specific antigen blood test, there was a statistically significant relationship between the students' knowledge and some of their socio-demographic characteristics, namely age (p value = 0.0037; 95% confidence interval (0.50-1.77)); gender (p value = 0.0034; 95% confidence interval (1.43-2.38)); study cycle (p value ˂ 0.0001; 95% confidence interval (0.56-5.13)) and whether or not they had completed a placement in a urology department (p value ˂ 0.0001; 95% confidence interval (0.49-1.55)). On the contrary, there was no statistically significant relationship between students' knowledge of the digital rectal examination and their study cycle (p value = 0.082; 95% confidence interval (0.18-3.44)).

CONCLUSION

Medical students in Lomé have a good theoretical knowledge and a fair practical level of the digital rectal examination clinical examination and an average theoretical knowledge and a below average practical level of prostate-specific antigen, increasing however along the curriculum in the context of prostate cancer screening.

Breast Cancer in Togolese Women: Imaging and Clinicopathological Findings

Background:

Breast cancer is the most common cancer in women, and its incidence and mortality rates are expected to increase significantly over the next few years, particularly in developing countries. The aim of this study was to describe the epidemiological, clinical, radiological, histopathological, and prognostic aspects of breast cancer in Togo.

Materials and methods:

We retrospectively analyzed at our Department of Pathology of Lomé all cases of breast cancer in women confirmed by histology over a period of 20 years (2000-2019).

Results:

We collected 804 cases of breast cancer in women. The median age was 46.7 years (range, 12-86 years). Patients aged <40 years represented 48.38% of cases, and the left breast was more affected (51.24%). Most women were sexually active (71.52%) and resided in urban areas (66.29%). Carcinomas represented the predominant histological group (796 cases, 99.00%) with a predominance of invasive nonspecific type carcinoma (92.34%). These cancers were diagnosed at late stage III using Nottingham grading (55.10%). The TNM classification showed a predominance of grades T2NxMx (72.45%) and T4N1Mx (17.76%). The luminal B profile (40.85%) was found mostly, and the mutation of BRCA2 and BRCA1 genes was found in 2.61% of cases. Mastectomy was performed in 7.59%, radiotherapy in 3.61%, and chemotherapy in 18.66%.

Conclusion:

Breast cancer is a frequent pathology in Togolese women, predominant in young adults, often diagnosed at a late stage with limited possibilities of treatment. The establishment of early care programs is essential.

Breast cancer in togolese women: immunohistochemistry subtypes

Background

Molecular classification of breast cancer is an important factor for prognostic and clinical outcomes. There are no data regarding molecular breast cancer subtypes among Togolese women. The objective of this study was to evaluate the expression of ER, PR, HER2, and molecular subtypes of breast cancer receptors in Togolese patients and to establish the correlation between clinical and histological data and molecular types.

Methods

Clinicopathologic data of patients were collected from clinical records. Immunohistochemistry biomarkers (ER, PR, and HER2) were assessed in patients who have been diagnosed with invasive breast cancer from March 2016 to March 2020 in the department of oncology. The analysis of variance and the Chi-square Test was used to analyze the data.

Results

A total of 117 cases were collected. The mean age of patients was 52.05 ± 12.38 with an age range of 30 to 85 years. Half of the patients were over 50 years old and the majority (70.9%) was postmenopausal. More than half of patients (52.1%) presented with T3-T4tumors.The most common histologic subtype of breast cancer was invasive ductal carcinoma of no special type (95.7%). Tumors grade 2 were predominant (51.3%) followed by grade 3 (42.7%). Advanced carcinomas were found in 69 patients (59%). The percentage of ER+, PR+, and HER2 positive tumors was 54.7%, 41%, and 15.4% respectively. The predominant molecular subtype was Triple negative (37.6%), followed by Luminal A (30.8.7%), Luminal B subtype (23.9%), and HER2 enriched (7.7%). There was a significant association between stage and breast cancer subtypes (p 0.025), histologic grade, and subtype (p < 0.0001) but no correlation was found with age, menopausal status, and tumor size.

Conclusion

Breast carcinoma in our patients are high grade tumors and are diagnosed at an advanced stage. Triple negative and Luminal A are the two predominant breast cancer subtypes in Togolese women. Consequently, Receptor testing availability should be a priority to offer the best breast cancer treatment.

Effects of extracts and molecules derived from medicinal plants of West Africa in the prevention and treatment of gynecological cancers. A Review

Medicinal plants are a potential source of drug discovery and development of new pharmacological compounds for cancer chemoprevention. More than 80% of the West African population uses medicinal plants. It is estimated that over 60% of approved anti-cancer agents are derived from plants. The plant raw material used in African traditional medicine and particularly in West Africa can be an important source for the research of anti-tumor drugs against gynecological cancers. These tumors have a negative impact on women's general health status and causes enormous health costs as they affect all age groups. Gynecological cancers remain thus a major concern worldwide, especially in West Africa where these cancers are the leading cause of cancer deaths in women. This review reports on the contribution of West African flora to the discovery of potential antiproliferative and/or cytotoxic phytochemical compounds against gynecological cancer cells. Scientific databases such as PubMed, ScienceDirect, Scopus and GoogleScholar were used to extract publications reporting West African plants and/or isolated compounds used in cell models of gynecological cancers. Thresholds of cytotoxicity and modes of action of these phytochemicals have been summarized. This research can serve as a basis for taking medicinal plants into account in the management of these gynecological cancers in resource-limited countries such as those in West Africa.

Male Breast Cancer in Togo: Imaging and Clinicopathological Findings

Background

Breast cancer in men is a rare condition, often diagnosed late. The purpose of this study was to describe its epidemiological, histopathological, and radiographic aspects in Togo.

Materials and Methods

This was a descriptive retrospective study on cases of breast cancer in humans diagnosed histologically at the Laboratory of Anatomy Pathological and Imagery of the University Hospital in Lomé, over a period of 25 years (1995 to 2019). The parameters studied were epidemiological, anatomopathological, and imaging.

Results

Eighty-two (82) cases were diagnosed, an annual frequency of 3.28 cases. The mean age was 45 ± 2.5 years; the range was 27-63 years. The family history of 47 patients (57.32%) was known. Carcinomas represented the predominant histological group with predominantly nonspecific invasive carcinoma (87.5%). These cancers were diagnosed at late stages (75.71% grade II). They were mainly of luminal B profile (38.75%) and associated with mutations of the BRCA2 and BRCA1 genes in 14.63% of the cases. The lesions were classified ACR 5 in 61.5% (11/18). Two cases of breast angiosarcoma were diagnosed by the identification of CD31 markers and factor VIII in immunohistochemistry. Hormone therapy such as tamoxifen was prescribed in all luminal patients (43 patients). Radiotherapy was administered to 15 patients (18.3%), with acute toxicity in 20% of the cases. After a median follow-up of 36 months, the evolution was complete remission in 27 patients (32.93%).

Conclusion

Breast cancer in men is rare, often diagnosed late with a poor prognosis.

Time intervals experienced between first symptom recognition and pathologic diagnosis of breast cancer in Addis Ababa, Ethiopia: a cross-sectional study

OBJECTIVES

This study aimed to estimate the magnitude of patient and diagnostic delays and associated factors among women with breast cancer in Addis Ababa.

DESIGN

This is a cross-sectional study.

SETTINGS AND PARTICIPANTS

All women newly diagnosed with breast cancer in seven major healthcare facilities in Addis Ababa (n=441) were included in the study.

MAIN OUTCOMES AND MEASURES

Patient interval (time from recognition of first symptom to medical consultation) and diagnostic interval (time from first consultation to diagnosis). Patient intervals >90 days and diagnostic intervals >30 days were considered delays, and associated factors were determined using multivariable Poisson regressions with robust variance.

RESULTS

Thirty-six percent (95% CI [31.1%, 40.3%]) of the patients had patient intervals of >90 days, and 69% (95% CI [64.6%, 73.3%]) of the patients had diagnostic intervals of >30 days. Diagnostic interval exceeded 1 year for 18% of patients. Ninety-five percent of the patients detected the first symptoms of breast cancer by themselves, with breast lump (78.0%) as the most common first symptom. Only 8.0% were concerned about cancer initially, with most attributing their symptoms to other factors. In the multivariable analysis, using traditional medicine before consultation was significantly associated with increased prevalence of patient delay (adjusted prevalence ratio (PR) = 2.13, 95% CI [1.68, 2.71]). First consultation at health centres (adjusted PR = 1.19, 95% CI [1.02, 1.39]) and visiting ≥4 facilities (adjusted PR = 1.24, 95% CI [1.10, 1.40]) were associated with higher prevalence of diagnostic delay. However, progression of symptoms before consultation (adjusted PR = 0.73, 95% CI [0.60, 0.90]) was associated with decreased prevalence of diagnostic delay.

CONCLUSIONS

Patients with breast cancer in Addis Ababa have prolonged patient and diagnostic intervals. These underscore the need for public health programme to increase knowledge about breast cancer symptoms and the importance of early presentation and early diagnosis among the general public and healthcare providers.