Breast Cancer Stage at Diagnosis in a Nigerian Hospital: Trend over a Decade

BACKGROUND

Breast cancer outcomes are poor in Nigeria, partly due to late-stage diagnosis. To assess the impact of past and present interventions, a review of an institutional data base was performed to determine the trend with respect to stage at diagnosis over a decade.

METHODS

A retrospective analysis of an institutional data base was performed over a decade. The review period was divided into segments (2013-2015, 2016-2018 and 2019-2022). The latter period (2019-2022), corresponds to a time of more intense community interventions aimed at promoting early diagnosis and treatment around the locality of the teaching hospital. The stage at diagnosis within these periods were compared. The relationship between stage and sociodemographic variables (age, religion, marital status, menopausal status, and level of education) was assessed.

RESULTS

There were 910 patients, 144 within the first period (2013-2015), 318 in the second (2016-2018) and 454 in the third period (2019-2022). The majority presented with stage 3 disease (73.8%). There was a significant decline in the proportion of metastatic cases and a concomitant increase in early cases in the latter part of the review. The proportion of metastatic cases reduced from 23.6% (2013-2015), to 15.7% (2016-2018) and 9.3% (2019-2022) (p=0.001). Level of education was significantly associated with stage (p=0.001).

CONCLUSION

This study shows a trend towards downstaging of breast cancer in our locality. This trend corresponds to the period of more intense community interventions, justifying the need to further interrogate the direct impact of each of the interventions. This will provide a firm basis for sustaining or improving on current efforts to achieve more robust gains.

The African Research Group for Oncology: A decade fostering colorectal cancer research in Nigeria

The African Research Group for Oncology (ARGO) was formed in 2013 to undertake methodologically rigorous cancer research in Nigeria, and to strengthen cancer research capacity in the country through training and mentorship of physicians, scientists, and other healthcare workers. Here, we describe how ARGO's work in colorectal cancer (CRC) has evolved over the past decade. This includes the consortium's scientific contributions to the understanding of CRC in Nigeria and globally and its research capacity-building program.

Abstract P3-04-02: Population level access to diagnostic mammography and ultrasound guided breast biopsy in Nigeria: a geospatial analysis

Introduction: Breast cancer is the most common cause of cancer-related mortality among women in Nigeria. Physical proximity to a diagnostic center is an important component of access, which has direct implication on the cost and timeliness of diagnosis and treatment. Beyond diagnostic mammography, ultrasound (US)-guided biopsy is an essential tool in the diagnostic pathway for suspicious lesions of the breast and is recommended by the Whole Health Organization Breast Health Global Initiative for LMICs. Unfortunately, there is a dearth of data on the population level access to mammography and US-guided breast biopsy in Nigeria and little is known about the geospatial inequities in access that targeted programming or investment could potentially address. This study undertook a comprehensive evaluation of breast imaging and diagnostic services in Nigeria and using a previously validated geographic information system (GIS) model, evaluated geospatial access to diagnostic mammography and US-guided breast biopsy in Nigeria. Methods: A comprehensive list of public and private facilities offering diagnostic mammography and/or US-guided breast biopsy was compiled using publicly available facility data from the Nigerian Ministry of Health, a survey administered to members of the Breast Imaging Society of Nigeria (BISON) as well as key stakeholder interviews from each of the countries six geopolitical zones. A novel survey was delivered to BISON members to identify additional/new facilities not captured by the latest Nigerian Ministry of Health data. Facility location, administration (public vs. private) and duration of service delivery were elicited from respondents and paired with the Ministry of Health facility dataset. Data on provider training and volume were also captured in the survey. All facilities were geolocated using Google Earth™ (Google, Mountain View, CA). A previously described cost-distance model, that uses open-source population density data to 100m2 (GeoData Institute) and road network data (OpenStreetMap) was used to estimate population level travel time to the nearest diagnostic center. Any portion of a route that included travel over terrain without roads was assigned a walking speed of 5 kmh-1. Geospatial access was calculated for mammography and US-guided biopsy separately and as well as by geopolitical zone. This study was approved by the research ethics board at Obafemi Awolowo University. Results: In addition to publicly available data from the Ministry of Health, facility and practice data was obtained from 63 Nigerian Radiologists from across the country. In total, 124 centers were identified that offer diagnostic mammography, of which 78 (63%) are privately administered. Nine of the countries 36 states did not have a center offering this service. Across the country, 33 centers offer US-guided breast biopsy, of which the majority (72.7%) are public. At a population level, 83.1% of the population has access within 120 minutes of continuous one-way travel to a center with diagnostic mammogram or US. At 240 minutes of continuous one-way travel, which corresponds to a full day of travel round-trip, 80.8% of the population has access to US-guided breast biopsy. However, there are differences in access between geopolitical zones. Just 68.7% of the population in the North East geopolitical zone has access to US-guided biopsy within a day’s travel (i.e. 240 minutes one-way). The remaining five geopolitical zones have population level access to this service of ≥80%. Conclusions: This is the first comprehensive evaluation of breast cancer imaging and diagnostic services in Nigeria. Our results, demonstrate that the majority of the population in Nigeria has reasonable geospatial access to basic breast cancer imaging services. However, there are inequalities in access between states and geopolitical zones in the north and south of the country, which may have an impact on timely diagnosis and care.

Citation Format: Adeleye Omisore, Elizabeth J. Sutton, Gavin Tansley, Rachael Adeyanju AKINOLA, Gregory Knapp. Population level access to diagnostic mammography and ultrasound guided breast biopsy in Nigeria: a geospatial analysis [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P3-04-02.

Contemporary management of breast cancer in Nigeria: Insights from an institutional database

High-quality data are needed to guide interventions aimed at improving breast cancer outcomes in sub-Saharan Africa. We present data from an institutional breast cancer database to create a framework for cancer policy and development in Nigeria. An institutional database was queried for consecutive patients diagnosed with breast cancer between January 2010 and December 2018. Sociodemographic, diagnostic, histopathologic, treatment and outcome variables were analyzed. Of 607 patients, there were 597 females with a mean age of 49.8 ± 12.2 years. Most patients presented with a palpable mass (97%) and advanced disease (80.2% ≥ Stage III). Immunohistochemistry was performed on 21.6% (131/607) of specimens. Forty percent were estrogen receptor positive, 32.8% were positive for HER-2 and 43.5% were triple negative. Surgery was performed on 49.9% (303/607) of patients, while 72% received chemotherapy and 7.9% had radiotherapy. At a median follow-up period of 20.5 months, the overall survival was 43.6% (95% CI -37.7 to 49.5). Among patients with resectable disease, 18.8% (57/303) experienced a recurrence. Survival was significantly better for early-stage disease (I and II) compared to late-stage disease (III or IV) (78.6% vs 33.3%, P < .001). Receipt of adjuvant radiotherapy after systemic chemotherapy was associated with improved survival in patients with locally advanced disease (68.5%, CI -46.3 to 86 vs 51%, CI 38.6 to 61.9, P < .001). This large cohort highlights the dual burden of advanced disease and inadequate access to comprehensive breast cancer care in Nigeria. There is a significant potential for improving outcomes by promoting early diagnosis and facilitating access to multimodality treatment.

A symptom-based model to predict colorectal cancer in low-resource countries: Results from a prospective study of patients at high risk for colorectal cancer

BACKGROUND

Colorectal cancer (CRC) rates in low-resource countries, which typically lack CRC screening programs, are rising. This study determined whether a risk model for patients with rectal bleeding could identify patients with curable CRC.

METHODS

This prospective, cross-sectional study evaluated a model constructed from data from 1 hospital and validated at 2 other hospitals. The primary endpoint was the ability of the model to predict CRC, as diagnosed by colonoscopy, from clinical characteristics. The secondary endpoint was to determine the percentage of patients who had CRC.

RESULTS

Consecutive patients who were 45 years old or older and had self-reported rectal bleeding for more than 1 week were evaluated. From January 2014 to July 2016, 362 patients answered a questionnaire and underwent colonoscopy. In the validation cohort, 56% of patients with rectal bleeding, weight loss, and changes in bowel habits had CRC, whereas 2% of patients with bleeding alone did. Overall, 18.2% of the patients had CRC, and 8.6% had adenomas. The proportion of CRC patients with potentially curable stage II or III disease was 74%, whereas the historical rate was 36%. The combination of rectal bleeding with both symptoms significantly predicted CRC in the validation set (odds ratio, 12.8; 95% confidence interval, 4.6-35.4; P < .001).

CONCLUSIONS

In low-resource settings, patients with rectal bleeding, weight loss, and changes in bowel habits should be classified as high risk for CRC. Patients with a high risk score should be prioritized for colonoscopy to increase the number of patients diagnosed with potentially curable CRC. Cancer 2018;124:2766-2773. © 2018 American Cancer Society.

Development and Reliability of a User-Friendly Multicenter Phenotyping Application for Hemorrhagic and Ischemic Stroke

BACKGROUND

Annotation and Image Markup on ClearCanvas Enriched Stroke-phenotyping Software (ACCESS) is a novel stand-alone computer software application that allows the creation of simple standardized annotations for reporting brain images of all stroke types. We developed the ACCESS application and determined its inter-rater and intra-rater reliability in the Stroke Investigative Research and Educational Network (SIREN) study to assess its suitability for multicenter studies.

METHODS

One hundred randomly selected stroke imaging reports from 5 SIREN sites were re-evaluated by 4 trained independent raters to determine the inter-rater reliability of the ACCESS (version 12.0) software for stroke phenotyping. To determine intra-rater reliability, 6 raters reviewed the same cases previously reported by them after a month of interval. Ischemic stroke was classified using the Oxfordshire Community Stroke Project (OCSP), Trial of Org 10172 in Acute Stroke Treatment (TOAST), and Atherosclerosis, Small-vessel disease, Cardiac source, Other cause (ASCO) protocols, while hemorrhagic stroke was classified using the Structural lesion, Medication, Amyloid angiopathy, Systemic disease, Hypertensive angiopathy and Undetermined (SMASH-U) protocol in ACCESS. Agreement among raters was measured with Cohen's kappa statistics.

RESULTS

For primary stroke type, inter-rater agreement was .98 (95% confidence interval [CI], .94-1.00), while intra-rater agreement was 1.00 (95% CI, 1.00). For OCSP subtypes, inter-rater agreement was .97 (95% CI, .92-1.00) for the partial anterior circulation infarcts, .92 (95% CI, .76-1.00) for the total anterior circulation infarcts, and excellent for both lacunar infarcts and posterior circulation infarcts. Intra-rater agreement was .97 (.90-1.00), while inter-rater agreement was .93 (95% CI, .84-1.00) for TOAST subtypes. Inter-rater agreement ranged between .78 (cardioembolic) and .91 (large artery atherosclerotic) for ASCO subtypes and was .80 (95% CI, .56-1.00) for SMASH-U subtypes.

CONCLUSION

The ACCESS application facilitates a concordant and reproducible classification of stroke subtypes by multiple investigators, making it suitable for clinical use and multicenter research.