Leisure-time physical activity is associated with reduced risks of breast cancer and triple negative breast cancer in Nigerian women

BACKGROUND

Leisure-time physical activity(LTPA) is associated with a reduced risk of breast cancer, but this has less been investigated by cancer subtypes in Africans living in Sub-Saharan Africa(SSA). We examined the associations between LTPA and breast cancer including its subtypes in Nigerian women and explored the effect modification of body size on such associations.

METHODS

The sample included 508 newly diagnosed primary invasive breast cancer cases and 892 controls from the Nigerian Integrative Epidemiology of Breast Cancer(NIBBLE) Study. Immunohistochemical(IHC) analysis was available for 294 cases. Total metabolic equivalents(METs) per hour/week of LTPA were calculated and divided by quartiles(Q1 <3.75, Q2:3.75-6.69, Q3:6.70-14.74, Q4:14.75 ≤). We applied logistic regressions to estimate the adjusted Odds Ratios(ORs) between LTPA and breast cancer and by its molecular subtypes and whether age-adjusted associations are modified by BMI.

RESULTS

The mean age(Mean±SD) of cases vs. controls(45.5 ± 11.1vs.40.1 ± 9.0) was higher, and the mean total METs hour/week was higher in controls vs. cases(11.9 ± 14.9vs.8.3 ± 11.1,p-value<0.001). Overall, 43.2%(N = 127/294) were classified as HRP, and 41.8%(N = 123/294) as TNBC. Women in the higher LTPA quartiles(Q3-Q4) vs. Q1 had lower odds of having breast cancer(OR_Q4vs.Q1=0.51,95%CI:0.35-0.74) and TNBC(OR_Q4vs.Q1=0.51, 95%CI:0.27-0.96), but not HRP(OR_Q4vs.Q1=0.61,95%CI:0.34-1.09) after adjusting for age, age at first menarche, body size, breastfeeding, menopausal, parity, contraceptives, demographics, alcohol, smoking, and physical activity at home and work. Lastly, LTPA and its age-adjusted association with breast cancer was more pronounced in women with BMI< 30 vs. BMI 30 + .

CONCLUSIONS

LTPA may reduce the risk of breast cancer, especially TNBC, which is the more aggressive and prevalent molecular subtype of breast cancer in SSA.

A matched case-control study of bean intake and breast cancer risk in urbanized Nigerian women

PURPOSE

Bean intake has been associated with reduced risk of breast cancer, however; only a few studies considered molecular subtypes status and none in African women living in Sub-Saharan Africa (SSA). Therefore, the purpose of this study was to examine the associations between dietary intake of beans and breast cancer including its subtypes in Nigerian women.

METHODS

Overall, 472 newly diagnosed patients with primary invasive breast cancer were age-matched (± 5 years) with 472 controls from the Nigerian Integrative Epidemiology of Breast Cancer (NIBBLE) Study from 01/2014 to 07/2016. We collected the dietary intake of beans using a food frequency questionnaire (FFQ). Beans_alone intake was categorized into three levels never (never in the past year), low (≤ 1 portion/week), and high intake (> 1 portion/week). We used conditional and unconditional logistic regression models to estimate the Odds Ratio (OR) and 95% Confidence Intervals (CI) of beans_alone intake and the risk of breast cancer and by its molecular subtypes, respectively.

RESULTS

The mean (SD) age of cases was 44.4(10.0) and of controls was 43.5(9.5) years. In the case group, more than half (51.1%) have never consumed beans_alone in the past year compared to 39.0% in the control group. The multivariable models showed inverse associations between beans_alone (high vs. none) and breast cancer (OR = 0.55; 95%CI: 0.36-0.86, p-trend = 0.03), triple-negative (OR = 0.51 95%CI: 0.28-0.95, p-trend = 0.02) and marginally associated with hormone receptor-positive (OR = 0.53, 95%CI: 0.29-0.96, p-trend = 0.06).

CONCLUSION

Dietary intake of beans_alone may play a significant role in reducing the incidence of breast cancer, particularly of the more aggressive molecular subtype, triple-negative, in African women living in SSA.

Molecular diagnostics to reduce inequity in breast cancer diagnosis

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Background: Modern management of breast cancer requires proper subtyping of the breast tumor to guide appropriate treatment and prognostication. However, there are barriers to availability of this resource in low- and middle-income countries (LMIC) which contributes to global inequalities in breast cancer management and outcomes. The non-availability is due to high cost, and lack of personnel and infrastructure required for immunohistochemistry (IHC), the current gold standard for subtyping. IHC results are affected by pre-analytic and analytic handling and are subjective. Alternative methods that are more objective, cost less and require less infrastructure and skilled personnel will improve access and reduce disparities. Methods: In the AFBRECANE Project, we compared the results of ER and PR subtyping of 1,000 breast cancer tumors from patients recruited from 5 clinical sites in Nigeria using IHC and Cepheid GeneXpert RNA STRAT4 biomarker assay at ACCME Lab in Nigeria and University of Maryland. Results: For ER, the sensitivities, specificities, and agreement between IHC and STRAT4 ranged from 50.0%, 71.4% and 59.4% to 77.1%, 80.0% and 78.5% while for PR, they ranged from 58.1%, 66.7% and 62.5% to 84.6%, 84.2% and 84.4%. Conclusions: The wide range of sensitivities, specificities, and agreement between IHC and STRAT4 in this study confirms the challenges of molecular subtyping of breast cancer in LMICs like Nigeria. Sustainable objective methods are sorely needed to improve diagnosis, treatment and prognostication, and reduce global disparities.

Heterogeneity in head and neck cancer incidence among black populations from Africa, the Caribbean and the USA: Analysis of cancer registry data by the AC3

BACKGROUND

Africa and the Caribbean are projected to have greater increases in Head and neck cancer (HNC) burden in comparison to North America and Europe. The knowledge needed to reinforce prevention in these populations is limited. We compared for the first time, incidence rates of HNC in black populations from African, the Caribbean and USA.

METHODS

Annual age-standardized incidence rates (IR) and 95% confidence intervals (95%CI) per 100,000 were calculated for 2013-2015 using population-based cancer registry data for 14,911 HNC cases from the Caribbean (Barbados, Guadeloupe, Trinidad & Tobago, N = 443), Africa (Kenya, Nigeria, N = 772) and the United States (SEER, Florida, N = 13,696). We compared rates by sub-sites and sex among countries using data from registries with high quality and completeness.

RESULTS

In 2013-2015, compared to other countries, HNC incidence was highest among SEER states (IR: 18.2, 95%CI = 17.6-18.8) among men, and highest in Kenya (IR: 7.5, 95%CI = 6.3-8.7) among women. Nasopharyngeal cancer IR was higher in Kenya for men (IR: 3.1, 95%CI = 2.5-3.7) and women (IR: 1.5, 95%CI = 1.0-1.9). Female oral cavity cancer was also notably higher in Kenya (IR = 3.9, 95%CI = 3.0-4.9). Blacks from SEER states had higher incidence of laryngeal cancer (IR: 5.5, 95%CI = 5.2-5.8) compared to other countries and even Florida blacks (IR: 4.4, 95%CI = 3.9-5.0).

CONCLUSION

We found heterogeneity in IRs for HNC among these diverse black populations; notably, Kenya which had distinctively higher incidence of nasopharyngeal and female oral cavity cancer. Targeted etiological investigations are warranted considering the low consumption of tobacco and alcohol among Kenyan women. Overall, our findings suggest that behavioral and environmental factors are more important determinants of HNC than race.

Predictive and prognostic relevance of immunohistochemical testing of estrogen and progesterone receptors in breast cancer in South East Nigeria: A review of 417 cases

ER/PgR testing are now routinely performed in breast cancer evaluation in Southeastern Nigeria. ER is predictive to show beneficiaries of hormonal therapy and a prognostic marker to establish tumors that will resist paclitaxel induced apoptosis so a cost effective combination of anthracylines can be used as treatment in our low resource setting thus improving survival, reducing recurrence, and cost. Four hundred seventeen cases of breast cancer seen over a period of 3 years were routinely tested for ER/PgR. ER positivity was defined as nuclear positivity of 1% in the presence of internal and external controls. Four hundred seventeen patients with Ductal Carcinoma participated. Majority were females 98.3%. Majority 60.2% were between 31 and 50 years old. Mean age was 33.5 ± 6.4 years. Two hundred fifty-seven (61.6%) were positive both for ER/PgR. 70.3% of age group 41–50 years had positive ER, age groups 20–30, and >70 years had positive ER also. ER positive cancer was 60.2%. Fifty-seven were 1%–9% positive. Most positive estrogen receptors were seen between 41 and 50 years at 70.3%. Least was seen at 31–40 years at 51.4%. Study provides an objective basis for using hormonal manipulation and makes cost affordable with appropriate chemotherapeutic agents in our low resource setting. Presentations were typically late. Seventy-six percent of stage 2 disease survived after 6 years compared with only 56% of stage 2 disease prior to immunotyping and radiotherapy in 2007. Both stage 3 and 4 had remarkable survival too at 55% and 33% respectively when compared with 2007 figures at 33% for stage 3 and 9.2% at stage 4.

Cancers Attributable to Overweight and Obesity From 2012 to 2014 in Nigeria: A Population-Based Cancer Registry Study

Background: Overweight and obesity are known risk factors for chronic diseases including cancers. In this study, we evaluated the age standardized incidence rates (ASR) and proportion of cancers attributable to overweight and obesity in Nigeria. Methods: We obtained incidence data from the databases of two population-based cancer registries (PBCRs) in Nigeria (Abuja and Enugu cancer registries), on cancer site for which there is established evidence of an association with overweight or obesity based on the International Agency for Research on Cancer (IARC) and the World Cancer Research Fund (WCRF) classification. We analyzed the data using population attributable fraction (PAF) for overweight or obesity associated cancers calculated using prevalence data and relative risk estimates in previous studies. Results: The two PBCRs reported 4,336 new cancer cases (ASR 113.9 per 100,000) from 2012 to 2014. Some 21% of these cancers were associated with overweight and obesity. The ASR for overweight and obesity associated cancers was 24.5 per 100,000; 40.7 per 100,000 in women and 8.2 per 100,000 in men. Overall, only 1.4% of incident cancers were attributable to overweight and obesity. The ASR of cancers attributable to overweight and obesity was 2.0 per 100,000. Postmenopausal breast cancer was the most common cancer attributable to overweight and obesity (n = 25; ASR 1.2 per 100,000). Conclusion: Our results suggest that a small proportion of incident cancer cases in Nigeria are potentially preventable by maintaining normal body weight. The burden of cancer attributed to overweight and obesity in Nigeria is relatively small, but it may increase in future.

Leisure Time Physical Activity Is Associated with Substantial Reduction in Risk of Breast Cancer and Breast Cancer Subtypes in Nigerian Women (P16-007-19)

Objectives

To examine the association between leisure-time physical activity (LTPA) and breast cancer in Nigerian women.

The hypothesis was that LTPA decreased breast cancer cases in Nigerian women.

To examine the association between LTPA and estrogen receptor positive (ER+), triple negative breast cancer (TNBC+), Luminal A breast cancer in Nigerian women.

The hypothesis was that LTPA decreased breast cancer subtypes in Nigerian women.

Methods

We enrolled 739 newly diagnosed primary invasive breast cancer and 739 age-matched controls in Nigeria from 01/2014 to 07/2016. This analysis is restricted to the 40% of cases for whom we have complete ER, TNBC, and Luminal-A data and their matched controls. We derived the average amount of time per week spent on LTPA over the past year using a modified Nurses’ Health Study II PA questionnaire. LTPA was calculated from the total metabolic equivalent (METs) assigned for each reported physical activity hour/week (i.e., walking, cycling, and dancing). We examined LTPA by comparing participants who attained the WHO physical activity recommendations of at least 150 minutes of moderate-intensity or/and 75 minutes of vigorous-intensity aerobic activity weekly with those who did not. We used conditional logistic regression to estimate the adjusted Odds Ratio (OR) of LTPA and overall as well as subtypes of breast cancer.

Results

The mean (SD) age of cases was 41.6 (9.1) and controls 43.9 (11.8) years. Women who attained the WHO physical activity recommendations had 43% decreased the risk of breast cancer (OR = 0.57, 95% CI:0.42–0.77) compared with those who did not, after controlling for demographic, anthropometric and fertility-related factors. LTPA was also associated with reduced risk of breast cancer subtypes by 41% for ER+, 59% for TNBC+and 59% for Luminal A.

Conclusions

Physical activity is associated with reduced risk of breast cancer overall and by subtypes in Nigerian women.

Funding Sources

Training Program in Nigeria for Non-Communicable Diseases Research (TRAPING NCD) grant number FIC/NIH D43TW009106 from the Fogarty International Centre. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Fogarty International Centre or the National Institutes of Health.

Tailoring Therapies: Improving the Outcome of Breast Cancer in a Comprehensive Cancer Center in West Africa—The University of Nigeria Teaching Hospital Experience

Background and context: Early detection and improved treatments are associated with a reduction in breast cancer mortality and morbidity. UNTH is a leading comprehensive cancer center in Nigeria with referrals from the entire southeast and south south regions. Our goal is to offer high quality comprehensive cancer care services across the cancer care continuum from public health awareness campaigns and provision of screening services all the way to palliative care and survivorship. This is the first attempt by any institution in the country to standardize and harmonize available treatment options for breast cancer. Aim: To optimize, standardize and harmonize treatment options and management strategies for breast cancer using a multidisciplinary approach by developing guidelines adapted to our peculiar infrastructure and health system. Strategy/Tactics: The practice guideline was specifically developed for UNTH using a multidisciplinary approach and taking into consideration circumstances peculiar to UNTH, including the following: UNTH's specific patient population; UNTH's services and structure; and UNTH's clinical information. Program/Policy process: The process used recognized methods that are robust, objective, scientifically valid, consistent and adaptable to UNTH and engaged all identified multisectoral and multidisciplinary stakeholders involved in the care of patients with breast cancer. Outcomes: We reviewed substantial evidence on documented and proven strategies for community screening and prevention, less expensive and only marginally less effective diagnostic tools, locoregional and systemic therapies for the management of breast cancer. The team also recommended all patients receive psycho-oncology support through a dedicated team and through the breast cancer support group. It was agreed that palliative care be incorporated within the first 8 weeks of commencing treatment in line with the current ASCO guidelines and receive consultation from the exercise immunology unit. What was learned: Institutionalized care offers better management strategies and standardized treatment in line with best global practices of care for patients with breast cancer across the cancer care continuum which will ultimately translate to better treatment outcomes.

Cancers Attributable to Alcohol Consumption in Nigeria: 2012-2014

Introduction

Alcohol consumption has been identified as a risk factor for many cancers but less attention has been paid to the fraction of those cancers that are attributable to alcohol consumption. In this study, we evaluated the incidence and population attributable fraction (PAF) of cancers associated with alcohol consumption in Nigeria.

Methods

We obtained data on incidence of cancers from two population-based cancer registries (PBCRs) in Nigeria and identified cancer sites for which there is strong evidence of an association with alcohol consumption based on the International Agency for Research on Cancer Monograph 100E. We computed the PAF for each cancer site by age and sex, using prevalence and relative risk estimates from previous studies.

Results

Between 2012 and 2014 study period, the PBCRs reported 4,336 cancer cases of which 1,627 occurred in males, and 2,709 occurred in females. Of these, a total of 1,808 cancer cases, 339 in males and 1,469 in females, were associated with alcohol intake. The age standardized incidence rate (ASR) of alcohol associated cancers was 77.3 per 100,000. Only 4.3% (186/4,336) of all cancer cases or 10.3% (186/1,808) of alcohol associated cancers were attributable to alcohol consumption. Some 42.5% (79/186) of these cancers occurred in males while 57.5% (107/186) occurred in females. The ASR of cancers attributable to alcohol in this population was 7.2 per 100,000. The commonest cancers attributable to alcohol consumption were cancers of the oral cavity and pharynx in men and cancer of the breast in women.

Conclusion

Our study shows that 4.3% of incident cancers in Nigeria can be prevented by avoiding alcohol consumption. While the incidence of cancers associated with alcohol intake is high, the proportion attributable to alcohol consumption is much lower suggesting that the number of cancers that may be prevented by eliminating alcohol intake in this population is relatively low.

Determinants of stage at diagnosis of breast cancer in Nigerian women: sociodemographic, breast cancer awareness, health care access and clinical factors

PURPOSE

Advanced stage at diagnosis is a common feature of breast cancer in Sub-Saharan Africa (SSA), contributing to poor survival rates. Understanding its determinants is key to preventing deaths from this cancer in SSA.

METHODS

Within the Nigerian Integrative Epidemiology of Breast Cancer Study, a multicentred case-control study on breast cancer, we studied factors affecting stage at diagnosis of cases, i.e. women diagnosed with histologically confirmed invasive breast cancer between January 2014 and July 2016 at six secondary and tertiary hospitals in Nigeria. Stage was assessed using clinical and imaging methods. Ordinal logistic regression was used to examine associations of sociodemographic, breast cancer awareness, health care access and clinical factors with odds of later stage (I, II, III or IV) at diagnosis.

RESULTS

A total of 316 women were included, with a mean age (SD) of 45.4 (11.4) years. Of these, 94.9% had stage information: 5 (1.7%), 92 (30.7%), 157 (52.4%) and 46 (15.3%) were diagnosed at stages I, II, III and IV, respectively. In multivariate analyses, lower educational level (odds ratio (OR) 2.35, 95% confidence interval: 1.04, 5.29), not believing in a cure for breast cancer (1.81: 1.09, 3.01), and living in a rural area (2.18: 1.05, 4.51) were strongly associated with later stage, whilst age at diagnosis, tumour grade and oestrogen receptor status were not. Being Muslim (vs. Christian) was associated with lower odds of later stage disease (0.46: 0.22, 0.94).

CONCLUSION

Our findings suggest that factors that are amenable to intervention concerning breast cancer awareness and health care access, rather than intrinsic tumour characteristics, are the strongest determinants of stage at diagnosis in Nigerian women.

The burden of HPV associated cancers in two regions in Nigeria 2012-2014

INTRODUCTION

HPV attributable cancers are the second most common infection-related cancers worldwide, with much higher burden in less developed regions. There are currently no country-specific estimates of the burden of these cancers in Nigeria just like many other low and middle income countries.

METHODS

In this study, we quantified the proportion of the cancer burden in Nigeria that is attributable to HPV infection from 2012 to 2014 using HPV prevalence estimated from previous studies and data from two population based cancer registries (PBCR) in Nigeria. We considered cancer sites for which there is strong evidence of an association with HPV infection based on the International Agency for Research on Cancer (IARC) classification. We obtained age and sex-specific estimates of incident cancers and using the World Standard Population, we derived age standardized incidence (ASR) rates for each cancer type by categories of sex, and estimated the population attributable fractions (PAF).

RESULTS

The two PBCR reported 4336 new cancer cases from 2012 to 2014. Of these, 1627 (37.5%) were in males and 2709 (62.5%) in females. Some 11% (488/4336) of these cancers were HPV associated; 2% (38/1627) in men and 17% (450/2709) in women. Of the HPV associated cancers, 7.8% occurred in men and 92.2% in women. The ASRs for HPV associated cancers was 33.5 per 100,000; 2.3 and 31.2 per 100,000 in men and women respectively. The proportion of all cancers attributable to HPV infection ranged from 10.2 to 10.4% (442-453 of 4336) while the proportion of HPV associated cancers attributable to HPV infection ranged from 90.6% to 92.8% (442-453 of the 488 cases). In men, 55.3% to 68.4% of HPV associated cancers were attributable to HPV infection compared to 93.6% to 94.8% in women. The combined ASR for HPV attributable cancers ranged from 31.0 to 31.7 per 100,000. This was 1.4 to 1.7 per 100,000 in men and 29.6 to 30.0 per 100,000 in women. In women, cervical cancer (n=392, ASR 28.3 per 100,000) was the commonest HPV attributable cancer, while anal cancer (n=21, ASR 1.2 per 100,000) was the commonest in men.

CONCLUSIONS

HPV attributable cancers constitute a substantial cancer burden in Nigerian women, much less so in men. A significant proportion of cancers in Nigerian women would be prevented if strategies such as HPV DNA based screening and HPV vaccination are implemented.

Burden of Cancers Attributable to Infectious Agents in Nigeria: 2012-2014

Introduction

Infections by certain viruses, bacteria, and parasites have been identified as risk factors for some cancers. In Nigeria, like many other developing countries, infections remain a leading cause of morbidity and mortality. While there are data on the incidence of different cancers in Nigeria, there has been no study of cancers attributable to infections. This study was carried out to determine the burden of cancers attributable to infections using data from two population-based cancer registries (PBCRs) in Nigeria.

Methods

We obtained data on cancers associated with EBV, human papillomavirus (HPV), hepatitis B and C, HIV, HHV8, Helicobacter pylori, and Schistosoma spp. from the databases of Abuja and Enugu cancer registries in Nigeria. We used population-attributable fraction for infections-associated cancers in developing countries that are based on prevalence data and relative risk estimates from previous studies.

Results

The PBCRs reported 4,336 incident cancer cases [age standardized incidence rate (ASR) 113.9 per 100,000] from 2012 to 2014, of which 1,627 (37.5%) were in males and 2,709 (62.5%) were in females. Some 1,030 (23.8%) of these cancers were associated with infections (ASR 44.4 per 100,000), while 951 (22.0%) were attributable to infections (ASR 41.6 per 100,000). Cancers of the cervix (n = 392, ASR 28.3 per 100,000) and liver (n = 145, ASR 3.4 per 100,000); and non-Hodgkin’s lymphoma (n = 110, ASR 2.5 per 100,000) were the commonest infections-associated cancers overall. The commonest infectious agents associated with cancers in this population were HPV, EBV, hepatitis B and C, HIV, and HHV8.

Conclusion

Our results suggest that 23.8% of incident cancer cases in this population were associated with infections, while 22.0% were attributable to infections. The infections attributable cancers are potentially preventable with strategies, such as vaccination, risk factor modification, or anti-infective treatment.

Cancers Attributable to Infectious Agents in Nigeria: 2012-2014

Abstract 60

Background:

Infections by certain viruses, bacteria, and parasites have been identified as risk factors for some cancers. In 2008, there were 12.7 million new cancer cases worldwide. About 2 million of these new cases were attributable to infections, which represent 16.1% of new cancer cases. The majority of these cancers occurred in less-developed regions of the world, where the Population Attributable Fraction (PAF) was estimated to be 23%. We carried out this study to evaluate the numbers of cancers in Nigeria from 2012-2014 that are attributable to infections using data from Population Based Cancer Registries (PBCR) in Nigeria.

Methods:

We considered cancers associated with Epstein-Barr virus (EBV), Human Papilloma Virus (HPV), Hepatitis B and C Virus (HBV/HCV), Human Immunodeficiency Virus and Human Herpes Virus 8 (HIV/HHV8), Helicobacter pylori, and Schistosoma haematobium that have been classified as oncogenic by IARC. We obtained data on the infection-associated cancers from registry databases of 3 PBCRs in Nigeria: Abuja, Enugu, and Calabar cancer registries. We used PAF for infectious agents associated cancers in developing countries, which were calculated using prevalence data and relative risk estimates in previous studies: EBV and Nasopharyngeal (90%), and Hodgkin's Lymphoma (80%); HPV and Cervical (100%), Vulval and Vaginal (40%), Anal (90%) and Oropharyngeal cancer (12%) in women; Penile (40%), Anal (90%) and Oropharyngeal cancer (12%) in men; HBV/HCV and Liver (92%), HIV/HHV8 and Kaposi sarcoma (100%), Non Hodgkin Lymphoma (100%); H. pylori and stomach (74%) and S. haematobium and Bladder cancer (56.6%).

Results:

The 3 PBCRs reported 4,861 cancer cases from 2012-2014: 1,875 male cases and 2,986 female cases. There were 412 infection-associated cancers in males accounting for 22% of total cancers in males, and 351 (85%) of these were attributable to infections. In females, there were 727 infection-associated cancers accounting for 24% of total cancers in females, and 674 (93%) of these were attributable to infections. Cancers of the Cervix (n=430), Liver (n=152), and Non-Hodgkin's Lymphoma (n=129) were the most common infection-associated cancers in both sexes. The most common infectious agents associated with cancers were HPV (n=453), HIV/HHV8 (n=199), HBV/HCV (n=143) and EBV (n=125).

Conclusion:

Our findings suggest that 85% of infection-associated cancers in males and 93% infection-associated cancers in females in Nigeria can be prevented with vaccination, safer risk behaviors, or anti-infective treatments.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST:

Michael Kolawole Odutola No relationship to disclose Elima Jedy-Agba No relationship to disclose Emmanuel Oga No relationship to disclose Festus Igbinoba Travel, Accommodations, Expenses: AstraZeneca Theresa Otu No relationship to disclose Emmanuel Ezeome Honoraria: Roche Travel, Accommodations, Expenses: Roche Ima-Obong Ekanem No relationship to disclose Ramatu Hassan No relationship to disclose Clement Adebamowo Speakers' Bureau: Merck

Developing National Cancer Registration in Developing Countries - Case Study of the Nigerian National System of Cancer Registries

The epidemiological transition in sub-Saharan Africa (SSA) has given rise to a concomitant increase in the incidence of non-communicable diseases including cancers. Worldwide, cancer registries have been shown to be critical for the determination of cancer burden, conduct of research, and in the planning and implementation of cancer control measures. Cancer registration though vital is often neglected in SSA owing to competing demands for resources for healthcare. We report the implementation of a system for representative nation-wide cancer registration in Nigeria - the Nigerian National System of Cancer Registries (NSCR). The NSCR coordinates the activities of cancer registries in Nigeria, strengthens existing registries, establishes new registries, complies and analyses data, and makes these freely available to researchers and policy makers. We highlight the key challenges encountered in implementing this strategy and how they were overcome. This report serves as a guide for other low- and middle-income countries (LMIC) wishing to expand cancer registration coverage in their countries and highlights the training, mentoring, scientific and logistic support, and advocacy that are crucial to sustaining cancer registration programs in LMIC.

Cancer patients’ information needs in Nigeria

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Background: The attitudes of Nigerian cancer patients on cancer diagnosis and prognosis were studied to ascertain what diagnostic and prognostic information were disclosed to them by their physicians, and what they wanted to know about their cancer diagnosis and prognosis. Methods: Structured questionnaires were administered on all consenting cancer patients that were managed at the University of Nigeria Teaching Hospital Enugu (UNTH-E) between July and October 2011. The data collected were analyzed with Statistical Package for Social Sciences (SPSS) software version 18. Results: Two hundred and forty four (244) patients participated in the study. While 95% of the participants wanted to know the nature of their diagnosis, only76.7% admitted to being informed of the diagnosis by their doctors. Nearly 54% of participants will like to be informed of a bad prognosis when death is imminent. The word “cancer” was used to disclose the diagnosis to 69.4% of the patients. Hundred and eight (44.3%) of the patients did not have any idea what “cancer” meant or did not know how to explain it while 39.8% knew it as a deadly, incurable or a painful disease and 8.6% described it as a tumour or abnormal growth. The nature of the disease was explained to 155(66.0%) of the patients among whom 114(76%) felt they received adequate or more than adequate explanation of their cancer to enable them undergo treatment. Patient factors that significantly improved the disclosure of diagnostic information were education (p=0.044) and site of the cancer (p=0.043). There was no statistically significant association between the desire for diagnostic and prognostic information and the patients’ age, gender, educational attainment or site of the cancer. Conclusions: Most of the surveyed cancer patients in Nigeria desire to know the truth about the diagnosis of their disease and more than 50% of them desire to know when the cancer stage becomes terminal and death imminent. Physicians in Nigeria should consider the information needs of the individual patients and satisfy them.

Case-control study of risk factors for breast cancer in Nigerian women

This study evaluated the potential risk factors for breast cancer in Nigerian women using a case-control design of 250 women with breast cancer and their age-matched female controls. Both cases and controls were recruited from 4 University Teaching Hospitals in Midwestern and Southeastern Nigeria. Data on the clinical and epidemiological characteristics were collected using interviewer-administered structured questionnaires. The mean age of the cases and controls were 46.1 and 47.1 years, respectively. Fifty-seven percent of the cases were premenopausal while 43% were postmenopausal. The association of risk factors with breast cancer was assessed using conditional logistic regression. Positive family history of breast cancer in first- and second-degree relatives (Odds ratio [OR] = 8.07, 95% confidence interval [CI], 1.003, 64.95, p = 0.04), education of high school level and above (OR = 1.35, 95% CI 1.04, 1.74, p = 0.0205), age at first fullterm pregnancy (FFTP) greater than 20 years (OR = 1.32 95% CI 1.01, 1.71, p = 0.0413) and waist/hip ratio (WHR) (OR = 1.98, 95% CI 1.27, 3.10, p = 0.0026) were associated with increased risk of breast cancer in the final multiple conditional logistic regression model. The findings from this study have shown that sociodemographic characteristics, reproductive variables and anthropometric measures are significant predictors of breast cancer risk in Nigerian women.

Cytochrome P4501A1 genetic polymorphisms and breast cancer risk in Nigerian women

In this case-control study based on 250 women with breast cancer and 250 age-matched controls, we sought to evaluate the role of four polymorphic variants in the CYP1A1 gene in breast cancer susceptibility in Nigerian women. Heterozygosity for the CYP1A1 M1 genotype (CYP1A1 M1 [T/C]) was associated with a 21% reduced risk of breast cancer (OR = 0.79, 95% CI 0.46-1.40) while homozygosity for the genotype (CYP1A1 M1 [C/C]) conferred a non-significant 9% reduced risk of breast cancer. These risk profiles were not significantly altered in subgroup analysis by menopausal status. While heterozygosity for the CYP1A1 M3 genotype (T/C) conferred a non-significant 24% reduced risk of breast cancer (OR = 0.76, 95% CI 0.47-1.22), homozygosity for the variant was associated a non-significant 1.95-fold increased risk of breast cancer (OR = 1.95, 95% CI 0.24-6.01). Subgroup analysis showed a non-significant 11% reduced risk in premenopausal heterozygous carriers (OR = 0.89, 95% CI 0.45-1.44) and a non-significant 6% increased risk of postmenopausal breast cancer for carriers of the CYP1A1 M3 (T/C) genotype. The CYP1A1 M2 (isoleucine to valine) polymorphism in exon 7 and CYP1A1 M4 (threonine to asparagine) variant in codon 461 of the CYP1A1 gene were found to be very rare in our study subjects. This study has shown that while the CYP1A1 M1 polymorphism conferred reduced risk of breast cancer, homozygosity for the CYP1A1 M3 (C/C) was associated with increased risk of breast cancer although these risks did not attain statistical significance.