Metastatic breast cancer in a Nigerian tertiary hospital

Background: Late presentation of breast carcinoma is common in resource-limited countries with attendant poor outcome. Objective: To describe the pattern of clinical presentation and challenges of treating patients presenting with metastatic breast carcinoma in a Nigerian hospital. Method: Clinical records of all patients who presented with metastatic breast carcinoma between January 1991 and December 2005 at the Obafemi Awolowo University Teaching Hospitals Complex; Ile-Ife; Nigeria were reviewed. Results: More than half of all histologically confirmed breast cancer patients seen within the study period presented with metastatic disease. Their ages ranged between 20-81years with a mean age of 45.9 years. Only 3(6 of 202) were males. Twothirds had more than one secondary site on initial evaluation and the commonest sites were liver (63); lung parenchyma (51); pleura (26) and contralateral breast in 25. On immunohistochemistry; basal like tumours were found in 46.1. Mastectomy was done in 37 patients with fungating breast masses while only one third of those referred to a nearby center for radiotherapy had it done. One year survival rate was 27. Conclusion: Metastatic disease is common in Nigeria and treatment is limited due to resource limitations. Improved awareness of the disease is advocated to reduce late presentation

Breast Fine Needle Aspiration Cytology in a Nigerian Tertiary Hospital

Objectives:Breast disease remains a major public health issue worldwide.It is the most common cancer among Nigerian women.Fine needle aspiration cytology (FNAC) is an important preoperative assessment tool along with clinical and mammography examination in both screen detected and symptomatic breast disease.This study provide opportunity to determining the accuracy of FNAC and factors affecting false negative rate in Obafemi Awolowo University Teaching Hospital complex; Ile-Ife; Osun state Nigeria Method:All patients seen in the breast clinic with lump were sent to the pathology department for FNAC from January 1997 to December 2004.The sociodemographic data; cytology result; final histology result and the clinical staging for breast cancer were analyzed.Results:Eight hundred and sixty-four patients had FNAC during the studied period; however only 632 cases had available final histological report.Of these; 20 (3.2) were male while 612 (96.8) were female; the age ranged from 15 years to 99 years; median of 36.50.We found that absolute sensitivity for malignancy to be 70.8.The false negative rate was 14.9; while the false positive rate was 1.8.The suspicious rate was 9.8while the inadequate rate was 5.4.Conclusion:FNAC remains the least invasive; the most rapid and the most cost effective method to confirm clinical and radiological suspicion of malignancy; however; the test has high false negative rate.We recommend that consultation between pathologists and the clinicians should be facilitated and encouraged to reduce the high false negative. Also; multi-disciplinary audits of difficult case should be part of the work routine