Experiences of women in survivorship following mastectomy in the Cape Metropole

Background: In spite of significant improvements in the treatment of breast cancer, many women still undergo mastectomy. The effects of breast cancer surgery on the diverse population of South African women have not been well studied. Insight may be gained in how to aid recovery in survivorship by identifying the support needs of women following mastectomy.This study aimed to explore and describe the lived experiences of women in the Cape Metropole following mastectomy in survivorship.Methods: A qualitative study guided by descriptive phenomenology and grounded in the post positivist philosophy of Husserl. Seven women from the Cape Metropole were interviewed in English following ethical approval. The semi-structured interviews were thematically analysed.Results: Three general themes emerged: Psychological impact of breast cancer diagnosis and treatment, the impact of an altered body image and concern for family and reliance on them for support, with a theme specific to stigmatisation within the Xhosa culture. Conclusion: The need to shield family members from breast cancer diagnosis was contrasted by the need for family support. Cultural stigmata still prevail within the South African population

Positive tumor margins in wide local excision of breast cancer: a 10-year retrospective study

Background. The safety of wide local excision as a standard surgical option for early stage breast cancer management in Ghana has not been evaluated. The aim of this study was to use retrospective histopathological descriptive study to evaluate the prevalence of positive tumor margins in wide local excision specimens and offer recommendations. Study design. We reviewed 147 breast lumps; following wide local excision; which were received in the Department of Pathology; for positive tumor margins. The data was analyzed using SPSS software (version 16). Results. A total of 2;751 female breast cancers were diagnosed during the study period; of which 147 (5.3%) were from wide local excisions (lumpectomies). Thirty-one (21.0%) had positive tumor margins. The mean age of women with positive margins was 53.4 (SD = 17.1) years. The mean size of primary tumor was 4.0 (SD = 2.1) cm; the majority (53.0%) of which were greater than 2.0?cm; but less than or equal to 5.0?cm (T2). A total of 26 (83.4%) of these tumors were invasive ductal carcinomas (NOS); 24 (92.3%) of the cases had combined Bloom-Richardson grading; and many; 10 (41.7%); were grade 1. Conclusion. Our study shows that 21.0% of all wide local excision biopsies had positive tumor margins; a figure that is comparable to those of other studies. Tumors with positive margins in this study were large; 4.0?cm (T2); and common in relatively young women. Treatment failure is therefore likely to occur in these patients

Three-Year Clinico-Pathological Observations of Breast Carcinoma in Okolobiri; Bayelsa State; Nigeria

Aim: To ascertain the clinico-pathological pattern of breast cancer at the Niger Delta University Teaching Hospital. Methods: This was a retrospective study of all BC patients treated from January 2007 to December 2009 in the Surgical Department of the Niger Delta University Teaching Hospital. Okolobiri; Bayelsa State; Nigeria. Relevant data including name; age; sex; history and examination findings and results of histopathology and other investigations were collected from case files of all the patients treated for BC during the period under review. The data was then analysed manually and by using stat-graphics version 2.3. Results: A total of 42 patients were included in the study and they were all females. Twelve patients (28.6) were of the 31-40 years age group; followed by 21-30 years age group with 10 patients (23.8). Thirty-one patients (73.8) between the ages of 21-50 years were premenopausal. The commonest histological type was infiltrating ductal carcinoma which was found in 23 (54.7) patients. Late presentation was seen in 38 (90.5) patients. The right breast was affected in 22 (52.4) cases; the left in 19 (45.2) and only one (2.4) was bilateral. Mortality was 4.8. Conclusion: Cancer of the breast is still a common problem presenting in the young to middle age groups. Infiltrating ductal carcinoma is the commonest variant. Late stage presentation is often the norm in this locality. There is the need to increase the awareness of the disease

Audit of Histopathology Reports for Breast Cancer in Aminu Kano Teaching Hospital

BACKGROUND: The usefulness of histopathology reports is a function of the quality of information contained therein. Thus there is need to establish minimum criteria to be met in reporting cases as a quality control mechanism. OBJECTIVE: To audit the quality of histopathology reports of mastectomy specimens received in the pathology laboratory of a Teaching Hospital. METHODS: Laboratory numbers of all cancer bearing mastectomy cases received in 10 years (1999-2008) were extracted from pathology reception registers and their accompanying original request cards were retrieved from archives. From these cards relevant information meeting six set audit criteria and average turn around times were determined and analysed. RESULTS: One hundred and sixty-five mastectomy cases were received but archival retrieval was possible for only 134 (81.2) cases. The reports documented tumour size; macroscopic resection margin; histological tumour type; histological grading; lymphatic/vascular invasion characterized by invasion of tumour cells into lymphatic vessels; arteries or more importantly veins; and microscopic resection margin. These were documented in 50; 62; 92; 40; 12and 64of cases respectively. Average turn around time was 15.8 days. Only three (2.2) of the reports met all the six criteria. CONCLUSION: This 10-year audit shows the lapses in our histopathology reports and the need for establishment of standard report formats as tools for quality assurance

Malignant Phylliodes Tumours: Results of Breast Conserving Surgery and Immediate Reconstruction

Background: Malignant phylliodes tumour (MPT) is a rare breast tumor. Surgery is the mainstay in treatment but varies from local resection to modified radical mastectomy. In this study; we present our experience using wide local excision or subcutaneous mastectomy and immediate breast reconstruction in the management of MPT. Methods and Results: Twenty-three recurrent MPT and ten patients with histological evidence of MPT were included. All patients with recurrent MPT (n=23) had subcutaneous mastectomy; tow centimeter wide excision of the scar and immediate breast reconstruction with either Latissimus Dorsi (LD) myocutaneous flap (n= 10) or Latissimus Dorsi muscle flap (n=13). Seven of the newly diagnosed patients had wide local excision of the tumor; reconstruction with LD muscle flap; tow had wide local excision and reduction of contra lateral breast; and one had subcutaneous mastectomy and silicon implant. The margin resection varied between five and fifteen centimeter in wide local resection group and subcutaneous mastectomy group respectively and the size of tumors varied between five and fifteen centimeters in diameter. Discussion: During the follow up period; which ranged between twenty-four and eighty-four months one local recurrence; was recorded (3.03) and none of the patients had distant metastasis or regional lymph nodes involvement. This approach has secured wider excision of MPT; offered breast reconstruction; and has reduced the chances of recurrence in our patients

Breast-conserving therapy in breast cancer patients - a 12-year experience : general surgery

Introduction. Twenty years ago prospective randomised controlled trials were initiated to compare conservative breast surgery plus radiation with radical mastectomy in the treatment of early-stage breast cancer. The results have shown no survival advantage for mastectomy over breast-conserving therapy (BCT). However; local recurrence of cancer after BCT has been reported to be as high as 14; necessitating salvage mastectomy. Methods. This retrospective study was performed on 165 breast cancer patients undergoing BCT in the 12 years up to August 2002. Resection and intraoperative cytological assessment were used to achieve clear excision margins. Adjuvant therapy (hormones; chemotherapy) was undertaken; and the incidence and times of local recurrence and distant metastases were recorded. Results. Ninety-four per cent of patients had clear margins at the initial operation. This was achieved irrespective of ductal carcinoma in situ alone or surrounding the cancer in 62of cases. At a median follow-up of 65 months one patient developed local recurrence (LR) in the breast synchronously with distant relapse. Two patients had non-nodal axillary recurrences but no patient suffered LR in isolation in the treated breast. Conclusion. BCT is a safe alternative to mastectomy provided that the tumour is completely excised. The segment containing the cancer should be resected from the nipple to the periphery of the breast. Intraoperative cytological assessment helps to ensure clear margins. Reexcision is recommended for patients with close/involved margins

Vecu psychologique des patientes traitees pour cancer du sein : au service de Gynecologie Obstetrique du CHU de Treichville

L'etude prospective que nous venons de mener au service de gynecologie obstetrique du CHU de Treichville s'est interessee a 480 patientes dont 20 porteuses de cancer du sein et suivies a l'unite de consultation des maladies du sein entre le 1er Septembre 2000 et le 30 Juin 2002; soit une prevalence de 4;16pour cent. Il s'agit de femmes ivoiriennes dont la majorite est encore en activite genitale (55pour cent) avec deja 4 grossesses au moins (70pour cent). Le type predominant est le carcinome canalaire infiltrant (80pour cent) localise indifferemment a droite et a gauche avec une Iegere predominance au sein droit (52;39pour cent); dans le quadrant supero- externe (47;62pour cent). Le nodule du sein et la mastodynie ont ete les principaux motifs de consultation. La chimiotherapie; la tumorectomie; la mastectomie; la radiotherapie ont ete l'eventail therapeutique propose. La manifestation de la souffrance psychique (inquietude; crainte; anxiete; depression; deni) s'est retrouvee a tous les etapes de la traversee du cancer (attente de la premiere consultation; attente de la confirmation diagnostique; confirmation du diagnostic; periode de traitement; periode de remission) comme etant la detresse psychologique declenchee avant tout par une maladie mortelle; mais liee egalement a l'ablation du sein et aux soucis esthetiques (alopecie). Le jeune age des patientes et Leur niveau socioeconomique trop bas pour faire face au cout eleve de la chimiotherapie ont influence negativement le vecu; contrairement a l'analphabetisme de la population d'etude (65pour cent) qui les protegeait des soucis supplementaires lies aux informations recueillies dans les ouvrages. Ces patientes ont puise leur volonte de vivre malgre tout dans la religion; aupres du conjoint; des enfants; des amis et du medecin traitant. Ce desir de vivre malgre tout a ete percu; chez ces patientes; dans leur recherche de soutien moral et financier; dans la reprise des relations aux autres (collegues de service; conjoint; entourage); dans la recherche de solution esthetique a l'alopecie (foulard; perruque) et dans l'elaboration des nouveaux projets de vie. Des recettes ont ete proposees aux gynecologues pour une prise en charge psychologique plus efficiente de ces patientes pour ne referer que les cas les plus graves

Cancer du sein chez l'homme africain : 46 observations dakaroises

Il s'agit d'une etude retrospective de 46 cas de cancers du sein survenus chez l'homme et colliges a l'institut du Cancer de Dakar de 1957 a 1999. L'age moyen des malades etait de 60;7 ans et la duree moyenne des symptomes etait de 37;5 mois. La repartition des malades selon la classification TNM de l' UICC revelait : 1T1; 1T2; 4T3; 40T4; 40N1; 1N2; SN3; 10M1 PUL; 8M1 OSS et 2M1 HEP. Le carcinome canalaire invasif representait 78;2 pour cent de l'ensemble des lesions histologiques. Nous avons realise 32 mastectomies dont 23 etaient associees a un curage axillaire. La chirurgie etait associe a une chimiotherapie dans 25 cas et a une radiotherapie dans 14 cas. Le traitement hormonal au Tamoxifene fut institue dans 7 cas. Le suivi moyen des malades etait de 24 mois. Le pronostic de ces cancers pourrait etre ameliore par une meilleure education et un diagnostic plus precoce