Breast Cancer Screening in a Resource Poor Setting: A Preliminary Report

ABSTRACT

Background: Breast cancer is a leading cause of death among Nigerian women. Patients typically present late with advanced and aggressive diseases from a younger age. Cure for breast cancer is only possible when the disease is discovered early and breast cancer screening greatly increases the chances of early detection. We present the results of a breast cancer screening program at the Taimako Breast and Cervical Cancer Screening Centre; Lafia; Nigeria. Methodology: This is a prospective study of subjects who presented to our breast cancer screening centre between May 2009 and April 2010. A community mobilization and awareness campaign was mounted 3 months before screening began. A structured questionnaire was administered on each subject to elicit demographic data and risk factors. Each had a clinical breast examination. Those 35 years and above had a mammography while those below 35 years had breast ultrasound scan. Where a lump was discovered; it was subjected to tissue biopsy and histology. Results: Two thousand and ninety five subjects were seen over the one year period. Mean age was 34 + 12 years. Mean age at menarche was at 14.3 + 1.7 years; mean parity was 3.6 +2.6. Two thousand and thirty six subjects (97.2) had some knowledge about breast cancer; 1;269 (60.5) had no formal education; 881(42.1) were petty traders while 501(23.9) were full time housewives. Four hundred and seventy (22.4) had a positive family history of breast disease; 437 (20.9) had history of use of oral contraceptives; and 9 (0.4) had a previous breast biopsy. Four hundred and sixty one (22.0) complained of breast discomfort; 184 (8.8) complained of breast lumps; but only 95 (4.6) of them had lump on clinical breast examination; while a further 8 (0.4) lumps were found on breast imaging. One thousand nine hundred (90.7) had normal breast screening results; 166 (7.9) had benign breast diseases and 29 (1.4) had breast cancer. Conclusion: Knowledge about breast cancer was high because of prior campaigns and should be encouraged. Proportion of subjects with breast cancer is low even though many complained of breast lumps on presentation. Majority of the lumps were found at clinical breast examination while mammogram had a very low yield. A treatment arm needs to be incorporated into the screening program to demonstrate survival benefit