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.

Developing a Breast Cancer Screening Program in Nigeria: Evaluating Current Practices, Perceptions, and Possible Barriers.

PURPOSE: In low- and middle-income countries like Nigeria, women present with advanced breast cancer at an earlier age. Given the limited resources, development of screening programs that parallel resource capabilities of low- and middle-income countries is imperative. The objective of this study was to evaluate the perceptions, practices, and barriers regarding clinical breast examination (CBE) screening in a low-income community in Nigeria. MATERIALS AND METHODS: A cross-sectional survey of women age 40 years or older in Ife, Nigeria, using multistaged sampling was performed. Information on sociodemographics, knowledge of breast cancer, screening practices, and willingness to participate in CBE screening was obtained using an interviewer-administered questionnaire. RESULTS: A total of 1,169 women whose ages ranged from 40 to 86 years (mean age, 47.7 years; standard deviation, 8.79 years) were interviewed. The majority of women (94%) knew about breast cancer, whereas 27.5% knew someone who had had breast cancer, the majority of whom (64.5%) had died of the disease. Of the 36% of women who had breast screening recommended to them, only 19.7% had an actual CBE. Of these, only 6% had it in the last year. The majority of women (65.4%) were willing to have regular CBEs and did not care about the sex of the examiner in most instances. Lack of perceived need was the reason cited by women unwilling to participate. CONCLUSION: The majority of women were aware of breast cancer and knew it as a fatal disease. With the relatively encouraging number of those willing to be examined, a carefully designed CBE program coupled with advocacy to correct uneducated beliefs seems promising.

Impact of introduction of laparoscopic surgery on management of unresolved intra-abdominal malignancies in a West African hospital.

BACKGROUND: Intra-abdominal malignancies often pose diagnostic problems to surgeons in resource-challenged centers such as ours due to limitations in modern imaging and other facilities. This prompted the adoption of laparoscopy in our hospital as an adjunctive tool in diagnosing these conditions. METHOD: Pre- and per-operative data of consecutive cases of clinically unresolved advanced intra-abdominal tumors subjected to laparoscopy from January 2009 through June 2013 were reviewed. Anatomic diagnosis and tissue biopsies were carried out during the procedures. RESULTS: Of the 152 patients seen with intra-abdominal tumors, 74 (48.7 %) had advanced conditions that could not be resolved clinically. Of these, 33 (44.6 %) were able to afford and had computed tomography (CT), scan while the remaining (N = 41; 55.4 %) less endowed only had an ultrasound scan. This cohort underwent laparoscopic evaluation, and biopsies confirmed the following: 27 (36.5 %) metastatic adenocarcinomas, 12 (16.2 %) primary hepatic malignancies, 11 (14.9 %) cases each of lymphomas and colonic adenocarcinomas, 4 (5.4 %) gastrointestinal stromal tumors, 3 (4.1 %) pancreatic carcinomas, 2 (2.7 %) cases each of carcinoid tumors and abdominal tuberculosis, and one case each of schistosomiasis and HIV-related Kaposi's sarcoma. Additionally, 26 (35.1 %) had ascites, while 29 (39.1 %) had peritoneal surface malignancies. With local adaptations and improvisations, laparoscopy was cheaper than an abdominal CT scan in our setting, with the additional benefit of obtaining tissue diagnosis to institute treatment. CONCLUSION: Although laparoscopy is commonly used for staging intra-abdominal tumors, we found it useful in complementing clinical diagnosis and attaining histopathological confirmation in a setting where access to and funding of modern imaging is limited.

Burden of prostate cancer in southwestern Nigeria.

OBJECTIVES: To determine the pattern of presentation, prevalent age, hospital incidence, and outcome of management of prostate cancer in our environment. METHOD: Patients with histopathology evidence of prostate cancer managed between January 1991 and December 2007 were studied. Information entered into a pro-forma sheet and analyzed included the age of patients, clinical features, investigations, histopathology diagnosis, outcome of management, and duration of follow-up. RESULTS: During the period, 189 patients aged 46-99 years (mean, 68.0; 9.8 SD) confirmed and managed for prostate cancer were studied. The average hospital incidence (2002-2004) was 182.5 per 10(5) male admissions with 15.1-month mean duration of symptoms. Most 178 (94.2%) patients presented with advanced diseases, with 1 or multiple complications in 172 (91.0%), obstructive lower urinary tract symptoms 156 (82.5%), distant metastasis 97 (51.3%), lower back pain 95 (50.3%), weight loss 95 (50.3%), hematuria 86 (45.5%), anemia 77 (40.7%), renal failure 74 (39.2%), and inability to walk 42 (22.2%). Eighty-nine (47.0%) patients were farmers, 111 (58.7%) indulged in alcohol, and 46 (24.3%) smoked cigarettes. Mean prostate-specific antigen results available in 53 patients was 106.0 ng/mL (187.2SD) and digital rectal examination was valuable in diagnosis. Adenocarcinoma (186 [98.4%]) was the main histopathology type and most patients 136 (71.9%) had bilateral orchidectomy with or without antiandrogens. Mean duration of follow-up was 83.7 weeks. CONCLUSIONS: The burden of prostate cancer in our developing community is worrisome. It is prevalent between 46 and 99 years in our community. Presentation is late, often with urinary retention and other complications. In our setting, treatment is still essentially palliative with orchidectomy, which we found to be beneficial, acceptable, and the most affordable to our patients.

Paradox of wellness and nonadherence among Nigerian women on breast cancer chemotherapy.

CONTEXT: Intentional nonadherence among cancer patients is rare and may occur only when the benefits of treatment are not obvious to the patient. AIMS: To highlight a group of women on chemotherapy for breast cancer who defaulted from their medications because they were improving. SETTINGS AND DESIGN: A study was carried out of the reasons for nonadherence to medications among women receiving chemotherapy for breast cancer at a Nigerian teaching hospital between January 1993 and December 2002. MATERIALS AND METHODS: A retrospective review of patients' records was done. RESULTS: Of the 188 women who received chemotherapy during the study period, 152 (80.9%) defaulted from treatment at one point or another. The reasons for nonadherence were available in 101 patients. Among these, 18 (18.0%) reported nonadherence because they felt better after commencing chemotherapy. They were aged 31-50 years (Mean = 35.6 (SD3.2)). Six (33.3%) of them presented in AJCC Stage I, and 10 (55.6%) in stage II. Age and disease stage at presentation were found to have significant influence on their reason for nonadherence. Of the nine women on neo-adjuvant chemotherapy, six (66.7%) had complete response but defaulted and five (55.6%) re-presented within a year with metastatic disease. Three of the patients receiving systemic post-surgery chemotherapy presented within a year with local recurrence. Most of the other patients were subsequently lost to follow-up. CONCLUSIONS: Nonadherence due to wellness among breast cancer patients is associated with poor outcome. We propose a detailed prospective study to establish factors that may influence such behavior.