Breast cancer and risk factors in an African population: a case referent study.

Numerous studies have investigated different aspects of breast cancer including the known risk factors in the Western world. In sub-Saharan Africa breast cancer in women despite being a public health problem has not received attention from national health providers. This case-referent study investigated the association between a number of risk factors and breast cancer in Tanzania. There was a strong evidence of breast cancer risk increasing with parity chi 2 = 10.6; p = 0.001. However lactation did not show a significant protective effect against breast cancer (OR = 0.6, p = 0.5). Other factors investigated included age at menarche, age at first sex, marital status, age at menopause and duration of menstruation. Statistical analysis revealed that these factors were not significantly associated with breast cancer in these Tanzanian women. The influence of these results are discussed in terms of possible intervention strategies.

Breast cancer and conservative surgery in sub Saharan Africa.

This study investigated the profile of breast cancer patients in Tanzania during 1974-87 period. The results were compared with those of African patients in countries south of the Sahara. The maximum number of patients with breast cancer were seen in the sexually active age groups. In Sudan breast cancer was in leading position amongst all female cancers but with a lower proportion of women below 30 years, 6.4% (95% CI 5.3-7.6); x2 = 7.3 (p = 0.006). While in other sub-Saharan countries the disease ranked second to cervical cancer in frequency, but with a high proportion of patients below 30 years of age. This proportion was highest in Nigeria when compared with other African countries studied 14.7% (95% CI 8.9-22.3); x2 = 3.9 (p = 0.04). Mastectomy continues to be the treatment of choice for breast cancer in the sub Saharan countries despite the fact that this procedure is resented. Also that the Halstedian principle which governed the treatment of the disease for a century now has been disputed regarding its usefulness. The biological basis for adopting conservative surgery for breast cancer, the need for early detection and the oncogenesis of the disease are discussed.

Cholelithiasis in Dar es Salaam, Tanzania.

In a five year review, there were 30 cases of cholelithiasis treated at the Muhimbili Medical Centre, Dar es Salaam, Tanzania. The male to female ratio was 1:3, and the peak age for cholelithiasis was in the 30 to 49 years age group. Right upper quadrant abdominal pain was the commonest presenting symptom (100 pc), and cholecystectomy was performed in all patients. Local complications of gall stones were recorded in seven patients (23.3 pc) and these included; gall bladder empyema, pericholecysteal abscess, CBD stone, gall bladder adenoma, gall bladder mucocele, and two patients had acute cholecystis. Stones were multiple in 90 pc of patients, and on macroscopic classification the ratio of cholesterol to pigment stones was 2:1. There was no death in this series of 30 patients.

Pneumatosis cystoides intestinalis--in Tanzania.

Pneumatosis cystoides intestinalis (PCI) is a rare benign condition affecting portions of the intestinal tract, characterised by: multiple subserosa and submucosal gas cysts, unknown aetiology, and non specific clinical presentation. Its diagnosis is often coincidental. Management of PCI entails that of the associated condition.

Complete rectal prolapse in adults: a Tanzanian experience.

This is a retrospective report of nine patients with complete rectal prolapse managed by the authors at the Muhimbili Medical Centre, Dar es Salaam between 1990 and 1993. The average age of patients was 36 years and eight of the patients were males. Six of the patients presented as emergency admissions of whom three had irreducibility and required perineal proctosigmoidectomy. This was the procedure of choice for irreducible complete rectal prolapse.

Experience with subfascial ligation for varicose veins in Tanzania: a brief communication.

From January 1987 through December 1989, ten patients with varicose veins complicated by postphlebitic ulcers were treated at Muhimbili Medical Center, Tanzania, by subfascial ligation of perforating veins. The technique employed was a posterior subfascial approach which avoids making the skin incision through the ulcer itself. The follow up periods ranged from one to three years and there was no recurrence of the ulcer in any of the patients in the study. The major indication for performing the procedure was the presence of a varicose stasis ulcer. Before surgery, all patients had a complete peripheral vascular examination to exclude deep venous thrombosis. Healing of varicose ulcers and elimination of stasis eczema had to be achieved four weeks before surgery. The authors maintain that patients who present with varicose veins of the lower leg and a postphlebitic stasis ulceration invariably have incompetence of the valves in the perforating veins and should be treated by subfascial ligation of the perforating veins.