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Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death in female's worldwide. Its incidence is on the ascendancy in Africa including Ghana. In addition, Ghanaian women are more likely to be diagnosed with high-grade tumours that are triple negative breast tumours. The objectives of the study were to investigate the clinicopathologic features of breast cancer in Ghanaian women; identify and describe breast cancer survival pattern in Ghana and factors that explain the disparity in survival rates for breast cancer by the use of Cox proportional hazard. Two thousand three hundred and ninety seven (2397) women were sampled for the study from the Korle-Bu Teaching Hospital (KBTH), of which 1022 (42.64%) were diagnosed with breast cancer between the periods 1 st January 2002 to 31 st December 2008. The cases were followed up to January 2011. It was found that Mean age for the cases was 47.97 years. The largest number of cases being 59.69% was aged 40 -49 years. Invasive Ductal Carcinoma (IDC) was 72.90%, 71.28% had lump size of 2-5 cm. Axillary lymph node involvement was found in 90% of the women diagnosed with breast cancer. 5-year cumulative survival was 91.94% for stage 0&I and 15.09% for stage IV. Data relating to tumour grading were 92.07% for high grade 2 and 3. Triple negative breast cancer was identified in 66.38% (77 out of 116) of the cases with complete information on Estrogen Receptor, Progesterone Receptor and HER2 status. Cumulative 5-year survival was 47.91. Survival rate was better for early staged presentation; lymph node involvement of less than 25% and tumour size of less than 5 cm. The study reinforces the urgent need for improved screening techniques for early detection, and for an aggressive health education campaign to increase the awareness of women in Ghana about the potential risk of breast cancer and early detection by regular testing.

Objectives:To determine the epidemiology of, and define the morbidity and mortality factors following emergency surgery for patients with perforated peptic ulcer disease in Accra, Ghana. Design: A retrospective and prospective hospital-based study. Setting: The general and paediatric surgical wards of the Korle-Bu Teaching Hospital. Main outcome measures: Demography, the systolic BP, pulse rate and haemoglobin on admission at ER, co-morbid conditions, site of perforation, surgical method and treatment outcome. Subjects: A total of 326 cases treated for peptic ulcer perforation, 267 males and 59 females; ratio 4.5:1, with mean age of 40.9, SD 16.4 and range 4-87 years, were studied. Results: The incidence of peptic ulcer perforation rose from 1.6% in 1998 to 5.3% in 2002 and stabilised at 5%, and overall accounted for 4.6% of acute abdomen. Co-morbid conditions were present in 48 (18.2%) of cases. Ulcerogenic substance intake was in 177 (67%) patients. One hundred and twenty two (46.2%) patients reported to hospital within 24 hours of perforation. There were 287 (88%) duodenal, 22 (7.1%) prepyloric, and 19(4.9%) type 1 gastric ulcer perforations. Simple closure with omental patch was performed in 299(94.3%), truncal vagotomy and drainage in 10 (3.2%), and Billroth II partial gastrectomy in seven (2.2%). Post-operative complications occurred in 62 (19%); overall mortality was 36 (11%). Logistic regression analysis of the patients clinical variables showed that age less that 60 years (p-value, OR and 95% CI; 0.002, 3.964 and 1 .668-9.420), duration of perforation of more than 24 hours before admission (p-value, OR and 95%CI; 0.011,2.471 and 1.228-4.971), alcohol intake (p-value, OR and 95%CI; 0.009, 2.543 and 1.259-5.135) and resectional surgery (p-value, OR and 95%CI; 0.000, 8.25E and 74204908.138-9162648048.1) were statistically significant in determining postoperative complications. Age 60 years and above (p-value, OR and 95%CI; 0.018,4.359 and 1.284-14.802), alcohol intake (p-value, OR and 95%CI; 0.042, 3.238 and 1.046-10.021) and resectional surgery (p-value, OR and 95% CI; 0.000, 1.20E and 938112920.94-1.54E+ 11) were the factors that showed statistical significance in determining post-operative mortality. Conclusion: Perforated peptic ulcer disease is emerging as a frequent cause of acute abdomen in our centre and affects the youth commonly. Age 60 years and above, duration of perforation for more than 24 hours before admission, alcohol intake and resectional surgery were the variables that showed statistical significance in predicting post-operative morbidity and/or mortality.

Objectives: To determine the causes of delayed presentation in breast cancer patients at Korle Bu Teaching Hospital (KBTH), and reasons for patients absconding before and during treatment. Design: Questionnaire survey. Setting: Out patient departments and surgical wards of KBTH. Participants: Women newly diagnosed with breast cancer and breast cancer patients who previously absconded and were returning for treatment. Results: Sixty six newly-diagnosed patients aged between 20 and 84 (mean 44.8, median 43) years and 35 previous absconders aged 20 to 74 (mean 44.5, median 44) years were interviewed. The causes of delayed presentation were: previous medical consultations 26(29.4%), ignorance 19(28.8%), fear of mastectomy 16(24.2%), herbal treatment 13(19.7%), prayer/prayer camps 13(19.7%) and financial incapability 12(18.2%). Fear of mastectomy 20(57.1%), herbal treatment 13(37.1%), financial incapability 11(31.4%) and prayers/prayer camps 10(28.6%) which were prominent causes of late presentation, were the main reasons for absconding. Newly diagnosed patients had duration of symptoms one week to five years (mean 46, median 34 weeks). Those whose lumps were found by clinical breast examination in the community presented to hospital between six weeks to two years (mean 47, median 39 weeks). Married women were more likely to abscond (p=0.001). Conclusions: There are similar reasons for delayed presentation and absconding among Ghanaian patients. These must be addressed in outreach programmes, and patients must be counselled at time of diagnosis. Dealing with the causes of delayed presentation appears more important than attempts to screen for breast cancer, since patients identified through community screening still present late to hospital.

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