Background Breast cancer remains a serious public health problem globally. It is particularly increasing among adolescents and premenopausal women. Breast self-examination (BSE) is the most effective and feasible means of detecting breast cancer early in developing countries. This study aimed at evaluating and comparing knowledge of BSE among secondary and tertiary school students and at revealing their attitudes and practices about BSE. Method This cross-sectional study was conducted among 1036 female secondary and tertiary school students of Kwame Nkrumah University of Science and Technology and Technology Senior High School. Data was obtained using a pretested questionnaire to access sociodemography, knowledge, attitudes, and practice of BSE among the students. Result Most students were within the age of 15–24 years; 90.9% were aware of BSE. A high level of knowledge on BSE was found in 54.5% of the students. Knowledge was significantly higher in tertiary than secondary school students (p=0.002). 24.1% of the students thought BSE could be performed anytime; however only 8.1% of the students performed BSE monthly as recommended, whilst 41.8% had never practiced. Of these, more secondary students had never practiced BSE as compared to the tertiary students. 22.3% indicated they would wait for a change in a detected breast lump before seeking medical attention. 96.3% of the participants agree BSE is a good practice which must be encouraged. Conclusion Teaching of BSE should be intensified beginning at the high school level, emphasizing practice and its benefits for early detection of breast cancer.

Women with African ancestry in western, sub-Saharan Africa and in the United States represent a population subset facing an increased risk of being diagnosed with biologically aggressive phenotypes of breast cancer that are negative for the estrogen receptor, the progesterone receptor, and the HER2/neu marker. These tumors are commonly referred to as triple-negative breast cancer. Disparities in breast cancer incidence and outcome related to racial or ethnic identity motivated the establishment of the International Breast Registry, on the basis of partnerships between the Komfo Anokye Teaching Hospital in Kumasi, Ghana, the University of Michigan Comprehensive Cancer Center in Ann Arbor, Michigan, and the Henry Ford Health System in Detroit, Michigan. This research collaborative has featured educational training programs as well as scientific investigations related to the comparative biology of breast cancer in Ghanaian African, African American, and white/European American patients. Currently, the International Breast Registry has expanded to include African American patients throughout the United States by partnering with the Sisters Network (a national African American breast cancer survivors’ organization) and additional sites in Ghana (representing West Africa) as well as Ethiopia (representing East Africa). Its activities are now coordinated through the Henry Ford Health System International Center for the Study of Breast Cancer Subtypes. Herein, we review the history and results of this international program at its 10-year anniversary.

Hormonal treatment of breast cancer is effective only in patients whose tumors express estrogen and/or progesterone receptors (ER, PR). Receptor assessment is often not available in low-resource areas, and the choice may be to apply endocrine therapy to all or none of breast cancer patients, depending on the proportion of patients that can be expected to respond. Fifty-one invasive breast cancers from Ghana and 100 from Norway diagnosed in the same laboratory during the same time period were reexamined in a blinded slide review. Of Ghanaian tumors, 76% were ER+ (≥1% ER+ tumor cells). Of Norwegian tumors, 85% were ER+. Triple-negative tumors were seen in 22% of Ghanaian patients and in 7% of Norwegian patients. A review of previous similar studies in sub-Saharan patients shows very discrepant results. Standardization and quality control of receptor assessment and well-designed clinical trials in sub-Saharan African breast cancer patients are needed to give a sound basis for endocrine treatment in this area.

Introduction Androgen Receptor (AR) is the most commonly-expressed nuclear hormone receptor in breast cancer and may be a marker of response to targeted anti-androgen therapy, a particularly attractive option in the setting of triple negative breast cancer (TNBC). Gene expression studies suggest that AR-positivity may distinguish a luminal/AR TNBC subtype from mesenchymal, stem cell-like, and basal-like subtypes. Furthermore, frequency of TNBC is 2–3-times higher in African American and African compared to White American and European breast cancer pts, yet little is known regarding the distribution of TNBC subtypes in the high-risk African-ancestry populations. We sought to characterize AR expression and TNBC patterns among a series of breast cancers from Ghana, Africa. Methods Formalin-fixed, paraffin-embedded invasive breast cancer specimens from 147 pts treated at a single teaching hospital in Ghana were studied at a comprehensive cancer center in the United States and analyzed for estrogen receptor (ER), progesterone receptor (PR), HER2/neu, ALDH1 and AR expression via immunohistochemistry. Results Median patient age was 45 (range, 28–76yrs). Only 31 cases (21%) were ER-positive, and 14 (10%) were HER2-positive; 89 tumors (61%) were TNBC. For the entire group, 44% were AR-positive and 45% were ALDH1-positive. ER/PR-positive tumors were more likely to be AR-positive compared to ER/PR-negative tumors (87% versus 26%; p<0.0001) but there was no association between ALDH1 and AR expression. Among the TNBC cases, 45% were ALDH1-positive and 24% were AR-positive. ALDH1-positivity versus negativity was associated with AR-positivity within the subset of TNBC tumors (36% versus 14%; p=0.019). Conclusions We confirmed the results of others showing that the majority of African breast cancers are triple-negative. We also found that AR expression is lower than that reported in other populations. Surprisingly, a marker of mammary stem cell expression was found to correlate with AR expression among triple negative tumors in this series, suggesting that novel TNBC subtypes may be identified by studying TNBC patterns among more diverse international populations.

Background: In Ghana, information on the prevalence and pattern of Head and Neck Cancers (HNCA) is scarce. There are few publications based on specific sub-sites of the head and neck, however, literature on the prevalence and pattern of HNCA in general is lacking. The present study aimed to describe the pattern of HNCA among patients seen at the multidisciplinary HNCA clinic of Komfo Anokye Teaching Hospital. Methods: This is a retrospective review of all consecutive patient records seen at the multidisciplinary clinic from 2004 to 2009. Results: There were 149 males and 103 females giving a male to female ratio of 1.45:1. The age range was 2-95 years with a mean of 48.1 years. The commonest type of HNCA in this review is cancers of the oral cavity (29.4%), followed by accessory sinuses (13.9%) and larynx (13.5%). Nasopharyngeal cancer affected young people, with 34.5% of affected patients aged between 10 and 19 years. The commonest histopathological type was squamous cell carcinoma (49.6%). Majority (47.6%) of patients presented at stage IV. Conclusion: The commonest HNCA is oral cancer. Majority of patients with HNCA are presenting late calling for public health education to raise awareness and promote early detection.

BackgroundPostpartum haemorrhage (PPH) is the leading cause of maternal deaths, the world over. The aim of this study was to determine laboratory parameters that could serve as risk factors for primary PPH.MethodsThis comparative cohort study involved 350 pregnant women at term who were recruited consecutively from the Komfo Anokye Teaching Hospital, Kumasi, Ghana. PPH was defined as a measured blood loss ≥ 500 ml or enough to cause haemodynamic shock. Basic demographic data was gathered and blood was collected for laboratory assays before delivery. Univariate and multivariate logistic regression models were used to identify variables that were significantly associated with primary PPH.ResultsOf the total recruited study participants (350), five declined to participate and 74 went through caesarean section, episiotomy or instrumental deliveries and were excluded. Of the remaining (271) study participants who went through spontaneous vaginal delivery, fifty five (55) were diagnosed with primary PPH (Group 1) and the remaining 216 were those who did not have PPH (Group 2). Demographic characteristics did not differ between the two groups (P > 0.05). Univariate analysis showed that AST (P = 0.043), urea (P < 0.001), creatinine (P = 0.002), urea-to-creatinine ratio (P = 0.014) and the proportion of abnormal peripheral blood smear (P < 0.001) was higher among women in Group 1 compared to those in Group 2. Women in Group 1 had a significantly lower haemoglobin concentration (10.7 g/dL) compared to those in Group 2 (12.1g/dL). Upon multivariate analysis, an abnormal peripheral blood smear (AOR = 2.9672), Hb, (AOR = 0.5791), moderate to severe anaemia (Hb <10 g/dL) (AOR = 3.1385), Urea (AOR = 3.6435) and intra-renal azotaemia (AOR = 0.1893) remained significant.ConclusionMany laboratory parameters are associated with primary PPH but only a few are independent risk factors. A total clinical work-up including laboratory evaluation of the independent blood variables identified in this study will help a great deal to identify individuals at high risk for PPH.

Breast carcinoma develops gradually through multiple steps, some of which are recognizable as benign or premalignant histological changes. The age-standardized breast-cancer incidence rate is three times higher in Norway than in Ghana. A similar difference in the prevalence of benign and premalignant breast changes in the general populations would be expected if the difference in incidence rates were mainly due to cancer initiation factors, but not if it were caused by later stage promotion and progression factors. Breast tissue was taken by a standardized protocol from the autopsies of 44 Ghanaian and 26 Norwegian women between 15 and 60 years of age. Blind-labelled hematoxylin and eosin stained sections were examined independently by each of the three authors and the occurrence of histological changes in each section was recorded. The study revealed no significant difference between Norwegian and Ghanaian women in the prevalence of either proliferative or non-proliferative breast changes. The recorded incidence of breast cancer in Ghana may be under-estimated because of lower access to health services, lower patient awareness, and absence of population screening for breast cancer. Otherwise, the results support the conclusion that the lower incidence of breast cancer in Ghana than in Norway is mainly due to late-stage promotion and progression rather than initiation factors.

BackgroundHead and neck cancers include carcinomas of the oral cavity, larynx, sinonasal tract and nasopharynx. Studies on molecular expression of prognostic tumour markers in Ghana are scarce. The purpose of this study was to determine the expression of p53, p16, EGFR, Cyclin-D1 and HER2 among patients with non-oropharyngeal head and neck squamous cell carcinoma (HNSCC).MethodologyTissue microarrays from 154 histologically confirmed non-oropharyngeal HNSCC at the Komfo Anokye Teaching Hospital from 2006–2014 were constructed using duplicate cores of representative and viable areas from tumours. Expression of EGFR, p53, p16, Cyclin-D1 and HER2 was evaluated using immunohistochemistry.ResultsFor non-oropharyngeal HNSCC, majority of the cases (66.2%; 102/154) had stage IV disease. EGFR was the most expressed molecular marker (29.4%; 25/85) followed by p53 (24.0%; 29/121), p16 (18.3%; 23/126) and Cyclin-D1 (10.0%; 12/120). HER2 was not expressed in any of the cases. There was a significantly (p = 0.022) higher expression of Cyclin-D1 in tumours of the oral cavity (19.6%; 9/46) than in those of the larynx (4.7%; 2/43) and nose (3.2%; 1/31). Tumours in stages I–III were more frequently positive for p16 (28.6%; 12/42) than tumours in stage IV (13.1%; 11/84).ConclusionExpression of p53, EGFR, p16 and Cyclin-D1 in non-oropharyngeal HNSCC in Ghana is largely similar to what has been reported in published studies from other countries.