There is little information on breast cancer (BC) survival in Ethiopia and other parts of sub-Saharan Africa. Our study estimated cumulative probabilities of distant metastasis-free survival (MFS) in patients at Addis Ababa (AA) University Radiotherapy Center, the only public oncologic institution in Ethiopia. We analyzed 1,070 females with BC stage 1-3 seen in [2005][2006][2007][2008][2009][2010]. Patients underwent regular follow-up; estrogen receptor-positive and -unknown patients received free endocrine treatment (an independent project funded by AstraZeneca Ltd. and facilitated by the Axios Foundation). The primary endpoint was distant metastasis. Sensitivity analysis (worst-case scenario) assumed that patients with incomplete follow-up had events 3 months after the last appointment. The median age was 43.0 (20-88) years. The median tumor size was 4.96 cm [standard deviation (SD) 2.81 cm; n 5 709 information available]. Stages 1, 2 and 3 represented 4, 25 and 71%, respectively (n 5 644). Ductal carcinoma predominated (79.2%, n 5 1,070) as well as grade 2 tumors (57%, n 5 509). Median follow-up was 23.1 (0-65.6) months, during which 285 women developed metastases. MFS after 2 years was 74% (69-79%), declining to 59% (53-64%) in the worst-case scenario. Patients with early stage (1-2) showed better MFS than patients with stage 3 (85 and 66%, respectively). The 5-year MFS was 72% for stages 1 and 2 and 33% for stage 3. We present a first overview on MFS in a large cohort of female BC patients (1,070 patients) from sub-Saharan Africa. Young age and advanced stage were associated with poor outcome.

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580 Background: There is little information on breast cancer (BC) patients (pts) receiving standardized treatment in Sub-Saharan Africa. This study evaluates pts presenting 2005-10 at the University Radiotherapy Center in Addis Ababa, the only institution in the country offering standardized radiotherapy, systemic therapy and free endocrine treatment (ET) during that time. Methods: All pts with histologically verified BC were included. Ethical approval was obtained. Axios/AstraZenaca provided free ET. Therefore, the majority of pts underwent regular follow-up (FUP). We analyzed survival at 18 months by means of Kaplan-Meier survival analysis. We assumed right-censoring to be unrelated to the risk of metastasis. In a worst case sensitivity analysis, we considered all censored pts developing metastasis. Results: Pts with primary diagnosis between July 1st, 2005 and December 31st, 2010 were included (n=1303). The majority of pts were female (95.2%), most (52.3%) postmenopausal. Mean age was 44.1yrs (20-88yrs). Stages 1-4 presented in 3/19/53/25% respectively (36% unknown). Grade 2 tumors were seen in 434 out of 574 pts (58%). Estrogen receptor was pos. in 251 out of 381 pts (66%). Most M0-pts (n=942) underwent surgery (84%), received chemotherapy (59%), and received ET (63%). Median FUP was 18.4 months, 186 events (metastases) occurred. Metastasis-free survival (MFS) was 86%. Worst case analysis on censored observations revealed that MFS declined down to 52%. Pts with early stage 1/2 showed a better MFS than pts with stage 3 disease (93 to 77%). Surgery (no surgery 78% vs surgery 87%) and ET (79% vs 89%) improved MFS. The 5-year MFS for stage 1/2 was 78% and stage 3 was 38%. Conclusions: To our knowledge this is the first presentation of clinical features in 1300 pts with BC in Sub-Saharan Africa. Most pts in Addis Ababa (AA) are <45yrs and present at stage 3/4. Differences to 5-year MFS from Europe stage 1/2 around 90% (AA 78%) and stage 3 around 70% (AA 38%) are smaller in pts treated with surgery and ET. This data is consistent with overall survival in a treated pt cohort from Uganda stage 1/2: 74% and stage 3/4: 39% (n=285) (Gakwaya Brit J Cancer 2008). Policies should focus on earlier presentation and access to care.

Zusammenfassung Statistische Berechnungen an nach Altersgruppen geordneten absoluten Lymphozytenwerten von Schafen leukosefreier Herden führten zu einem objektiven Beurteilungsschema für die Feststellung von Tieren mit krankhaft erhöhten Lymphozytenwerten. Legt man dieses Schema zugrunde, so ergibt sich, daß bei Schafen einer leukoseverseuchten Herde persistierende Lymphozytosen als Ausdruck einer Leukoseerkrankung regelmäßig diagnostizierbar waren. Auf Grund unserer bisherigen Untersuchungen wird unter praktischen Bedingungen folgender hämatologischer Leukoseschlüssel empfohlen: 1. Lebensjahr < 10 000 10–13 000 > 13 000 2.–4. < 8 000 8– 9 000 > 9 000 5. und mehr < 7 000 7– 8 000 > 8 000 Liegen die Lymphozytenwerte bei einem Schaf über einen längeren Zeitraum persistierend im mäßig oder stark erhöhten Bereich, so kann dies als Hinweis auf eine Leukoseerkrankung interpretiert werden. Summary Studies on the normal and leucotic white cell picture in sheep Statistical analysis of the absolute lymphocyte values in sheep from leucosis‐free flocks, the animals being arranged in age groups, resulted in an objective classification suitable for assessing animals with pathologically raised lymphocyte counts. Taking this scheme as a basis, the results show that sheep in a leucosis‐infected flock could readily be detected as having a persistent leucocytosis as an expression of the disease. On the basis of the authors' earlier findings the following haematological key for leucosis is recommended as a practical one: 1. year < 10,000 10–13,000 > 13,000 2.–4. < 8,000 8– 9,000 > 9,000 5. and more < 7,000 7– 8,000 > 8,000 If the lymphocyte value in a sheep is persistently moderately or markedly high over a long period this can be interpreted as due to leucosis. The actual values for normal counts and for moderate or marked elevation are given for sheep of three age groups — one year, 2–4 years and 5 years and over. Résumé Formule leucocytaire chez des moutons normaux et atteints de leucose Des calculs statistiqeus par groupes d'âge sur les valeurs lymphocytaires absolues chez des moutons de troupeaux exempts de leucose ont permis d'établir un schéma objectif pour juger les animaux ayant des valeurs lymphocytaires augmentées. En prenant ce schéma pour base, on a constaté que les lymphocytoses persistantes chez des moutons d'un troupeau ayant la leucose étaient l'expression d'une leucose rógulièrement diagnostiquée. Etant données nos recherches, on peut recommander de manière pratique les valeurs hématologiques suivantes: Age normal élevé fortement élevé 1 an < 10 000 10–13 000 > 13 000 2–4 ans < 8 000 8– 9 000 > 9 000 5 ans et plus < 7 000 7– 8 000 > 8 000 Si les valeurs lymphocytaires persistent durant un certain temps dans des données fortement élevées, on peut interpréter cela comme une indication de leucose. Resumen Estudios sobre el cuadro hematológico blanco normal y el leucótico en ovejas Los cálculos estadísticos llevados a cabo con valores linfocíticos, ordenados con arreglo a los grupos de edad, de ovejas de rabaños libres...