Contemporary management of breast cancer in Nigeria: Insights from an institutional database

Abstract

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.

The iBreastExam versus clinical breast examination for breast evaluation in high risk and symptomatic Nigerian women: a prospective study

“…Given that 80% of breast cancers in Nigeria present as stage 3 or 4, and the mean breast tumour size at presentation to the OAUTHC is 10•5 cm, 28…”

Female breast cancer in sub‐Saharan Africa: A PRISMA‐S‐compliant systematic review of surgery

“…The “FBC surgical excision or reconstructive” studies reported mastectomy or MRM and reconstructive or conserving procedures and involved 2779 FBC patients (median age: 48 years) (Table 2). Two studies 17,18 reporting one case of lumpectomy each were set in Table 1 of the “FBC surgical excision only” group.…”

“…Of the four retrospective studies, two reported the 5‐year overall and metastasis‐free survival 19,20 . Stage status and histology data were reported and specified in seven; 17–23 among these, five studies reported hormonal status 17–21 . Only one study registered the status of the nodes, 19 and only one another mentioned the axillary dissection 20 .…”

“…Two studies missed data about the type of surgery 17,22 ; in the remaining five studies, MRM was the most frequent surgical procedure. Only one study missed data about CT, 24 and hormonal therapy (HT) was reported in five studies 18–22 . RT data were present in four studies 18,20–22 .…”

“…Only one study missed data about CT, 24 and hormonal therapy (HT) was reported in five studies 18–22 . RT data were present in four studies 18,20–22 . Simple or MRM was reported in 2683/4121 (65%).…”