Breast Carcinoma in Northern Nigeria

Abstract

Breast carcinoma continues to pose a worldwide problem with respect to both early detection and effective therapy, but the magnitude of the problem varies from one geographical setting to another [1]. Jos University Teaching Hospital, a 515-bed hospital connected with Nigerian University, has an annual admission rate of 50,310 patients, serves a population of well over 14 million people, and is one of the tertiary centres for treatment of malignant lesions in the country. Patients are referred both from the Government General Hospital and from private clinics.From January 1979 to December 1984 there were 78 new referrals with histologically proven breast carcinoma, for an average of 13 new cases a year. The mean age at presentation was 43 years (range, 20 to 68 years). Most of the patients (88.7%) were married. Parous patients constituted 90.2%, with 73.2% having had more than three issues. All parous patients had at one time or other breastfed their infants; the average duration of suckling was 9 months, 2 days.Family history of breast cancer was an uncommon observation and was noted in only 2.8% of the cases. The duration of history before presentation ranged from 2 months to 10 years (mean, 1 year and 3 months), showing that most patients from this part of the world present very late. In this series, 60.6% of the patients were in Manchester Stages III and IV at presentation. In the same vein, 81.4% of the patients showed axillary node involvement. This contrasts with 40% observed for white Americans and 36.59% observed for black Americans [2]. However, in a series reported from Jordan, axillary node involvement was observed in 74.6%.Female breast cancer generally occurs earlier in the Nigerian population; age range in our study was 25 to 55 years while that reported in the Western literature was 35 to 55 years (Figure 1.) In this study the correct ages of only 64 patients could be ascertained. A recent report from South Eastern State of Nigeria cites an at risk age of 25 to 50 years [4].Surgery still remains the mainstay of treatment in our environment. Radiotherapy is not yet readily available in all centres. Hormonal manipulation in the form of oophorectomy is used for pre-menopausal patients, with tamoxifen administered to patients in all age groups. Combination chemotherapy is used in advanced cases. Our crude three-year survival figure is 20.9%, with a five-year survival of 12.5%. These rates undoubtedly reflect the advanced disease state that exists in our patients.Because of multiparity and habitual breastfeeding, women in this geographical region are prone to ignore breast disease.Unfortunately women in our society first seek care from traditional healers before attending hospital, by which time the disease is advanced. Eventually, all patients end up at the hospital. Given that parity, lactation, and early age at first pregnancy are a few of the generally accepted determinants and are relatively common in our population of women, it can be argued that the low incidence of breast cancer in our environ...