Population-Level Access to Breast Cancer Early Detection and Diagnosis in Nigeria.

PURPOSE: Mammography, breast ultrasound (US), and US-guided breast biopsy are essential services for breast cancer early detection and diagnosis. This study undertook a comprehensive evaluation to determine population-level access to these services for breast cancer early detection and diagnosis in Nigeria using a previously validated geographic information system (GIS) model. METHODS: A comprehensive list of public and private facilities offering mammography, breast US, and US-guided breast biopsy was compiled using publicly available facility data and a survey administered nationally to Nigerian radiologists. All facilities were geolocated. A cost-distance model using open-source population density (GeoData Institute) and road network data (OpenStreetMap) was used to estimate population-level travel time to the nearest facility for mammography, breast US, and US-guided biopsy using GIS software (ArcMAP). RESULTS: In total, 1,336 facilities in Nigeria provide breast US, of which 47.8% (639 of 1,336) are public facilities, and 218 provide mammography, of which 45.4% (99 of 218) are public facilities. Of the facilities that provide breast US, only 2.5% (33 of 1,336) also provide US-guided breast biopsy. At the national level, 83.1% have access to either US or mammography and 61.7% have access to US-guided breast biopsy within 120 minutes of a continuous one-way travel. There are differences in access to mammography (64.8% v 80.6% with access at 120 minutes) and US-guided breast biopsy (49.0% v 77.1% with access at 120 minutes) between the northern and southern Nigeria and between geopolitical zones. CONCLUSION: To our knowledge, this is the first comprehensive evaluation of breast cancer detection and diagnostic services in Nigeria, which demonstrates geospatial inequalities in access to mammography and US-guided biopsy. Targeted investment is needed to improve access to these essential cancer care services in the northern region and the North East geopolitical zone.

Knowledge, attitudes and practice of breast cancer screening among female health workers in a Nigerian urban city.

BACKGROUND: Late presentation has been observed as the hallmark of breast cancer in Nigerian women and an earlier onset has been reported in this population. This study was designed to assess the awareness of female health workers about risk factors and screening methods for early detection of breast cancer. METHODS: A cross-sectional descriptive study was carried out among female health workers in the two major government health institutions in Benin City, Edo State capital in Nigeria.Data analysis was by SPSS version 10 and test of significance was done with differences considered significant at p < 0.05. RESULTS: Three hundred and ninety-three (393) female health workers out of five hundred and five eligible subjects completed and returned the questionnaires, giving a response rate of 77.8%. One hundred and two (26%) were Doctors, two hundred and fifty-four (64.6%) Nurses, and thirty-seven (9.4%) were Radiographers, Laboratory Scientists and Pharmacists. A high proportion of our respondents had very poor knowledge about risk factors for breast cancer (55%). The awareness of mammography as a diagnostic method was very high (80.7%), but an extremely low knowledge of mammography as a screening method was found. Mammography practice of only 3.1% was found among those above 40 years of age who qualify for routine annual screening. Relatively low knowledge (45.5%) about Breast Self Examination (BSE) as a screening method was found. CONCLUSION: These female health workers who are expected to act as role models and educate the public had poor knowledge of risk factors for breast cancer and practice of breast cancer screening. There is very urgent need for regular update courses for health workers concerning breast cancer education including screening methods.

Ultrasound reference values for inferior vena cava diameter and collapsibility index among adult Nigerians

Background: Correct estimation of intravascular volume is crucial in critically ill and traumatized patients. Measurement of the central venous pressure (CVP) is invasive and time consuming. Studies have shown that inferior vena cava diameter (IVCD) correlates with CVP. Sonographic assessment of IVCD and its respirophasic changes (collapsibility index; CI) is a non-invasive, quick and reliable means of estimating CVP and hence, intravascular fluid volume. Data on such studies are scanty among adult Nigerians. Aim: To establish normograms of IVCD and CI for healthy adults in Benin City, Nigeria as well as determine the relationship of IVCD and CI with height, weight, body mass index (BMI), age and gender. Method: Four hundred apparently healthy adult volunteers were prospectively studied by means of ultrasound. Demographic data and BMI were obtained. The IVCD was measured during inspiration, expiration and sniff. The CI was subsequently calculated for each subject. Statistical Package for the Social Sciences (SPSS) version 17.0 was used for data analysis including tests of significance. Probability values less than or equal to 0.05 were considered significant. Results: The mean IVCD in this study was 6.1±2.2mm and 13.0±4.0 mm for inspiration and expiration respectively. The mean CI was 49.7±0.5%. There was no statistically significant correlation between IVCD and CI with height and BMI. Conclusion: This study has determined normal IVCD and CI reference range for healthy Nigerian adults. The CI is independent of height, weight, BMI and gender. Since the CI is not dependent on physical attributes and gender, it may serve as an objective tool for monitoring the fluid status of patient