Determinants of late detection and advanced-stage diagnosis of breast cancer in Nigeria.

OBJECTIVE: To describe the risk factors for late detection and advanced-stage diagnosis among patients who detected their BC early. METHOD: Using secondary data, we analyzed the impact of socio-demographic factors, premorbid experience, BC knowledge, and health-seeking pattern on the risk of late detection and advanced-stage diagnosis after early BC detection. Test of statistical significance in SPSS and EasyR was set at 5% using Sign-test, chi-square tests (of independence and goodness of fit), odds ratio, or risk ratio as appropriate. RESULT: Most socio-demographic factors did not affect detection size or risk of disease progression in the 405 records analyzed. High BC knowledge, p-value = 0.001, and practicing breast self-examination (BSE) increased early detection, p-value = 0.04, with a higher probability (OR 1.6 (95% CI 1.1-2.5) of detecting <2cm lesions. Visiting alternative care (RR 1.5(95% CI 1.2-1.9), low BC knowledge (RR 1.3(95% CI 1.1-1.9), and registering concerns for hospital care increased the risk of advanced-stage diagnosis after early detection (64% (95% CI 55-72)). Adhering to the monthly BSE schedule reduced the risk of advanced-stage diagnosis by -25% (95% CI -49, -1.1) in the presence of socioeconomic barriers. CONCLUSION: Strategies to increase BC knowledge and BSE may help BC downstaging, especially among women with common barriers to early diagnosis.

Determinants of Delayed Presentation and Advanced-Stage Diagnosis of Breast Cancer in Africa: A Systematic Review and Meta-Analysis.

BACKGROUND/OBJECTIVE: Breast cancer (BC) mortality is exceptionally high in Africa due to late presentation and advanced-stage diagnosis. Previous studies examining barriers to early BC presentation are markedly inconsistent, showing conflicting findings within and between African regions, making resource allocation and designing interventional campaigns challenging. Our objective was to assess the strength or magnitude of the association between determinants/risk factors and delayed presentation/advanced-stage diagnosis of BC in Africa. METHODS: Electronic searches in PubMed, AJOL, Google, ResearchGate, ScienceDirect, and PubMed Central found eligible articles between 2000 and 2020. The meta-analytical procedure in Meta-XL used the quality effect model. I-squared (I2) above 75% indicated high heterogeneity. The summary effect size was the odds ratio with 95% confidence intervals. RESULTS: The effect of socio-economic and demographic determinants on delay varies across African regions. Low level of education (1.63, 95% CI 1.01-2.63), and not performing breast self examination (BSE) (13.59, 95% CI 3.33-55.4) were significantly associated with delayed presentation. Younger patients had more significant delays in West Africa (WA, 1.41, 95%CI 1.08-1.85), and the reverse occurred in North Africa (0.68, 95%CI 0.48-0.97). Lack of BC knowledge (1.59, 95% CI 1.29-1.97), not performing BSE, or no history of undergoing clinical breast examination (CBE) (2.45, 95% CI 1.60-3.40), were associated with advanced-stage disease at diagnosis. Older patients had significantly more advanced disease in WA, and the reverse occurred in South Africa. Aggressive molecular BC subtypes [Triple negative (OR 1.62, 95% CI 1.27-2.06) or HER2 positive (1.56, 95% CI 1.10-2.23)] were significant determinants of advanced-stage diagnosis. CONCLUSION: Promoting early presentation and reducing advanced-stage BC throughout Africa should focus on modifiable factors, including providing quality education, improving breast health awareness and BC knowledge, and developing strategies to increase BSE and CBE. Interventions targeting socio-demographic determinants should be context-specific.

Presentation intervals and the impact of delay on breast cancer progression in a black African population.

BACKGROUND: The help-seeking interval and primary-care interval are points of delays in breast cancer presentation. To inform future intervention targeting early diagnosis of breast cancer, we described the contribution of each interval to the delay and the impact of delay on tumor progression. METHOD: We conducted a multicentered survey from June 2017 to May 2018 hypothesizing that most patients visited the first healthcare provider within 60 days of tumor detection. Inferential statistics were by t-test, chi-square test, and Wilcoxon-Signed Rank test at p-value 0.05 or 95% confidence limits. Time-to-event was by survival method. Multivariate analysis was by logistic regression. RESULTS: Respondents were females between 24 and 95 years (n = 420). Most respondents visited FHP within 60 days of detecting symptoms (230 (60, 95% CI 53-63). Most had long primary-care (237 of 377 (64 95% CI 59-68) and detection-to-specialist (293 (73% (95% CI 68-77)) intervals. The primary care interval (median 106 days, IQR 13-337) was longer than the help-seeking interval (median 42 days, IQR 7-150) Wilcoxon signed-rank test p = 0.001. There was a strong correlation between the length of primary care interval and the detection-to-specialist interval (r = 0.9, 95% CI 0.88-0.92). Patronizing the hospital, receiving the correct advice, and having a big tumor (> 5 cm) were associated with short intervals. Tumors were detected early, but most became advanced before arriving at the specialist clinic. The difference in tumor size between detection and arriving at a specialist clinic was 5.0 ± 4.9 cm (95% CI 4.0-5.0). The hazard of progressing from early to locally advanced disease was least in the first 30 days (3%). The hazard was 31% in 90 days. CONCLUSION: Most respondents presented early to the first healthcare provider, but most arrived late at a specialist clinic. The primary care interval was longer than the help-seeking interval. Most tumors were early at detection but locally advanced before arriving in a specialist clinic. Interventions aiming to shorten the primary care interval will have the most impact on time to breast cancer presentation for specialist oncology care in Nigeria.

Prevalence of Themes Linked to Delayed Presentation of Breast Cancer in Africa: A Meta-Analysis of Patient-Reported Studies.

PURPOSE: The prevalence of themes linked to delay in presentation of breast cancer (BC) and their underlying factors vary considerably throughout Africa. Regional differences and trends are largely unreported. The purpose of this research was to provide summary estimates of the prevalence and distribution of the themes and underlying factors linked to delay in the presentation of BC, regional variation, and trends in an effort to identify targets for intervention. DESIGN: We screened articles found through PubMed/Medline, African Journal OnLine, Science Direct, Google/Google Scholar, and ResearchGate. We included patient-reported surveys on the reasons linked to delayed presentation under 6 previously identified themes: symptom misinterpretation, fear, preference for alternative care, social influence, hospital-related factors, and access factors. The meta-analytical procedure in MetaXL used the quality-effect model. RESULTS: Twelve of the 236 identified articles were eligible for this review. The overall summary estimate of late presentation (> 90 days) was 54% (95% CI, 23 to 85) and was worst in the eastern and central regions. Symptom misinterpretation was the most common theme (50%; 95% CI, 21 to 56), followed by fear (17%; 95% CI, 3 to 27), hospital-related theme (11%; 95% CI, 1 to 21), preference for alternative care (10%; 95% CI, 0 to 21), social influence (7%; 95% CI, 0 to 14), and access-related theme (6%; 95% CI, 0 to 13). The most common factor underlying symptom misinterpretation was mischaracterizing the breast lesion as benign (60%; 95% CI, 4 to 100) which surpassed lack of awareness in the last decade. Misdiagnosis and failure to refer were the dominant hospital-related factors. CONCLUSION: Modifiable factors such as mischaracterizing malignant masses as benign, fear, misdiagnosis, and failure to refer were the prevalent factors contributing to delays throughout Africa. These factors are promising targets for intervention.

An observation of umbilical coiling index in a low risk population in Nigeria.

OBJECTIVES: The umbilical coiling index (UCI) is one of cord parameters for foetal assessment with limited studies in our environment. With recent advances in its evaluation, its significance, pattern, abnormalities and correlates need to be defined in our parturients. METHODS: The umbilical cords of 436 neonates were examined. Gross examination was done within 5 min of delivery. The UCI was defined as the number of complete coils per centimetre of cord. Normal UCI was defined as values between the 10th and 90th percentiles of the study population. RESULTS: The mean umbilical cord length was 52.7±11.5 cm, mean number of coils was 10.8±5.1 and mean UCI was 0.21±0.099. The range was between 0.0 and 1.0. UCI values of 0.13 and 0.30 were 10th and 90th percentiles, respectively. Normal UCI was observed in 351 (80.5%) neonates, 44 (10.4%) and 41 (9.1%) had hypo- and hypercoiled cords, respectively. Congenital abnormalities occurred in the normocoiled and hypercoiled groups but was not demonstrated in the hypocoiled group. The mean value of UCI in neonates with congenital abnormalities was 0.29±0.12 (P=0.011). There was no significant statistical relationship between foetal outcome and degree of UCI. CONCLUSION: The UCI was not associated with adverse perinatal outcome in this study.

Mammographic Parenchymal Patterns in Asymptomatic Women.

BACKGROUND: Breast density has been found to be an independent risk factor for breast cancer. Mammographic breast parenchymal pattern or percent density is mainly a reflection of the proportion of glandular tissue to fatty tissue, and studies have shown that it works synergistically with other risk factors such as nulliparity in predicting breast cancer risk. This study analyses the various mammographic breast patterns and correlates this with some demographic variables and final Breast Imaging Reporting and Data System outcomes of asymptomatic women in our center. MATERIALS AND METHODS: This is a prospective descriptive study of mammographic breast pattern in 459 females who presented at the breast imaging suite of our institution. Mammography was performed after completion of an assisted administered questionnaire for demographic information. A GE Senographe DMR machine using two standard views (craniocaudal and mediolateral oblique) and additional views were used when necessary. RESULTS: A total of 459 women ranging in age from 34 to 80 years were included in the study, of which 46.6% were in the age range of 41 to 50 years. The scattered fibroglandular pattern was the most common pattern found (44%), and the homogeneous dense pattern was the least common (0.4%). A significant association with age and menopause status was found, while no association was found with age at the time of the woman's first delivery and family history of breast cancer. CONCLUSION: This study demonstrates that there is a significant association between breast cancer and age and menopause status. However, no correlation was found with the age of women at their first delivery and family history of breast cancer.

Relationship between gross placental characteristics and perinatal outcome of low-risk singleton deliveries.

BACKGROUND: Gross examination of the placenta may provide useful insight into the aetiology of newborn and maternal complications. A review of literature revealed only a few epidemiological studies that determined the relationships between placental abnormalities, gestational age and occurrence of adverse outcome in babies of healthy pregnant women in our region. PATIENTS AND METHODS: A prospective cross-sectional study was conducted at the Department of Obstetrics and Gynecology of University of Ilorin Teaching Hospital, between 1 st February and August 2013. Pregnant women in labour at ≥28 weeks' gestational age with singleton pregnancies were recruited. Gross examination of the placenta and umbilical cord after delivery were performed. RESULTS: Four hundred and twenty-eight singleton deliveries were studied. The average placental weight was 580.8 ± 130.6 g (range = 125-1500 g). The mean values of the umbilical cord length and width were 52.7 ± 10.5 cm and 1.96 ± 1.11 cm, respectively. Placental abnormalities occurred in 1.2%. The umbilical cord was centrally inserted in 290 (67.8%), marginally in 31% of cases. There was significant but weak positive correlation between the placental weight, birth weight and gestational age at 40 weeks (P ≤ 0.001, r = 0.356). Placental weight was directly related to birth weight (P < 0.0001, r = 0.244) and greater in babies with congenital abnormalities (P = 0.002). CONCLUSIONS: There was an association between placental parameters and foetal outcome at birth. Placental weight was positively correlated with birth weight, gestational age and occurrence of congenital abnormalities.

A five year audit of mammography in a tertiary hospital, North Central Nigeria.

BACKGROUND: Breast imaging plays a vital role in the multidisciplinary approach to management of breast disease. A baseline data is apt and necessary for collaborative studies. MATERIALS AND METHODS: This is a prospective descriptive study carried out between January 2009 and December 2013 at our institution. Patients who had breast imaging were recruited into the study. Film-screen mammograms were acquired with a General Electric (GE) Senographe DMR machine. Breast ultrasound done using an Aloka Prosound SSD-350+ ultrasound machine equipped with linear and curvilinear 7.5-10 MHz transducer. Findings were categorized using the ACR-BIRADS (American college of Radiologists-Breast imaging reporting and data system). Data was collated and analysed using social statistical package (SPSS) version 17. RESULT: The mammograms of 824 patients were evaluated during this study period. Their age ranged from 40-85 years with a mean age of 50.9 ± 8.1 years. Eight hundred and sixteen (99%) were females and eight (1%) were males. The commonest clinical indication was breast lump (23.9%). The commonest density pattern was BIRADS 2-scattered fibroglandular pattern (43.9%). Mammograms were normal in 266 (32.3%) and positive in 558 (67.7%). The final BIRADS assessment showed BIRADS 0, 1, 2, 3, 4, 5 and 6 constituted 6.6%, 30.1%, 29.7%, 22.2%, 5.9%, 5.0% and 0.5% respectively. CONCLUSION: The level of awareness of breast cancer is quite high with the positive mammographic yield emphasizing the value of a multidisciplinary approach in the management of breast diseases.

Neuroimaging of young adults with stroke in Ilorin Nigeria.

BACKGROUND: Stroke in young adults is relatively uncommon. Computed tomography (CT) and magnetic resonance imaging (MRI) are the most valuable tools for the diagnosis of stroke. Recent data on stroke in young adults in Nigeria is sparse. The aim of this study is to document the imaging pattern in young patients aged 15-45 years with suspected cerebrovascular accidents (CVA) in the Nigerian environment. MATERIALS AND METHODS: This was a retrospective study of 69 patients aged 15-45 years, with clinical diagnosis of stroke, referred for neuro-imaging, from October 2008 to November 2013. All patients with the clinical diagnosis of stroke within this age group were recruited into the study. Images were obtained from a four slice channel general electric CT machine and a 0.2 Tesla Siemens Magnetom Concerto MRI scanner. RESULTS: A total of 69 patients (44 males and 25 females) were studied. Sixty out of 69 (87.0%) patients were accurately diagnosed with CVA, with 9 (13.0) cases of misdiagnoses. A total of 21 (35%) out of the 60 cases confirmed on imaging had intracerebral hemorrhage (ICH), 10 (16.7%) had subarachnoid hemorrhage (SAH) and 29 (48.3%) had cerebral infarct (CI). Hypertension was the common risk factor for all stroke subtypes. The most common location for ICH, was the basal ganglia in 8 (38.8%), while the commonest pattern for CI, was lacunar infarct in the basal ganglia (51.7%). CONCLUSION: The incidence of hemorrhagic CVA (ICH and SAH combined) was slightly higher than ischemic CVA in this study. Lacunar infarcts in the basal ganglia and also ICH in the basal ganglia were the most common patterns, both are strongly linked to hypertension. A diagnostic protocol of stroke in young adults, to include neuroimaging and other ancillary investigations is advocated for stroke in young adults as some of the etiologies are treatable.

Ultrasound evaluation of brain infections and its complications in Nigerian infants.

Infantile meningitis is a clinical diagnosis. However, suspicion of its complications may warrant further investigations; and transfrontanelle ultrasound is a reliable and cheap way to evaluate the usefulness of ultrasonography in diagnosing the complications of infantile meningitis. This is a retrospective study of the transfrontanelle ultrasound findings in 40 infants presenting with clinical indicators of complicated acute bacterial meningitis. There were 20 boys and 20 girls aged 5-115 days (mean, 42.6+/-30.1 days). The complications of meningitis detectable on ultrasound were: hydrocephalus (21[52.5%]); cerebral abscess (2[5%]); subdural empyema (2 [5%]); and ventriculitis (3[7.5%]). Twelve babies (30%) had no abnormal findings. Hydrocephalus is the most common complication of meningitis in our setting. Transfontanelle ultrasound proved to be very reliable in the initial diagnosis and follow-up of complicated meningitis.