Breast Cancer Screening in a Resource Poor Setting: A Preliminary Report

Background: Breast cancer is a leading cause of death among Nigerian women. Patients typically present late with advanced and aggressive diseases from a younger age. Cure for breast cancer is only possible when the disease is discovered early and breast cancer screening greatly increases the chances of early detection. We present the results of a breast cancer screening program at the Taimako Breast and Cervical Cancer Screening Centre; Lafia; Nigeria. Methodology: This is a prospective study of subjects who presented to our breast cancer screening centre between May 2009 and April 2010. A community mobilization and awareness campaign was mounted 3 months before screening began. A structured questionnaire was administered on each subject to elicit demographic data and risk factors. Each had a clinical breast examination. Those 35 years and above had a mammography while those below 35 years had breast ultrasound scan. Where a lump was discovered; it was subjected to tissue biopsy and histology. Results: Two thousand and ninety five subjects were seen over the one year period. Mean age was 34 + 12 years. Mean age at menarche was at 14.3 + 1.7 years; mean parity was 3.6 +2.6. Two thousand and thirty six subjects (97.2) had some knowledge about breast cancer; 1;269 (60.5) had no formal education; 881(42.1) were petty traders while 501(23.9) were full time housewives. Four hundred and seventy (22.4) had a positive family history of breast disease; 437 (20.9) had history of use of oral contraceptives; and 9 (0.4) had a previous breast biopsy. Four hundred and sixty one (22.0) complained of breast discomfort; 184 (8.8) complained of breast lumps; but only 95 (4.6) of them had lump on clinical breast examination; while a further 8 (0.4) lumps were found on breast imaging. One thousand nine hundred (90.7) had normal breast screening results; 166 (7.9) had benign breast diseases and 29 (1.4) had breast cancer. Conclusion: Knowledge about breast cancer was high because of prior campaigns and should be encouraged. Proportion of subjects with breast cancer is low even though many complained of breast lumps on presentation. Majority of the lumps were found at clinical breast examination while mammogram had a very low yield. A treatment arm needs to be incorporated into the screening program to demonstrate survival benefit

Breast Cancer Screening in a Resource Poor Setting: A Preliminary Report

Background: Breast cancer is a leading cause of death among Nigerian women. Patients typically present late with advanced and aggressive diseases from a younger age. Cure for breast cancer is only possible when the disease is discovered early and breast cancer screening greatly increases the chances of early detection. We present the results of a breast cancer screening program at the Taimako Breast and Cervical Cancer Screening Centre; Lafia; Nigeria. Methodology: This is a prospective study of subjects who presented to our breast cancer screening centre between May 2009 and April 2010. A community mobilization and awareness campaign was mounted 3 months before screening began. A structured questionnaire was administered on each subject to elicit demographic data and risk factors. Each had a clinical breast examination. Those 35 years and above had a mammography while those below 35 years had breast ultrasound scan. Where a lump was discovered; it was subjected to tissue biopsy and histology. Results: Two thousand and ninety five subjects were seen over the one year period. Mean age was 34 + 12 years. Mean age at menarche was at 14.3 + 1.7 years; mean parity was 3.6 +2.6. Two thousand and thirty six subjects (97.2) had some knowledge about breast cancer; 1;269 (60.5) had no formal education; 881(42.1) were petty traders while 501(23.9) were full time housewives. Four hundred and seventy (22.4) had a positive family history of breast disease; 437 (20.9) had history of use of oral contraceptives; and 9 (0.4) had a previous breast biopsy. Four hundred and sixty one (22.0) complained of breast discomfort; 184 (8.8) complained of breast lumps; but only 95 (4.6) of them had lump on clinical breast examination; while a further 8 (0.4) lumps were found on breast imaging. One thousand nine hundred (90.7) had normal breast screening results; 166 (7.9) had benign breast diseases and 29 (1.4) had breast cancer. Conclusion: Knowledge about breast cancer was high because of prior campaigns and should be encouraged. Proportion of subjects with breast cancer is low even though many complained of breast lumps on presentation. Majority of the lumps were found at clinical breast examination while mammogram had a very low yield. A treatment arm needs to be incorporated into the screening program to demonstrate survival benefit

Prognostic factors in typhoid ileal perforation: a prospective study of 53 cases.

BACKGROUND: Typhoid ileal perforation remains a serious complication of typhoid enteritis with high morbidity and mortality in many tropical countries. AIMS AND OBJECTIVES: To determine the prognostic factors in typhoid perforation in Kano, Nigeria. METHODOLOGY: Fifty-three consecutive patients with typhoid perforation managed surgically were prospectively studied at the general surgical unit of Aminu Kano Teaching Hospital Kano, from March 2004 to February 2006. RESULTS: There were 26 (49.1%) males and 27 (50.9%) females, with age range of 2-55 years and a mean +/- SD of 12.2 +/- 10.2 years. The morbidity was 49.1% and the most common postoperative complications included wound infection, wound dehiscence, burst abdomen, residual intra-abdominal abscesses and enterocutaneous fistula. Mortality was 15.1% and was significantly affected by multiple perforations, severe peritoneal contamination and burst abdomen (p value <0.05, odds ratio >1). The mean duration of hospital stay for survivors was 16.1 days with a range of 8-57 days. CONCLUSION: This study has attempted to determine the factors that statistically influence mortality in typhoid perforation in our environment.

Experience with surgical internal drainage of pancreatic pseudocyst.

BACKGROUND: Pancreatic pseudocyst is an uncommon disorder in Nigeria compared with the Caucasian population. OBJECTIVE: This study was carried out to determine the pattern and outcome of surgical management of the disease in a Nigerian population. METHODS: The authors reviewed the records of 10 consecutive patients with pancreatic pseudocysts who were surgically managed in Aminu Kano Teaching Hospital, Kano, Nigeria, from November 1998 to October 2005. RESULTS: There were four males and six females, with a mean age of 19.2 years. The etiological factors included idiopathic acute pancreatitis in a two-year old child and blunt abdominal trauma in two patients. In seven patients, the cause could not be determined. The most common clinical features included epigastric pain, fever, intra-abdominal mass and vomiting. The duration of symptoms ranged from 15-204 days (mean=102 days). Open cystogastrostomy was done in eight patients, and two patients had cystoduodenostomy. The mean duration of hospital stay after surgery was 9.4 days (range = 7-15 days). There was no recurrence in any of the patients after about 3-9 months of follow-up with ultrasonography, and no death was recorded. CONCLUSION: Open surgical internal drainage is safe and effective with low morbidity and mortality. There is a need for provision of facilities for minimally invasive laparoscopic and endoscopic techniques.