Breast cancer survival in Ethiopia: a cohort study of 1,070 women.

There is little information on breast cancer (BC) survival in Ethiopia and other parts of sub-Saharan Africa. Our study estimated cumulative probabilities of distant metastasis-free survival (MFS) in patients at Addis Ababa (AA) University Radiotherapy Center, the only public oncologic institution in Ethiopia. We analyzed 1,070 females with BC stage 1-3 seen in 2005-2010. Patients underwent regular follow-up; estrogen receptor-positive and -unknown patients received free endocrine treatment (an independent project funded by AstraZeneca Ltd. and facilitated by the Axios Foundation). The primary endpoint was distant metastasis. Sensitivity analysis (worst-case scenario) assumed that patients with incomplete follow-up had events 3 months after the last appointment. The median age was 43.0 (20-88) years. The median tumor size was 4.96 cm [standard deviation (SD) 2.81 cm; n = 709 information available]. Stages 1, 2 and 3 represented 4, 25 and 71%, respectively (n = 644). Ductal carcinoma predominated (79.2%, n = 1,070) as well as grade 2 tumors (57%, n = 509). Median follow-up was 23.1 (0-65.6) months, during which 285 women developed metastases. MFS after 2 years was 74% (69-79%), declining to 59% (53-64%) in the worst-case scenario. Patients with early stage (1-2) showed better MFS than patients with stage 3 (85 and 66%, respectively). The 5-year MFS was 72% for stages 1 and 2 and 33% for stage 3. We present a first overview on MFS in a large cohort of female BC patients (1,070 patients) from sub-Saharan Africa. Young age and advanced stage were associated with poor outcome.

Gastric carcinoma at Tikur Anbessa Hospital, Addis Ababa.

OBJECTIVE: To provide a baseline epidemiologic information on gastric cancer from Ethiopia based on hospital data. DESIGN: Prospective study. SETTING: Department of Surgery, Tikur Anbessa Hospital, Faculty of Medicine, Addis Ababa University, Addis Ababa. SUBJECT: Ninety six patients treated for gastric cancer from 1992-1996. INTERVENTIONS: Data including demographic and clinical features, pathology of the disease and treatment outcome were analysed on 96 of 125 cases of gastric cancer. MAIN OUTCOME MEASURES: Duration of symptoms, diagnosis and stage of disease at the time of definitive diagnosis, and postoperative mortality. RESULTS: Sixty eight patients were males and 28 females. The mean age was 48.2 +/- 12.7 (range 20-73) years. The histopathology was adenocarcinoma with a Laurence intestinal type in 89 cases. Majority of the cases (90%) had advanced (stage III-IV) tumours. More than forty four per cent of cases had resectable lesions. Postoperative mortality rate was 18.6%. Twenty seven of the 70 cases operated on (57 survived the operations) could be followed up only for less than one year. CONCLUSION: This study, although based on the relative frequency in a hospital material, indicates that gastric cancer is not rare in Ethiopia. Patients appear to present late with advanced cancers.

Oesophageal carcinoma in Tikur Anbessa Hospital, Addis Ababa.

A five year review of oesophageal carcinoma in Tikur Anbessa Hospital (TAH), Department of Surgery, Faculty of Medicine is presented. One hundred and forty two patients representing 32.5% of all gastrointestinal and 13.8% of all malignant tumours were seen in the Department during the study period. The age range was 22 to 88 years with a mean of 54 years. There were 54 females and 88 males. Dysphagia, weight loss and anaemia were the significant features in the majority and 40% of patients presented between four and seven months. Squamous cell cancer accounted for 93% of all histologic types. The middle third was the commonest site of tumour formation (49%) while the lower third accounted for 44%. An operability rate of 56% is recorded but only 24% were suitable for oesophagectomy. The post operative mortality was 28%. The commonest causes of death were sepsis secondary to anastomotic leak and pneumonia. Follow up was possible only for three months for eleven patients and seven months for seven patients. The rest could not be traced. It is difficult not to implicate the commonly used dietary ingredients in the causation of this tumour.

Cancer of the lower gastrointestinal tract: a five year experience in Ethiopia.

To provide the pattern and outcome, 131 patients admitted to Tikur Anbessa Hospital, Department of Surgery, between 1992 and 1996 with a diagnosis of lower gastrointestinal tract (colo-anorectal and small bowel) cancer were analysed. Lower gastrointestinal tract cancer accounted for 30% of all gastrointestinal tract malignancies, excluding hepatic cancer, seen in the Department during the study period. The female to male ratio was 1.0:1.8. The mean age was 47.1 +/- 15.7 (range 17-85) years. Among the 131 cases, 52.7% and 16% were under 50 and 30 years of age, respectively. The mean duration of symptoms on admission was 11.2 +/- 8.9 (range 0.2-43) months. The most frequent clinical features included weight loss (93%), pain (86%), rectal bleeding (79%), tenesmus (74%) and anorectal lesion (62%). Adenocarcinoma accounted for 92% of the pathology. Among 94 surgically staged cases, 63 had Dukes' C and D lesions. The most common site of primary tumours was the rectum (61.1%). Ninety per cent of the cases were operable and of these, 63 had resections with curative intent. Twenty patients refused surgery. There were fifteen postoperative hospital-stay deaths. The mean follow up was 5.7 +/- 3.1 (range 0.2-48) months. Cancer of the lower gastointestinal tract seemed to occur in rather younger age and diagnosis was late.

Gangrenous sigmoid colon secondary to twisted pedunculated left ovarian tumour.

A case of strangulated sigmoid colon secondary to a twisted left ovarian tumour in an 18 year old female is presented. No similar case was identified in the literature.

Gastrointestinal tract cancer: a five year study in a teaching central referral hospital, Ethiopia.

Due to lack of national cancer registry, the pattern and outcome of gastrointestinal tract (GIT) cancer is unknown in Ethiopia. In the period 1992-1996, a prospective study was carried out in 534 patients with GIT malignant tumours admitted to the Tikur Anbessa Hospital Department of Surgery, Addis Ababa. Relevant data were recorded on a prepared proforma for specific disease. Of these, 437 cases (82%), 142 oesophageal, 68 pancereato-biliary, 96 gastric, and 131 lower GIT cancers have been included in this study. The mean age was 52 +/- 13 (range 17-88) years. The male to female ratio was 1.7:1.0. The mean duration of the presenting symptoms was 10 months. One hundred and thirty-six patients were not operated because of poor clinical performance status or advanced metastatic disease in 105 patients and refusal to undergo surgery in 31 patients. In nearly 50% of 301 operated cases, the tumours were resected. Clinical staging was defined in 269 cases. Of these, 224 (83.3%) were advanced and only 45 were early cancers. The histopathology in 371 cases showed a predominance of adeno and squamous cell carcinomas. An overall postoperative in-hospital mortality rate was 20%. Of the 241 operative survivals (80%), only 110 (46%) had a limited follow-up of 3 to 12 months. Few cases were followed longer. The diagnosis was late and the follow-up was poor. A high index of suspicion of GIT cancer in all age groups will result in earlier diagnosis and improved survival.

The role of changing diet and altitude on goitre prevalence in five regional states in Ethiopia

Objective: Iodine Deficiency Disorders (IDD) as one of the leading nutritional problems has been increasing through time due to iodine deficiency; aggravating factors and IDD knowledge in many parts of Ethiopia. The effect of changing diet and altitude on goitre prevalence is assessed. Methodology: Randomly selected five regional states (Amhara; Oromiya; Tigray; SNNP and Benshangul-Gumuz) were used to conduct cross-sectional study on IDD. In each region cluster sampling method was applied to select study subjects. Low land and adjacent high land were independently sampled to investigate the role of altitude on goiter prevalence. Totally 6960 children and the same number of biological mothers of the children were included in the clinical examination for goiter and household interview. Urine samples were collected from children for urinary iodine examination/analysis (UIE). Besides; in all clusters qualitative data were collected on IDD knowledge and cassava introduction; cultivation and consumption. Results: Cassava consumption and living in high altitude were found to be risk factors for IDD. In the two regions (SNNP and Benshangul-Gumuz) among three where cassava is cultivated; those who consume cassava frequently were significantly (p0.001) affected by goitre than those consuming rarely or not. In the last thirty years cassava consumption has been increasing with the concomitant increase in goitre rate and other associated health problems. Acute cyanide intoxication in children from cassava meal was reported. In Amhara region; goitre rate was significantly (p0.05) higher in high altitudes than in low both for children and mothers. This was due to significantly (p0.01) low level of iodine intake in high lands than in low as indicated by UIE. Due to stigma; parents do not send goitrous children to schools and goitrous girls are not wanted for marriage. Conclusion: Besides low level of iodine intake; cassava consumption and living in high altitude were responsible for the observed variation and severity in goitre rates. IDD affects several dimensions of human life including school enrolment and marriage. Addressing IDD in-terms of salt iodization and training communities on cassava processing techniques to remove cyanide; awareness creation on IDD and soil conservation are highly recommended