Factors contributing to delays in diagnosis of breast cancers in Ghana, West Africa.

BACKGROUND: Late diagnoses and poor prognoses of breast cancer are common throughout Africa. METHODS: To identify responsible factors, we utilized data from a population-based case-control study involving 1184 women with breast malignancies conducted in three hospitals in Accra and Kumasi, Ghana. Interviews focused on potential breast cancer risk factors as well as factors that might contribute to presentation delays. We calculated odds ratios (OR) and 95% confidence intervals (CI) comparing malignances with biopsy masses larger than 5 cm. (62.4% of the 1027 cases with measurable lesions) to smaller lesions. RESULTS: In multivariate analyses, strong predictors of larger masses were limited education (OR 1.96, 95% CI 1.32-2.90

Developing cancer control plans in Africa: examples from five countries.

The creation and implementation of national cancer control plans is becoming increasingly necessary for countries in Africa, with the number of new cancer cases per year in the continent expected to reach up to 1·5 million by 2020. Examples from South Africa, Egypt, Nigeria, Ghana, and Rwanda describe the state of national cancer control plans and their implementation. Whereas in Rwanda the emphasis is on development of basic facilities needed for cancer care, in those countries with more developed economies, such as South Africa and Nigeria, the political will to fund national cancer control plans is limited, even though the plans exist and are otherwise well conceived. Improved awareness of the increasing burden of cancer and increased advocacy are needed to put pressure on governments to develop, fund, and implement national cancer control plans across the continent.

Recruiting population controls for case-control studies in sub-Saharan Africa: The Ghana Breast Health Study.

BACKGROUND: In case-control studies, population controls can help ensure generalizability; however, the selection of population controls can be challenging in environments that lack population registries. We developed a population enumeration and sampling strategy to facilitate use of population controls in a breast cancer case-control study conducted in Ghana. METHODS: Household enumeration was conducted in 110 census-defined geographic areas within Ghana's Ashanti, Central, Eastern, and Greater Accra Regions. A pool of potential controls (women aged 18 to 74 years, never diagnosed with breast cancer) was selected from the enumeration using systematic random sampling and frequency-matched to the anticipated distributions of age and residence among cases. Multiple attempts were made to contact potential controls to assess eligibility and arrange for study participation. To increase participation, we implemented a refusal conversion protocol in which initial non-participants were re-approached after several months. RESULTS: 2,528 women were sampled from the enumeration listing, 2,261 (89%) were successfully contacted, and 2,106 were enrolled (overall recruitment of 83%). 170 women were enrolled through refusal conversion. Compared with women enrolled after being first approached, refusal conversion enrollees were younger and less likely to complete the study interview in the study hospital (13% vs. 23%). The most common reasons for non-participation were lack of interest and lack of time. CONCLUSIONS: Using household enumeration and repeated contacts, we were able to recruit population controls with a high participation rate. Our approach may provide a blue-print for others undertaking epidemiologic studies in populations that lack accessible population registries.

The use of carbohydrate antigen (CA) 15-3 as a tumor marker in detecting breast cancer.

This study was carried out to determine the sensitivity and specificity of serum CA 15-3 as a marker in detecting and monitoring treatment in, breast cancer patients. One hundred and ten patients comprising 35 known breast cancer patients, 75 suspected cases and 20 controls entered the study. Blood samples were taken before and after treatment from the 35 known cases as well as the 75 suspected cases from which biopsy specimens were also taken. Serum CA 15-3 was measured by BioCheck CA 15-3 Enzyme Immunoassay. There was a significant difference between the concentration of serum CA 15-3 of the 35 known breast cancer patients before and after treatment (p < 0.05). Out of the 75 suspected cases, 46 had breast cancer and 29 had benign breast disease (histologically proven). There was a strong positive correlation between the level of serum CA 15-3 and the histopathology results of the biopsies (r = 0.518). The mean serum CA 15-3 concentration of the 46 patients (80.6 +/- 70.2 U mL(-1)) was significantly higher (p < 0.05) than that of the 29 patients with benign breast disease (12.0 +/- 9.0). The sensitivity and specificity of the serum CA 15-3 in detecting breast cancer was 76.1 and 100%, respectively at a cut-off of 35 U mL(-1). Serum CA 15-3 was found to have a value in the early detection and monitoring of treatment of breast cancer in Ghana.