The severity, outcome and challenges of breast cancer in Nigeria
The severity, outcome and challenges of breast cancer in Nigeria
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DOI：
10.1016/j.breast.2005.06.008
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发表时间：
2006-06-01
期刊：
影响因子：
3.9
通讯作者：
Durosimi, M. A.
中科院分区：
文献类型：
--
作者：
Adesunkanmi, A. R. K.;Lawal, O. O.;Durosimi, M. A.
乳腺癌在尼日利亚是一种非常常见的疾病。由于各种原因，它通常与预后不良有关。本研究旨在调查尼日利亚教学医院乳腺癌管理结果的挑战，严重程度，结果和影响因素，以期找到改善该疾病患者目前惨淡前景的方法。回顾了教学医院两个单位8年（1996-2003年）内乳腺癌患者的临床记录。这两个单位为尼日利亚西南部一些地区的城市、半城市和农村社区提供服务。在这项为期8年的研究中，共观察了212例乳腺癌患者。平均年龄为48岁（23-85岁）。有211名女性和1名男性。103例患者（48.7%）接受过小学后或高等教育。66.7%的人绝经前，79.2%的人在生命早期怀孕，并且是多产的。这些也给了他们的孩子长期母乳喂养的历史。195例（92%）自我检测出肿瘤。平均症状持续时间为11.2个月（9天至7年）。疼痛100例（47%），左侧乳腺癌113例（53.3%）。85例（40%）局限性癌位于上外象限，而55例（26%）累及整个乳房。在157例患者（74%）中观察到晚期癌症的局部区域特征。83例（39%）肿瘤呈真菌样生长，28例（13%）患者有全身转移的临床证据。174例（80.6%）患者为晚期疾病（3期和4期）。185例（87.3%）可行再次手术，65例（30.6%）需行新辅助化疗，178例（84%）需行术后辅助化疗，联合用药包括CMF-环磷酰胺、甲氨蝶呤、5-氟尿嘧啶、CMFP-CMF+泼尼松、CAF-环磷酰胺、阿霉素、5-氟尿嘧啶。在转诊至放射治疗单位的患者中，已知仅70例（33.2%）患者接受过放射治疗，术后治疗依从性良好。门诊就诊率也很低，只有27名（12.7%）仍在门诊就诊，83名患者（39%）已知死亡，102名患者失访。平均随访时间为8.4个月（1周至6年）。总之，乳腺癌在我们尼日利亚的实践领域非常常见;我们的大多数患者是处于癌症晚期的年轻和绝经前妇女。治疗依从性非常差。大多数患者在诊断后一年内死亡或失访。(c)2005爱思唯尔有限公司保留所有权利。
Breast cancer is a very common disease in Nigeria. It is often associated with a poor prognosis for a variety of reasons. This study was designed to investigate the challenges, severity, outcome and factors influencing the outcome of the management of breast cancer in a Nigerian Teaching Hospital with a view to finding ways to improve the current dismal outlook for patients with the disease. The clinical records of patients seen with breast cancer over an 8-year period (1996-2003) in the two units of the Teaching hospital were reviewed. The two units serve the urban, semi-urban and rural communities of some parts of southwestern Nigeria. Two hundred and twelve patients with breast cancer were seen over the 8-year period of the study. The mean age was 48 years (23-85 years). There were 211 female and one male. One hundred and three patients (48.7%) had either postprimary or tertiary education. A proportion of 66.7% were premenopausal, 79.2% had pregnancy early in life and were multi-parous. These also gave a history of prolonged breast-feeding of their children. The tumour was self-detected in 195 (92%). The mean duration of symptoms was 11.2 months (9 days-7 years). Pain in 100 patients (47%) was the most common symptom and the cancer was in the left breast in 113 (53.3%). Localized cancer was in the upper outer quadrant in 85 (40%), whereas the whole breast was involved in 55 patients (26%). Loco-regional features of advanced cancer were seen in 157 patients (74%). The tumour was fungating in 83 (39%) and there was clinical evidence of systemic metastasis in 28 patients (13%). One hundred and seventy-four (80.6%) patients had advanced disease (stages 3 and 4). Definitive surgery was possible in 185 patients (87.3%), neoadjuvant chemotherapy was required in 65 (30.6%), postoperative adjuvant chemotherapy in 178 (84%; drug combinations were CMF-cyclophosphamide, methotrexate, 5fluorouracil, CMFP-CMF plus prednisone, and CAF-cyclophosphamide, adriamycin, 5-fluorouracil), tamoxifen was administered in all the patients. Only 70 (33.2%) patients were known to have received radiotherapy among those referred to the Radiotherapy unit, with associated fair treatment compliance after surgery. Outpatient clinic attendance was also very poor, only 27 (12.7%) were still being seen in the clinic, 83 patients (39%) were known to be dead and 102 patients were lost to follow-up. The mean follow-up period was 8.4 months (1 week-6 years). In conclusion, breast cancer is very common in our area of practice in Nigeria; the majority of our patients were young and premenopausal women presenting in the advanced stages of cancer. Treatment compliance was very poor. The majority of the patients were dead or lost to follow-up within a year of diagnosis. (c) 2005 Elsevier Ltd. All rights reserved.