Parity and breastfeeding are protective against breast cancer in Nigerian women

As the relation between reproductive factors and breast cancer risk has not been systematically studied in indigenous women of sub-Saharan Africa, we examined this in a case–control study in Nigeria. In-person interviews were conducted using structured questionnaires to collect detailed reproductive history in 819 breast cancer cases and 569 community controls between 1998 and 2006. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CI). Compared with women with menarcheal age <17 years, the adjusted OR for women with menarcheal age ⩾17 years was 0.72 (95% CI: 0.54–0.95, P=0.02). Parity was negatively associated with risk (P-trend=0.02) but age at first live birth was not significant (P=0.16). Importantly, breast cancer risk decreased by 7% for every 12 months of breastfeeding (P-trend=0.005). It is worth noting that the distribution of reproductive risk factors changed significantly from early to late birth cohorts in the direction of increasing breast cancer incidence. Our findings also highlight the heterogeneity of breast cancer aetiology across populations, and indicate the need for further studies among indigenous sub-Saharan women.

Genetic polymorphisms in uridine diphospho-glucuronosyltransferase 1A1 and breast cancer risk in Africans

The UDP-glucuronosylatransferase 1A1 (UGT1A1) gene is involved in the metabolism of estrogen and detoxification of potential carcinogens. The number of TA repeats in the promoter region of UGT1A1 has been linked to breast cancer risk, but results varied by race. We performed a comprehensive assessment of genetic polymorphisms in the UGT1A1 gene, and examined these polymorphisms and TA repeats in relation to breast cancer risk in a case-control study in Nigeria. 512 breast cancer cases and 226 community controls were genotyped for UGT1A1. Compared with high-activity TA repeat genotypes, the odds ratios (OR) for low-activity and moderate-activity genotypes were 0.47 (95% confidence interval CI, 0.26-0.83) and 0.64 (95% CI, 0.39-1.06), respectively, in premenopausal women (P = 0.009 for trend), but no association was observed in postmenopausal women (P = 0.24). The effect of TA repeats was also differentiated by age: the OR was 0.39 (95% CI 0.21-0.71) for low-activity genotypes and 0.58 (95% CI 0.33-1.00) for moderate-activity genotypes in women <45 years old (P = 0.002 for trend), but no association was observed in women >or=45 years old (P = 0.15). Haplotype analysis showed that UGT1A1 haplotypes were highly diverse with blocked structures. We found a specific haplotype in block 2 that was significantly associated with a 2.1-fold elevated risk (95% CI 1.05-4.39; P = 0.04). In contrast with previous studies, we found low-activity TA repeat alleles were protective against breast cancer among premenopausal indigenous Africans, suggesting that the role of UGT1A1 in breast cancer development may vary by population, presumably due to different environmental and genetic modifier effects.

Immunohistochemical and molecular subtypes of breast cancer in Nigeria

OBJECTIVE

Previous studies suggest that the majority of breast cancer in Africans are hormone receptor negative and thus differ from breast cancer in other populations. We decided to evaluate the hormone receptor status of patients seen in our practice to see if they indeed differ from that of other populations.

METHODS

We prospectively collected and analyzed tumors from consecutive patients presenting to our clinic over an 18 months period from July 2004. During the period, we saw 192 patients without previous histological diagnosis and conducted routine histological and immunohistochemical analysis of their tumors for hormone receptor status.

RESULTS

Most, 65.1% of tumors were ER+, 54.7% were PR+ and 79.7% were HER2 negative. Majority of the tumors, 77.6% were luminal type A, 2.6% were luminal type B, 15.8% were basal type and the remaining 4.0% (6/152) were HER2+/ER- subtype. We found an association between hormone receptor status and tumor grade but not with stage at presentation.

CONCLUSION

We conclude that there is no difference in the pattern of hormone receptors in breast cancer patients of African origin compared to other populations and urge more use of hormone manipulation for management of breast cancer in this population.

Primary osteogenic sarcoma of the breast

BACKGROUND

Primary extra-osseous osteogenic sarcomas have been reported in many tissues of the body but their occurrence in the breast is extremely rare. It can arise as a result of osseous metaplasia in a pre-existing benign or malignant neoplasm of the breast or as non-phylloides sarcoma from the soft tissue of a previously normal breast.

CASE PRESENTATION

A 40 year-old Nigerian woman was clinically diagnosed to have carcinoma of the left breast. The histology report of core-needle biopsy of the mass showed a malignant neoplasm comprising islands of chondroblastic and osteoblastic stromal cells. This report changed the diagnosis from carcinoma to osteogenic sarcoma of the breast. She had a left modified radical mastectomy, however there was significant post surgery skin deficit. A latissimus dorsi musculocutaneous flap was used to cover the anterior chest wall defect. Sections from the mastectomy specimen confirmed the diagnosis of osteogenic sarcoma. She died six months after mastectomy.

CONCLUSION

A diagnosis of osteogenic sarcoma of the breast was made based on histology report and after excluding an osteogenic sarcoma arising from underlying ribs and sternum. This is the second documented case of primary osteogenic sarcoma of the breast coming from Nigeria.

Voluntary participation and informed consent to international genetic research

OBJECTIVES

We compared voluntary participation and comprehension of informed consent among individuals of African ancestry enrolled in similarly designed genetic studies of hypertension in the United States and Nigeria.

METHODS

Survey questionnaires were used to evaluate factors associated with voluntariness (the number of people volunteering) and understanding of the study's genetic purpose. A total of 655 individuals (United States: 348; Nigeria: 307) were interviewed after participation in the genetic studies.

RESULTS

Most US respondents (99%), compared with 72% of Nigerian respondents, reported being told the study purpose. Fewer than half of the respondents at both sites reported that the study purpose was to learn about genetic inheritance of hypertension. Most respondents indicated that their participation was voluntary. In the United States, 97% reported that they could withdraw, compared with 67% in Nigeria. In Nigeria, nearly half the married women reported asking permission from husbands to enroll in the hypertension study; no respondents sought permission from local elders to participate in the study.

CONCLUSIONS

Our findings highlight the need for more effective approaches and interventions to improve comprehension of consent for genetic research among ethnically and linguistically diverse populations in all settings.

Spontaneous epigastric hernia causing gastric outlet obstruction: a case report

Epigastric hernia, a rare form of ventral abdominal hernia, accounts for 0.4 - 1.5% of all abdominal wall hernias. It usually occurs in middle - aged individuals and is rarely large enough to admit more than a small amount of extra-peritoneal fat. In this case report, we present a 64 years old woman with 6 days history of sudden onset of painful epigastric swelling associated with acute gastric outlet obstruction. We did not find a previous report of a similar case in the medical literature.

Africa must come on board the genomics bandwagon

With the completion and the success of the unraveling of the human and some nonhuman genetic codes comes the optimism that science, once again, is at the threshold of transforming human existence in an unprecedented way. The sequencing of the human genome with the science and technology by which it occurs is seen as a potential gateway to man's final conquest of most of the health and health related disorders that have for long plagued the human race.

While some developing nations like Cuba, Mexico and India have taken the initiative to be major players in the genomics arena by exploring its potentials towards enhancing improved quality of life for their citizens, the majority of others, especially in Africa, still occupy the spectators' seat. If this apparent lukewarm attitude continues, it implies that the present dependence on the developed nations as remote beneficiaries of gains of scientific breakthroughs will persist. It also means that the expectation that genomics should, among other benefits, re-dress the inequalities of access to health care between the rich and poor nations may be a mirage for a long time to come.

The expected benefits from the human genome project and genomics technologies are fascinating and hold the ace for improving the standards of living of the African people. However, these expectations are futuristic, time-dependent and capital intensive. They require commitments of national governments to policy re-orientation about research and development, strategic planning, resource mobilization, priority setting; and establishing, promoting and sustaining enabling environments for scientific and technological breakthrough. No doubt, there is dire need for assistance from the developed and the frontline developing nations in this regard. However, great initiatives and deep commitments to making significant scholarly contributions to the advancement of biotechnology and its potentials in the near future must come from within.

Enhancing the African bioethics initiative

BACKGROUND

Medical ethics has existed since the time of Hippocrates. However, formal training in bioethics did not become established until a few decades ago. Bioethics has gained a strong foothold in health sciences in the developed world, especially in Europe and North America. The situation is quite different in many developing countries. In most African countries, bioethics - as established and practiced today in the west- is either non-existent or is rudimentary.

DISCUSSION

Though bioethics has come of age in the developed and some developing countries, it is still largely "foreign" to most African countries. In some parts of Africa, some bioethics conferences have been held in the past decade to create research ethics awareness and ensure conformity to international guidelines for research with human participants. This idea has arisen in recognition of the genuine need to develop capacity for reviewing the ethics of research in Africa. It is also a condition required by external sponsors of collaborative research in Africa. The awareness and interest that these conferences have aroused need to be further strengthened and extended beyond research ethics to clinical practice. By and large, bioethics education in schools that train doctors and other health care providers is the hook that anchors both research ethics and clinical ethics.

SUMMARY

This communication reviews the current situation of bioethics in Africa as it applies to research ethics workshops and proposes that in spite of the present efforts to integrate ethics into biomedical research in Africa, much still needs to be done to accomplish this. A more comprehensive approach to bioethics with an all-inclusive benefit is to incorporate formal ethics education into health training institutions in Africa.

Necrotizing fasciitis

Necrotizing fasciitis (NF) is a rare but rapidly progressive and potentially fatal disease condition. It is characterized by progressive inflammation and extensive necrosis of the subcutaneous tissue and fascia, sparing the underlying tissue. It is a poly-bacterial infection and is associated with profound systemic toxicity, considerable morbidity and a high mortality rate. The outcome is influenced by early recognition and radical surgical debridement. We present a report of six cases of NF who presented to our surgical service within the past 5 years.

Obesity and height in urban Nigerian women with breast cancer

PURPOSE

To examine the relationship between obesity, height, and breast cancer in an urban Nigerian population.

METHODS

Between March 1998 and August 2000, we conducted a case-control study of hospital-based breast cancer patients (n = 234) and population-based controls (n = 273) using nurse interviewers in urban Southwestern Nigeria.

RESULTS

The study did not find a significant association between obesity (BMI >/= 30) and breast cancer among all women (OR = 1.51, 95% CI = 0.87-2.62) pre- (OR = 1.21, 95% CI = 0.56-2.60) and post-menopausal breast cancer patients (OR = 1.82, 95% CI = 0.78-4.31) in multivariate logistic regression analysis, while increasing height was positively associated with the risk of breast cancer among all women (OR = 1.05, 1.01 - 1.08), pre- (1.06, 1.01-1.10) and post-menopausal women (1.07, 1.01-1.13) for each cm. Age, irregular period, and early age of onset of periods were also found to be significantly associated with breast cancer risk.

CONCLUSION

This study failed to demonstrate an association between breast cancer risk and obesity while showing that height is positively associated with risk of breast cancer in urbanized Nigerian women.

Beckwith-Wiedemann Syndrome (BWS): a case report and literature review

Beckwith-Wiedemann Syndrome (BWS), also known as the EMG (Exomphalos, Macroglossia, Gigantism) syndrome was recognised independently by Beckwith in 1963 and Wiedemann in 1964 and is now a well established entity having been reported in more than two hundred individuals. It constitutes a wide spectrum of clinicopathologic entity with varied combinations of congenital and time dependent abnormalities that often make diagnosis and management tasking. There is paucity of report in the literature on this entity from the developing world. We present a case recently seen at the University College Hospital (UCH) Ibadan, Nigeria in order to create further awareness and highlight peculiarity of management as may be applicable in a setting as ours.

Waist-hip ratio and breast cancer risk in urbanized Nigerian women

BACKGROUND

The aim of this study was to examine the relationship between waist-hip ratio and the risk of breast cancer in an urban Nigerian population.

METHODS

Between March 1998 and August 2000, we conducted a case-control study of hospital-based breast cancer patients (n = 234) and population-based controls (n = 273) using nurse interviewers in urban Southwestern Nigeria.

RESULTS

Multivariable logistic regression showed a significant association between the highest tertile of waist-hip ratio and the risk of breast cancer (odds ratio= 2.67, 95% confidence interval = 1.05-6.80) among postmenopausal women. No association was found in premenopausal women.

CONCLUSION

The present study, the first in an indigenous African population, supports other studies that have shown a positive association between obesity and breast cancer risk among postmenopausal women.

Survey of the knowledge, attitude and practice of Nigerian surgery trainees to HIV-infected persons and AIDS patients

BACKGROUND

The incidence of HIV infection and AIDS is rising in Nigeria. Surgeons are at risk of occupationally acquired infection as a result of intimate contact with the blood and body fluids of patients. This study set out to determine the knowledge, attitude and risk perception of Nigerian surgery residents to HIV infection and AIDS.

METHODS

A self-administered postal questionnaire was sent to all surgery trainees in Nigeria in 1997.

RESULTS

Parenteral exposure to patients' blood was reported as occurring 92.5% times, and most respondents assessed their risk of becoming infected with HIV as being moderate at 1-5%. The majority of the respondents were not aware of the CDC guidelines on universal precautions against blood-borne pathogens. Most support a policy of routinely testing all surgical patients for HIV infection but 76.8% work in centers where there is no policy on parenteral exposure to patients' blood and body fluids. Most (85.6%) do not routinely use all the protective measures advocated for the reduction of transmission of blood borne pathogens during surgery, with the majority ascribing this to non-availability. Most want surgeons to be the primary formulators of policy on HIV and surgery while not completely excluding other stakeholders.

CONCLUSIONS

The study demonstrates the level of knowledge, attitude and practice of Nigerian surgery trainees in 1997 and the need for policy guidelines to manage all aspects of the healthcare worker (HCW), patients, and HIV/AIDS interaction.

Spontaneous rupture of incisional hernia--a case report

A case of spontaneous rupture of an incisional hernia is hereby presented. Though very rare in adults, it is a potentially fatal but preventable clinical condition.

Pattern of mechanical intestinal obstruction in Ibadan: a ten year review

A retrospective review of 232 patients with (mechanical) instestinal obstruction managed at the University College Hospital, Ibadan over a ten-year period: 1978 to 1987. The leading aetiological factor was obstructed inguinal hernia (45.7%), although its incidence seems to be on the decline. Ileo-colic type instussusception was the most prevalent variety (62.8%) with preponderance of the paediatric age group. There is an observed increase in the proportion of obstruction due to tumours. Ascaris infestation is no longer a prominent aetiological factor. One third of the 8.2% mortality rate observed was in neonates.