Breast Cancer: The Perspective of Northern Nigerian Women

A two-tool assessment of the quality of life of patients with breast cancer using generic and disease-specific tools in a Nigerian teaching hospital

Assessing the quality of life (QoL) of breast cancer (BC) patients using a triangulation of tools is crucial for understanding their well-being and tailoring specific interventions to improve their overall experience. The study assessed the QoL of BC patients using a combination of generic and disease-specific validated questionnaires. The study utilized a self-administered questionnaire-based cross-sectional design among BC patients attending the Oncology clinic in a Nigerian teaching hospital. The 23-item EORTC-BR23 questionnaire and the 15-item HRQoL 15D questionnaire were provided to consenting eligible respondents for data collection. Descriptive (e.g., frequency, percentages, mean, median, etc.) and inferential (T-test and one-way ANOVA) statistical analyses were conducted on the cleaned data, with significant p values set at less than 0.05. A total of 60 female BC patients participated in the study. Respondents that were aged 41-50 years and 50-60 years were 20 (33.3%) and 19 (31.7%) respectively. Patients who were diagnosed with BC one year ago before the study were 22 (39.3%) with 51 (85%) reporting no positive family history of BC. Patients who had undergone surgery, radiotherapy, hormonal therapy, and chemotherapy were 52 (86.7%), 27 (45.0%), 14 (24.1%), and 54 (90%) respectively. The patients scored 30.00 ± 4.67% and 72.36 ± 2.93% for future perspective and body image, respectively, in the functional scales of the EORTC-BR23 with a maximum possible score of 100%. On the symptom scale, they scored 47.46 ± 2.52% and 63.40 ± 5.03% for side effects of therapy and being upset about hair loss, respectively. The patients' quality of life utility score in the 15-D tool was 0.79 ± 0.02. With p values less than 0.005, age, time since diagnosis, and cancer stage were influential determinants of patients' QoL. The QoL of the participants based on the HRQoL-15D was determined to be high. For the EORTC-BR23, respondents reported high quality of life for body image and sexual function but low quality of life for both sexual enjoyment and future perspective in terms of the functional scale. The symptom scale of EORTC-BR23 showed high symptoms for only the domain of upset by hair loss resulting in low QoL. Socio-demographic factor that affects the QoL of BC patients were age, number of years since diagnosis and stage of BC.

Risk factors for breast cancer among women in Freetown, Sierra Leone, 2017: a case-control study

Introduction

breast cancer is the most commonly diagnosed malignancy and an important cause of cancer death among females worldwide. The disease accounted for 25% (1.67 million) of new cancer cases and the fifth cause of cancer deaths. Incidence of all types of cancers is approximately 25% in Sierra Leone. However, there was no documented evidence on risk factors for breast cancer among women in the country. The main aim of this study was to assess risk factors associated with breast cancer among women screened for breast cancer in Freetown Sierra Leone.

Methods

we conducted a case-control study on breast cancer involving 116 confirmed breast cancer cases and 116 controls. Questionnaire was designed to collect data on socio-demographic, reproductive and behavioral risk factors. Analysis was carried using logistic regression to assess the associations between breast cancer and the risk factors.

Results

in the final multiple logistic regression, had formal educational level, (aOR 0.1, 0.03-0.26, p= 0.001) physical activity for more than 30 minutes per week (aOR 0.5 (0.9- 0.7, p=0.001). Cigarette smoking (aOR 4.8, 1.2-18.5, p=0.023) and family history of breast cancer (aOR 9.9 cigarette smoking (OR 4.4, 1.2-18.5, p=0.023) and family history of breast cancer (OR 9.9, 2.7-36.45, p=0.040) were identified as the main risk factors for breast cancer. This study did not find any statistically significant associations between reproductive risk factors and breast cancer.

Conclusion

risk factors for breast cancer among women in Sierra Leone include educational level, physical activity, cigarette smoking and family history of breast cancer. We recommended screening program for women above 40 years and had history of breast cancer. Also, to establish breast cancer registry.

Comparative analysis of breast cancer characteristics in young premenopausal and postmenopausal women in Ghana

Breast cancer is increasingly common among young women in Ghana. BCa is heterogeneous with unique traits that impact causes, prognostic, and predictive outcomes of patients before and after menopause. However, limited evidence exists on differences between young premenopausal (YPM) and postmenopausal cases in Ghana. This study compared breast tumour characteristics between YPM women (under 35 years) and postmenopausal women. We conducted a prospective cross-sectional study involving 140 BCa-diagnosed women at the Breast Care Clinic of Komfo Anokye Teaching Hospital (KATH), Kumasi from November 2019 to June 2021. Thirty-one (22.1%) of participants were YPM and 109 (77.9%) were postmenopausal. The median ages for YPM and postmenopausal were 32.0 (range: 25.0-35.0) and 57.0 (48.0-86.0) respectively. Invasive carcinoma was the most common histological type (97.1%). Left tumour location was the most frequent in both groups (51.6% for YPM and 51.8% for postmenopausal). Lumps detected were frequently in the outer upper quadrant in both groups (61.3% and 56.0%). The majority of the YPM women (80.7%) and postmenopausal women (87.0%) had stage III and IV diseases. Most YPM (64.5%) and postmenopausal women (64.4%) exhibited triple-negative breast cancer (TNBC). Both YPM 13 (56.6%) and postmenopausal participants 40 (56.3%) exhibited a predominantly partial response to neo-adjuvant chemotherapy but YPM women (21.7%) experienced disease progression than the postmenopausal women (12.7%). The study highlights consistent tumour characteristics and advanced clinical stages at diagnosis in both groups with a higher prevalence of TNBC. TNBC and HER2+ subtypes respond better to Anthracycline-based neoadjuvant chemotherapy. Establishing Breast Care Clinics in district and regional hospitals for early detection is crucial and further studies are warranted to understand the higher TNBC prevalence in black Africans and re-evaluate breast education programs to address the persistently late presentations.

Understanding women's perspectives on breast cancer is essential for cancer control: knowledge, risk awareness, and care-seeking in Mwanza, Tanzania

BACKGROUND

Breast Cancer is the most common cancer in women worldwide. Since 2008, Mwanza, Tanzania, has worked to provide comprehensive cancer services through its Zonal consultant hospital. New national guidelines focused on clinical breast exam requires that women be aware of and seek care for breast concerns. Therefore, this study aims to understand breast cancer awareness in Mwanza and describe women-level barriers, care-seeking behavior, and perspectives on breast cancer.

METHODS

A community-based survey was administered to conveniently sampled women aged 30 and older to assess women's perspectives on breast cancer and care-seeking behavior.

RESULTS

Among 1129 women with a median age of 37 (IQR: 31-44) years, 73% have heard of cancer and 10% have received breast health education. Women self-evaluated their knowledge of breast cancer (from 1-none to 10-extremely knowledgeable) with a median response of 3 (IQR: 1-4). Only 14% felt they knew any signs or symptoms of breast cancer. Encouragingly, 56% of women were fairly-to-very confident they would notice changes in their breasts, with 24% of women practicing self-breast examination and 21% reporting they had received a past breast exam. Overall, 74% said they would be somewhat-to-very likely to seek care if they noticed breast changes, with 96% noting severity of symptoms as a motivator. However, fear of losing a breast (40%) and fear of a poor diagnosis (38%) were most frequent barriers to care seeking. In assessing knowledge of risk factors, about 50% of women did not know any risk factors for breast cancer whereas 42% of women believed long term contraceptive use a risk factor. However, 37% and 35% of women did not think that family history or being older were risk factors, respectively.

CONCLUSIONS

The success of efforts to improve early diagnosis in a setting without population-based screening depends on women being aware of breast cancer signs and symptoms, risks, and ultimately seeking care for breast concerns. Fortunately, most women said they would seek care if they noticed a change in their breasts, but the low levels of cancer knowledge, symptoms, and common risk factors highlight the need for targeted community education and awareness campaigns.

Breast cancer awareness in the sub-Saharan African ABC-DO cohort: African Breast Cancer-Disparities in Outcomes study

A greater understanding of the nature and drivers of poor breast cancer (BC) awareness in sub-Saharan Africa (SSA) will inform much needed awareness programmes. We aimed to assess the level and nature of BC awareness in the multi-country African Breast Cancer-Disparities in Outcome (ABC-DO) cohort of women newly diagnosed with BC during 2014-2017. Awareness indicators were assessed during a baseline interview at/near diagnosis. Logistic/ordinal regression was used to estimate odds ratios (OR) for indicators of BC awareness in relation to woman-level characteristics for individual settings and then meta-analyzed. In the 1,451 women included, almost all Namibian non-black women (n = 104) knew of BC and its curability, while in Namibian black and Zambian women, one in 7 (~ 15%) had not previously heard of BC and 25-40% did not know it was curable. In Uganda and Nigeria awareness was lowest: one in four women had no BC awareness, and 2 in 3 had no knowledge of its cure potential. Low educational level, unskilled employment, low socioeconomic position, rural residence, older age, being unmarried, and in some settings HIV-positivity, were associated with lower BC awareness-e.g., having unskilled employment was associated with not having heard of BC (summary OR 3.37; 95% confidence interval (CI) 2.17-5.23), believing that it is incurable (2.43; 1.81-3.26), and not recognizing a breast lump symptom (1.85; 1.41-2.43) but with between-setting variation (I2 > 68% for all). The findings provide evidence of the level and difference in BC awareness and beliefs across different settings, highlighting the urgent need for context-specific education programmes in the SSA region.

Level of Awareness and Knowledge of Breast Cancer in Nigeria. A Systematic Review

Background

Despite reports of improved awareness of breast cancer entity and seemingly upbeat levels of other awareness subthemes in Nigeria, patients continue to present late when treatment is least rewarding. This paradoxical trend of both rising awareness and late presentation coupled with reports suggesting other competing drivers of late presentation question the “theory of poor awareness” as the foremost driver of late presentations. By aggregating available data, we aimed to assess what still constitutes poor breast cancer awareness in Nigeria in order to suggest how to allocate resources to reverse the paradox

Method

Studies conducted on Nigerian populace from 2000 to date were reviewed systematically. Search was made in PROSPERO, PubMed/MEDLINE, AJOL, Cochrane library, GOOGLE, ResearchGate and ACADEMIA. Primary outcome was level of awareness about breast cancer entity.

Result

Fifty-one eligible (48 descriptive surveys, 3 interventional ones) studies were reviewed. They included 19,598 respondents (98.5% females; 43% rural dwellers). 17,086(87.2%) were laypersons in various walks of life; 2,512(12.8%) were healthcare professionals. There were high levels of awareness of breast cancer entity, BSE, knowledge of fatality and benefit of early detection (weighted percentages 80.6%, 60.1%, 73.2% and 73.9% respectively). Weighted percentages of knowledge of symptoms/signs was 45.1%. Weighted percentages of sense of susceptibility and performance of BSE were low-26.8% and 22.9% respectively. Generally, rate of performance of screening did not vary with changes in the level of awareness/knowledge of concepts.

Conclusion

In general, low awareness of breast cancer may not be the direct and foremost driver of persistent late presentation in Nigeria.

Study of the regulatory promoter polymorphism (-938C>A) of B-cell lymphoma 2 gene in breast cancer patients of Mazandaran province in Northern Iran

BACKGROUND

The incidence rate of breast cancer has been dramatically increasing since the last decade in Iran, and it is now one of the most common female malignant tumors. B-cell lymphoma 2 (BCL2) family is the most important regulator of apoptosis, and -938C>A single nucleotide polymorphism (SNP) of BCL2 gene promoter has been demonstrated to influence breast cancer susceptibility. In this research, we study the effect of -938C>A allelic variants on breast cancer risk in Mazandaran province at the North of Iran.

MATERIALS AND METHODS

This analysis performed on 120 breast cancer patients who underwent surgery in some referenced hospitals at Mazandaran province along with 130 healthy individuals as a control. DNA extracted from peripheral blood samples was applied in polymerase chain reaction-single-strand conformation polymorphism analysis to determine -938C>A genotype. The association of the -938C>A genotype and breast cancer risk as well as clinicopathological characters were analyzed by logistic regression method.

RESULTS

Results showed that genotype frequency of AA, AC, and CC genotypes was 10%, 62%, and 28% for case and 28%, 50%, and 22% in control group, respectively. In the logistic regression model, BCL2 - 938C/A variant genotype AA was associated with a decreased risk of breast cancer (P = 0.041) by 0.31-fold (odds ratio = 0.31, confidence interval = 0.091-0.909) compared to CC genotype. However, no significant association found between -938C>A genotype and clinicopathological characters.

CONCLUSION

The study showed that AA genotype of BCL2 gene (-938C>A) is associated with decreased susceptibility to breast cancer. Hence, investigating the -938C>A SNP of BCL2 gene promoter could be an appropriate molecular marker to determine individual sensitivity to breast cancer.