Presentation, Pattern and Outcome Of Breast Cancer In A Poor Economy: A Definition Of The Tripod Of Ignorance, Disease And Poverty

Abstract

Context: Most cases of breast cancer in developing countries present in advanced stages for several reasons.
Aims: The aim of this study was to determine the stage at which patients with breast cancer presented, evaluate reasons for late presentation and determine impact on outcome.
Methods: A six-year prospective study (2005-2010) was carried out by means of a structured questionnaire. All consenting patients of breast cancer that presented to the hospital were included in the study. Data on
clinical presentation, management and outcome of management were obtained from the case files. Data were analysed using percentages and tables.
Results: With most cases occurring in the 5 decade, there were 309 cases of breast cancer with patients in stages 3 and 4 accounting for 67%. There were only seven males. Over 22% of the patients presented after a year of noticing the symptom of breast cancer. Fear of mastectomy (24%), visit to prayer houses (18.3%), financial constraints (18.3%) and ignorance (16.3%) were the commonest reasons for late presentation. The commonest histological type was invasive ductal carcinoma (73%). Of the 206 patients that accepted mastectomy, 172 patients were in stages 3 and 4. Only 105 patients (including 18 mortalities) in stages 3 and 4 could be followed up for an average duration of one year.

Conclusion: Most patients with breast cancer present late to hospital for various reasons with attendant poor outcome. Follow up of patients is quite challenging. Health education is required to emphasise the importanceof early presentation.

Key Words: Cancer, Late, ignorance, poverty, poor outcomes.