Epidemiology of breast lesions in eastern Nigeria. A 10- year descriptive retrospective review.

Abstract

Objective: The paper aims to review the ‘epidemiologic features of breast lesions in Eastern Nigeria’ using a 10 year data collected from January 1998 to December 2007, and update available literature on the prevalence of common breast lesions in our environment. It simultaneously compares these with previous studies done here. Background: Our population like others in Sub-Saharan Africa is unexplored in terms of reliable health data on breast lesions and it is also a poorly screened population with virtual absence of mammography. Histopathology Departmental records show that the prevalence of breast lesion is increasing, growing from a yearly all time low of 93 specimens in 1999 to 358 biopsies in 2006, a 285% increase. Design: Two thousand two hundred and seven breast specimens were received in our Histopathology Department from January 1998 to December 2007. It is a reference laboratory catering for nearly 30 million people. These were analyzed using simple percentages to update data on breast lesions in our environment.Results: The most common breast lesion is fibroadenoma with n = 674 (30.5%). Its mean age of presentation is 23.8 years Standard Deviation (SD) 7.4 years. All were diagnosed as palpable lumps, the average sizes of these lumps at presentation were 3.2cm x 2.3cm x 1.4cm. Next was fibrocystic change with n = 343 (15.5%), presenting later, average age 34.1 SD 11.8 years. They presented as breast lumps measuring 4.2cm x 2.6cm x 1.6cm larger than the later. Phylloide's tumor (benign variant) n = 87 (3.9%) was seen at a mean of 23.1years SD 7.8 years. Mean size of Phylloide's was 13cm x 10.5cm x 5cm. Carcinomas of the breast had n = 649 (29.4%) with 640 females and 9 males. The average age of male presentation was 57.2years. Female breast cancers constituted 98.6% of cases and generally the mean age of presentation is 41.6years SD 11.4. Forty four % of the malignant samples were mastectomies while 55% were breast lumps whose average sizes were 5.6cmx4cmx2.5cm with 72% lymph node positive at presentation. The rest 450 (12.7%) represented other benign lesions. Conclusions: The most common breast lesion in our environment is fibroadenoma, it is likely to present in a young woman in her early twenties, as a lump of size less than 3.5cm. Large breast lumps measuring more than 6cm in its longest diameter and presenting in girls of same age are likely to be benign Phylloide's. Breast cancer presentation occurs at a mean age of 41.6 years, with 72% of lymph nodes positive at presentation. The relatively large sizes of the breast lumps and absence of lumpless cases are in keeping with a poorly screened population.

Keywords: Epidemiology, breast, lesions, Eastern Nigeria.