Breast cancer has a high case fatality rate in sub-Saharan Africa, and this is chiefly because of late detection and inadequate treatment resources. Progressive renovations in diagnostic and management modalities of non-metastatic breast cancer (NMBC) have been noted in the region but there is paucity of data describing the clinical progress of patients with NMBC. This study sought to determine the rates of local relapse, distant metastasis and sequelae and the time span from initial treatment to the occurrence of these adverse events among patients with NMBC.
This was a retrospective review of medical records of patients with histologically confirmed NMBC at the department of radiation therapy and oncology of the Douala General Hospital in Cameroon from the January 1997 to December 2012 period. Clinicopathological and treatment characteristics as well as occurrences of adverse events were studied.
A total of 260 cases were reviewed of which 224/260 (86.2%) had invasive ductal carcinoma. Surgery was performed on 258/260 cases (99.2%) with 187/258 (72.5%) being modified radical mastectomies. Various treatment combinations were used in up to 228/260 patients (87.5%) while surgery alone was the treatment in the remaining 32 cases (12.5%). Metastasis occurred in 142/260 cases (54.6%) of which 68/142 (26.2%) were local relapses and 74/142 (28.5%) were distant metastases. Among the cases of distant metastasis, 9.2% were bone, 8.5% lungs, 6.9% nodal, and 5.4% brain. Metastasis to multiple organs was noted in 4.7% of these cases. The median periods of occurrence of local relapse and distant metastases were 13 and 12 months respectively. Sequelae occurred in 26/260 cases (10%) and were noted after an average of 30 months. The main sequelae were lymphoedema (6.5%) and lung fibrosis (1.5%). At the end of the period under review, 118/260 patients (45.4%) were alive and disease-free with a median follow up time of 24 months.
Adverse events were frequent among patients who received primary treatment for NMBC. Available cancer therapeutic modalities ought to be supplemented with efficient strategies of follow-up and monitoring so as to optimize the care provided to these patients and improve on their survival.
Ginsburg OM. Breast and cervical cancer control in low and middle-income countries: human rights meet sound health policy. J Cancer Policy. 2013;1:e35–41. CrossRef
Enow-Orock G, Ndom P, Doh AS. Current cancer incidence and trends in Yaounde. Cameroon Oncol Gastroenterol Hepatol Rep. 2012;1(1):58–63. CrossRef
Abdulhadi TJ. Non metastatic breast cancer: clinical presentation and patterns of surgical treatment. Al Kindy Col Med J. 2009;5(1):40–6.
Budakoglu B, Altundag K, Aksoy S, Kaplan MA, Ozdemir NY, Berk V, et al. Outcome of 561 non-metastatic triple negative breast cancer patients: multicenter experience from Turkey. J BUON. 2014;19(4):872–8. PubMed
Danforth JDN. Disparities in breast cancer outcomes between Caucasian and African American women: a model for describing the relationship of biological and nonbiological factors. Breast Cancer Res. 2015;15:208. CrossRef
Popoola AO, Ibrahim NA, Omodele FO, Oludara MA, Adebowale SA, Igwilo AI. Pattern of spread of breast cancer among patients attending cancer unit of Lagos state university teaching hospital. Asian J Med Sci. 2012;4(3):89–94.
Ohene-Yaboah M, Adjei E. Breast cancer in Kumasi. Ghana Ghana Med J. 2012;46(1):8–13.
Essiben F, Foumane P, Mboudou ET, Dohbit JS, Mve Koh V, Ndom P. Diagnosis and treatment of breast cancer in Cameroon: A series of 65 cases. Mali Medical. 2013;28:1-5.
Elumelu TN, Adenipekun AA, Abdusalam AA, Bojude AD. Pattern of breast cancer metastasis at the radiatiotherapy clinic, Ibadan. A ten year review. J Am Sci. 2011;7(7):906–12.
Donkor A. Factors contributing to late presentation of breast cancer in Africa: a systematic literature review. Arch Med. 2015;8:2.
Noufel SM, AL-mukhtar R, Al-Dawoodi NS, Sulaiman TI. Recurrent breast cancer following modified radical mastectomy and risk factors. J Fac Med Baghdad. 2012;54(3):198–203.
Donnelly J, Mack P, Donaldson LA. Follow up of breast cancer: time for a new approach? Int J Clin Pract. 2001;55(7):431–3. PubMed
Chauleur C, Vulliez L, Trombert B, Raoux D, Khaddage A, Seffert P. Facteurs de risque de récidive des cancers du sein traités par chirurgie conservatrice: a propos de 254 cas. J Gynecol Obstet Biol Reprod. 2008;37:170–8. CrossRef
Ersumo T. Breast cancer in an ethiopian population, Addis Ababa. East and Central Afr J Surg. 2006;11(1):81–6.
Raina V, Bhutani M, Bedi R, Sharma A, Deo Suryanarayana VS, Shukla NK, et al. Clinical features and prognostic factors of early breast cancer at a major cancer center in North India. Indian J Cancer. 2005;42(1):36–41.
Elder EE, Kennedy CW, Gluch L, Carmalt HL, Janu N, Joseph MG et al. patterns of breast cancer relapse. Eur J Surg Oncol 2006; 32(9): 922-927.
Mabula JB, Mabula MD, Chalya PL, Giiti G, Chandika AB, Rambau P, et al. Stage at diagnosis, clinicopathological and treatment patterns of breast cancer at Bugando medical center in north western Tanzania. Tanzan J Health Res. 2012;14(4):1–14.
Shahpar H, Atieh A, Maryam A, Fatemeh HS, Massoome N, Mandana E et al. Risk factors of lymph edema in breast cancer patients. Int J Breast Cancer 2013; 2013: 641818 doi.org/ https://doi.org/10.1155/2013/641818
Anna P. An analysis of long term complications in breast cancer patients after conservative therapy. Rep Pract Oncol Radiother. 2006;11(2):81–9. CrossRef
- Evolutionary aspects of non-metastatic breast cancer after primary treatment in a sub-Saharan African setting: a 16-year retrospective review at the Douala general hospital, Cameroon
Bibiana Ateh Nzeangung
Martin Essomba Biwole
Benjamin Momo Kadia
Ndemazie Nkafu Bechem
Christian Akem Dimala
Albert Mouelle Sone
- BioMed Central
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