Inflammatory breast cancer: features and outcomes in a breast unit in Dakar, Senegal

Background: The aim of this study was to determine clinical features and outcomes of patients with inflammatory breast cancer (IBC) treated in our breast unit.Methods: This study was performed at Gynaecologic and Obstetric Clinic of Dakar Teaching Hospital, in which a breast unit was created since 2007. All women with diagnosis of inflammatory breast cancer in our Breast Unit between January 2010 and December 2013 were included in this study. The diagnosis of IBC was made clinically using the American Joint Committee on Cancer (AJCC) and confirmed histologically. The follow-up cut-off for this data set was December 31st, 2014. All analyses for this study were performed using SPSS software (version 20.0).Results: Between 2010 and 2013, 22 women with breast cancer who met eligibility criteria were included out of 161 patients followed for breast cancer leading to a frequency of 13.6%. The median age at diagnosis was 43.4 years (26-79 years). Mean time to diagnosis was 4 months. The mean time to recurrence was 11.2 months. This recurrence was observed in 45.5% of cases. The median overall survival was 13.3 months (CI 95% 8.576-18.526), the survival rate was 31.8%.Conclusions: This series shows a high frequency of inflammatory breast cancer. These tumours are very aggressive with a very poor prognosis

A hospital based case control study of female breast cancer risk factors in a Sub-Saharan African country

Background: Breast cancer is the most common cancer diagnosed in women worldwide with over 1.3 million new cases per year. There is a wide variation in the geographical burden of the disease with the highest incidences seen in the developed regions of the world and the lowest incidences observed in the least developed regions. The objective of this study was to understand further the risks for breast cancer in Senegalese population which can then inform public health strategies to try and reduce the burden of breast cancer.Methods: This matched case control study was conducted in 2015 in Aristide Le Dantec Teaching Hospital in Dakar. All women with pathologically confirmed primary breast cancer were considered as cases. For each case, 2 age-matched women were recruited. We collected and compared demographic factors, family history of breast cancer, socioeconomic variables, reproductive variables (age at menarche, age at first pregnancy and first live birth, parity, menopausal status, duration of breastfeeding), and exogenous hormone use up to 6 months. Odds ratios from univariate logistic regression were used to estimate the relative risk of breast cancer associated with the various factors, and their predictive effects.Results: In all, 212 women with breast cancer who were diagnosed as having breast cancer and 424 control women were involved in the study. The mean±SD age of cases and controls was 43.37±11.94 years (range 18-83 years) and 42.04±11.08 years (range 18-84 years), respectively. There were no significant differences between cases and controls with regards to marital status, parity, age at menarche, past oral contraceptive use, age at first last full-term pregnancy and history of breastfeeding. Breast cancer risk was significantly greater in women with a family history of the disease (OR 2.12, 95% confidence interval [CI] 1.35-3.31). A significant increase in breast cancer was observed among illiterate women compared to educated women (OR 1.27, CI 1.02-1.58), in premenopausal women and those without occupation.Conclusions: In this study, reproductive factors as early menarche or menopausal status were not associative to the risk of breast cancer and the early age at diagnosis and the positive history of breast cancer suggest a genetic pattern of this disease in Senegalese woman. But this fact is difficult to confirm for financial reasons

Improving fetal dystocia management using simulation in Senegal: midterm results

Background: Maternal mortality, which constitutes the extreme point of the existing inequality between women in poor and rich countries, remains very high in Africa south of the Sahara. The objective of this study was to introduce a new training approach in Emergency Obstetric and Neonatal Care (EmONC) entered in Senegal to strengthen the skills of healthcare providers.Methods: The approach was based on the skills training using the so-called "humanist" method and "lifesaving skills". Simulated practice took place in the classroom through thirteen clinical stations summarizing the clinical skills on EmONC. The evaluation was done in all phases and the results were recorded in a database to document the progress of each learner.Results: With this approach, 432 providers were trained in 10 months. The increase in technical achievements of each participant was documented through the database. The combination of training based on the model “learning by doing” has ensured learning and mastering all EmONC skills and reduced missed learning opportunities as observed in former EmONC trainings.Conclusions: The impact of training on EmONC indicators and the introduction of this learning modality in basic training are the two major challenges in terms of prospects

Fatal Cases of Gestational Trophoblastic Neoplasia in a National Trophoblastic Disease Reference Center in Dakar Senegal

Objectives: The objectives of this study were to analyze deaths after gestational trophoblastic neoplasia and to determine the factors of treatment failure. Methods: This is a retrospective study in Aristide Le Dantec teaching Hospital in Dakar, Senegal, between 1 January 2006 and 31 December 2014. We took into account socio-epidemiological characteristics of patients, initial diagnosis, time between uterine evacuation and admission, time to onset of gestational trophoblastic neoplasia (GTN), treatment received (deadlines, protocols), difficulties experienced in the diagnosis and the initiation of treatment and survival. Results: In total, 1044 patients were admitted during the study period; 164 cases of GTN were diagnosed (15.7%); and 21 deaths occurred leading to a specific lethality of 12.8%. The average age was 30 years. Almost all patients (n = 18; 85.7%) had low income or no income. Eight out of 21 patients (38.1%) were seen in our department after GTN onset. The mean time to onset of GTN of all patients was 22.1 weeks. For 66.6%, histology was not available; the diagnosis of hydatidiform mole was made on the clinical history and sonographic features and GTN on human chorionic gonadotrophin (hCG) evolution and ultrasound findings. None of the patients had regular chemotherapy due to financial reasons. Patients who died within 3 months after diagnosis had metastatic tumors (7 of 21). All these women had resistance to treatment or progressed after three courses of chemotherapy. Ten of the 12 women with high-risk GTN were not treated with multi-agent chemotherapy (EMA-CO) for purely financial reasons. Conclusion and Global Health Implications: The high incidence and mortality require a profound reorganization of our health system and a high awareness of practitioners to refer to time or to declare all suspected cases of hydatidiform mole or gestational trophoblastic neoplasia. Key words: Gestational • Trophoblastic Neoplasia • GTN • Outcome • Death • Senegal Copyright © 2016 Gueye et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Problématique de la prise en charge des cancers du sein au Sénégal: une approche transversale

At a time when innovative therapies in breast cancer multiply, poorer countries such as Senegal are still lag far behind in the overall management of this type of cancer. In Senegal, although the treatment of advanced breast cancer is now well codified, survival and morbidity outcomes are still mediocre in view of diagnostic delays and of sometimes expensive and poorly tolerated mutilating treatments become necessary. With respect to advanced cancers, the challenges will lie in building of palliative care centres and in developing multidisciplinary approaches to improve quality of life and to support patients. On the other hand, with respect to preclinical or potentially curable cancers, the challenges are immense given the importance of early detection, localisation and diagnosis (stereotactic or ultrasound guided biopsy) but also of precision surgery and of complete resection (indexing - excision ensuring a margin of healthy tissue and specimen radiograph) while minimizing complications such as those of classic dissection (sentinel lymph node biopsy). Our health structures are not always prepared to achieve these goals. This is a situational analysis of the contextual obstacles that still exist and add a burden on the overall management of breast cancer in Senegal.The Pan African Medical Journal 2016;2

Inflammatory breast cancer: features and outcomes in a breast unit in Dakar, Senegal

Background: The aim of this study was to determine clinical features and outcomes of patients with inflammatory breast cancer (IBC) treated in our breast unit. Methods: This study was performed at Gynaecologic and Obstetric Clinic of Dakar Teaching Hospital, in which a breast unit was created since 2007. All women with diagnosis of inflammatory breast cancer in our Breast Unit between January 2010 and December 2013 were included in this study. The diagnosis of IBC was made clinically using the American Joint Committee on Cancer (AJCC) and confirmed histologically. The follow-up cut-off for this data set was December 31st, 2014. All analyses for this study were performed using SPSS software (version 20.0). Results: Between 2010 and 2013, 22 women with breast cancer who met eligibility criteria were included out of 161 patients followed for breast cancer leading to a frequency of 13.6%. The median age at diagnosis was 43.4 years (26-79 years). Mean time to diagnosis was 4 months. The mean time to recurrence was 11.2 months. This recurrence was observed in 45.5% of cases. The median overall survival was 13.3 months (CI 95% 8.576-18.526), the survival rate was 31.8%. Conclusions: This series shows a high frequency of inflammatory breast cancer. These tumours are very aggressive with a very poor prognosis. [Int J Reprod Contracept Obstet Gynecol 2016; 5(2.000): 361-366

Endométriome ombilical: à propos d’un cas et revue de la littérature

L’endométriose se définit comme l’implantation de tissu endométrial en dehors de la cavité utérine. Elle touche environ 10% des femmes en âge de procréer. La localisation ombilicale est rare et la physiopathologie mal connue. Nous rapportons le cas d’une patiente de 42 ans, nulligeste, aux antécédents de myomectomie 5 ans auparavant, qui présentait une douleur cyclique avec une masse ombilicale dont le diagnostic était en faveur d’un endométriome ombilical, confirmée par l’étude histologique de la pièce de biopsie de la masse. Le traitement a consisté à une exérèse large de la masse associée à une exploration du pelvis et une plastie ombilicale

Improving fetal dystocia management using simulation in Senegal: midterm results

Background: Maternal mortality, which constitutes the extreme point of the existing inequality between women in poor and rich countries, remains very high in Africa south of the Sahara. The objective of this study was to introduce a new training approach in Emergency Obstetric and Neonatal Care (EmONC) entered in Senegal to strengthen the skills of healthcare providers.Methods: The approach was based on the skills training using the so-called "humanist" method and "lifesaving skills". Simulated practice took place in the classroom through thirteen clinical stations summarizing the clinical skills on EmONC. The evaluation was done in all phases and the results were recorded in a database to document the progress of each learner.Results: With this approach, 432 providers were trained in 10 months. The increase in technical achievements of each participant was documented through the database. The combination of training based on the model “learning by doing” has ensured learning and mastering all EmONC skills and reduced missed learning opportunities as observed in former EmONC trainings.Conclusions: The impact of training on EmONC indicators and the introduction of this learning modality in basic training are the two major challenges in terms of prospects