Factors contributing to delays in diagnosis of breast cancers in Ghana, West Africa

BACKGROUND: Late diagnoses and poor prognoses of breast cancer are common throughout Africa. METHODS: To identify responsible factors, we utilized data from a population-based case-control study involving 1,184 women with breast malignancies conducted in three hospitals in Accra and Kumasi, Ghana. Interviews focused on potential breast cancer risk factors as well as factors that might contribute to presentation delays. We calculated odds ratios (OR) and 95% confidence intervals (CI) comparing malignances with biopsy masses larger than 5 cm. (62.4% of the 1,027 cases with measurable lesions) to smaller lesions. RESULTS: In multivariate analyses, strong predictors of larger masses were limited education (OR=1.96, 95% CI 1.32–2.90 <primary vs. ≥senior secondary school), being separated/divorced or widowed (1.75, 1.18–2.60 and 2.25, 1.43–3.55, respectively, vs. currently married), delay in care seeking after onset of symptoms (2.64, 1.77–3.95 for ≥12 vs. ≤2 months), care having initially been sought from someone other than a doctor/nurse (1.86, 0.85–4.09), and frequent use of herbal medications/treatment (1.51, 0.95–2.43 for ≥3x/day usage vs. none),. Particularly high risks associated with these factors were found among less educated women; for example, women with less than junior secondary schooling who delayed seeking care for breast symptoms for 6 months or longer were at nearly 4-times the risk of more educated women who promptly sought assistance. CONCLUSIONS: Our findings suggest that additional communication, particularly among less educated women, could promote earlier breast cancer diagnoses. Involvement of individuals other than medical practitioners, including traditional healers, may be helpful in this process

Inflammatory bowel disease in Nigerian: Still a rare diagnosis?

Inflammatory bowel disease (IBD) has been thought to have a low incidence among subSaharan Africans mainly because of the sporadic cases reported from the continent in comparison with the larger numbers reported from North America and Western European countries. Is this difference based on real demographic susceptibilities or a reflection of lower level of healthcare delivery? Three cases of ulcerative colitis and one case of Crohn's disease diagnosed in a tertiary institution in northern Nigeria in the span of three years are reported. Their presentation coincided with the creation of the Gastrointestinal Surgery Unit of our hospital and with it the availability of endoscopic diagnostic procedures. All four patients were indigenous Nigerians. Our findings suggest that IBD may be more common in this part of the world than previously thought. With an increased awareness of the disease in our population, a greater utilization of modern medicine as against alternative medicine and with wider availability of diagnostic tools in our hospitals, it is our guess that more cases may be found in the future to dispel the belief that Africans are somewhat immune to this affliction.DOI: 10.4103/1596-3519.8206

Herniated Gravid Uterus: Clinical Course and Result of Treatment

Herniated gravid uterus in an incisional hernia of the anterior abdominal wall is relatively rare. A 30-year-old house wife presented with a six month gravid uterus that had herniated through an incisional hernia of the anterior abdominal wall. She had non-operative management till term, when she then had elective lower caesarian section. Physiotherapy of the anterior abdominal wall muscles to improve their tone was done. She subsequently had keel’s repair of the hernia. Aggressive physiotherapy of the anterior abdominal wall muscles followed by keel’s repair may be an alternative surgical technique in patients with a moderate defect of incisional hernia

Residency training program: Perceptions of residents

No Abstract

Anorectal carcinoma involving the female genital tract: the morbidity and implications for sexual function

Background: Carcinoma of the colon and anorectum affect a younger age group in Africans, and patients often present late with advanced disease. Method: A retrospective review of 22 females treated for anorectal carcinoma. Results: Fourteen females had genital tract involvement; their mean age was 33.8 years. Thirteen patients had abdominoperineal resection. The other patient had a divided colostomy. Adjuvant chemotherapy was given to 12 patients. Wound infection occurred in 3 patients, and wound dehiscence in one patient. Five patients resumed sexual activity 6 months after surgery. One patient died of pneumonia 23 days after surgery. Conclusion: Anerectal carcinoma causes morbidity related to the genital tract and sexual function in females. (Nig J Surg Res 2003; 5: 38 – 42) Key words: Anorectum, carcinoma, female, sexual functio

Breast masses in Zaria, Nigeria

Background: Breast masses are a common problem worldwide. There is usually an urgent need to differentiate benign from malignant masses. Method: A retrospective study of 428 patients at Ahmadu Bello University Teaching Hospital, Zaria, Nigeria with breast masses in fourteen (14) years was carried out. Results: There were 401 females and 27 males. There were three hundred and five (71.3%) benign lesions and 123 (28.7%) malignant lesions. One hundred and fifteen (26.9%)), 103 (24.%) and 65 (15.2%) of the masses were carcinoma, fibroadenoma and fibrocystic change respectively. Of the 123 malignant lesions, 115(93.5%) were primary breast carcinoma; of these six (5.2%) were in male patients. Eighty-five (73.9%) of the patients with carcinoma had advanced disease. The commonest histologic type was ductal carcinoma in 96 patients (83.5%). All the 305 patients with benign lesions had excisional biopsies. Majority of patients with carcinoma 104 (90.4%) had mastectomy, the other 11 patients had only biopsies. Eighty-nine females with carcinoma (72.4%) had, chemotherapy. Majority of the patients (91.1%) were seen once after discharge from hospital. Conclusion: Benign breast lesions (Fibroadenoma and fibroadanesis) are the commonest cause of breast Masses in our environment, followed by carcinoma of the breast. Patients with breast cancer commonly present late, with advanced disease. Keywords: Breast, cancer, advanced diseases Annals of African Medicine Vol.2(1) 2003: 13-1

External Beam Radiotherapy in Metastatic Bone Pain from Solid Tumours in Zaria, Nigeria

AimTo evaluate the effectiveness of external beam irradiation in bone pain secondary to metastases; with emphasis on the onset of symptoms relief, the duration of response and relate onset of pain relief to age in = 40 years and = 40years patients.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; SettingAhmadu Bello University Teaching Hospital, Zaria, Nigeria.ResultBreast cancer is the commonest cause of metastatic bone pain from solid tumours in Zaria, Nigeria. Females were more commonly affected. Two out of every 5 patients were less than 40 years old. Eighty-six percent of the patients obtained significant pain relief in the first week of treatment.At 12 weeks, the mean pain score and analgesic scores were 0.67 and 0.16 respectively.ConclusionExternal beam irradiation is an effective treatment modality in an African population with metastatic bone pain.Key Words: Bone, metastasis, radiotherapy, pain, contro