Directorate of Postgraduate Studies

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Browsing Directorate of Postgraduate Studies by Author "Ayuk, Nelson"

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    Magnitude and outcomes of advanced stage breast cancer as compared to early stage disease among women in Dar es Salaam.
    (Hubert Kairuki Memorial University, 2010-05) Ayuk, Nelson
    Advanced Breast Cancer is associated with a very poor prognosis and high mortality among women. Despite substantial improvements in its prevention, diagnosis and treatment, advanced breast cancer remains a significant clinical problem. Advanced stage breast cancer is rarely seen in the Western countries but is common in African countries. In Tanzania, many women turn up at hospitals with cancer at a very advanced stage, often only palliative care can be offered. The objective of this study was to determine the prevalence of advanced breast cancer and outcomes as compared to early stage disease among women at Ocean Road Cancer Institute (ORCI), Dar es Salaam. The study was a retrospective descriptive hospital based study in which data were gathered from the Medical Registry Office at ORCI using all available medical documents (files, records, etc), worked on and evaluated accordingly. Of the 171 patients with breast cancer recorded in this study, majority were in the age group 46-60 years (n=69; 40.4%). There was no patient below the age of 30 years. The mean age was 50.9 years. A great number of patients came from Dar es Salaam (n=67; 39.2%), and the least number of patients came from Mara and Songea with 0.6% (n=l) each. Most of the patients were peasants (n=49; 28.7%). A great majority of patients presented with advanced disease, the prevalence being 84.8%, with 53.2% in stage III and 31.6% in stage IV. Only 1.2% of patients had stage I disease at presentation. Meanwhile, 8.3% of patients with late stage presentation had progression of disease at 3 months after treatment, as compared to 3.8% of patients with early stage disease. Metastatic disease was present in 15.2% of late stage patients at 3 months as compared to 3.8% of those with early stage presentation. Mortality rate was 7.6% for those with advanced disease at presentation and 3.8% for patients with early stage disease at presentation. At 6 months of follow-up after treatment; 13.8% of late presentation patients had disease progression while none of the patients with early stage had progression of the disease. Furthermore, 13.1% of late stage patients had metastases at 6 months compared to none with early stage presentation. Ductal carcinoma was the most common type among women having breast cancer, with a proportion of 65.5%. Stage at presentation was significantly associated with age and occupation: A higher risk of having advanced breast cancer at presentation was found for women of over 46 years age as compared to women with age between 30-45 years (OR = 1.17, P < 0.05). Also, a higher risk was found in unemployed patients compared to patients who had been employed (OR = 1.68, P < 0.05). The study has conclusively shown that there is a high prevalence of advanced breast cancer at presentation at ORCI. It was also observed that outcomes after treatment were poor for patients with advanced disease particularly at 6 months follow-up. Therefore, it is recommended that more public health efforts be made focusing on screening, public awareness and treatment centers towards improving on early detection of breast cancer.