Stage at diagnosis, clinicopathological and treatment patterns of breast cancer at Bugando Medical Centre in north-western Tanzania
Breast cancer, although reported to be the commonest female malignancy worldwide has not been extensively studied in north-western Tanzania. The aim of this retrospective review was to describe in our setting, the stage at diagnosis, clinicopathological and treatment patterns among patients with breast cancer. Data were analyzed using SPSS software system. A total of 384 patients were studied. The median age was 45 years (range 21 to 78 years). The male to female ratio was 1: 46.8. Most of the patients were premenopausal (63.8%) and presented late with advanced breast cancer disease. Majority of patients (63.0%) presented with stage III disease. Lymph node and distant metastasis at the time of diagnosis was reported in 70.8% and 21.4% of patients, respectively. Invasive ductal carcinoma (91.7%) was the most frequent histopathological type and most patients (63.8%) had poorly differentiated tumour. Patients with tumour size greater than 6cm had significantly high rate of lymph node metastasis (P=0.001) and presence of necrosis within the tumour (P=0.012) compared to patients with tumour size less than 6cm in diameter. Patients younger than 45 years had significantly high rate of lymph node metastasis compared to the patients above this age (P=0.011). Mastectomy was the main modality of treatment that was used in 99.5% of the patients. Adjuvant chemotherapy and radiotherapy was reported in 44.8% and 11.7% of patients, respectively. Hormonal therapy (tamoxifen) was given postoperatively to all patients. The overall five-year survival rate was 21.8%. The age of patient at diagnosis, stage of disease, extent of lymph node involvement and histological grade were found to be independent predictors of overall survival rate (P<0.001). Local recurrence was 17.7% and it was significantly related to the stage of disease (P=0.003) and non-adherent to adjuvant therapy (P=0.021). Breast cancer patients in this region are relatively young premenopausal women and mostly present late with advanced stage and high rate of lymph node metastasis. There is need to improve public enlightenment of breast cancer and set up screening centres to encourage early presentations.