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DISEASES OF THE BREAST IN ACCRA Solomon E. Quayson MSc(Lond).,DIC.,FWACP

DISEASES OF THE BREAST IN ACCRA Solomon E. Quayson MSc(Lond).,DIC.,FWACP. Study period: 5-year period beginning January, 2000 and ending December, 2004. retrospective study. A total of 34,764 surgical specimens were received during period 3,929 were breast lesions,

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DISEASES OF THE BREAST IN ACCRA Solomon E. Quayson MSc(Lond).,DIC.,FWACP

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  1. DISEASES OF THE BREAST IN ACCRA Solomon E. Quayson MSc(Lond).,DIC.,FWACP

  2. Study period: 5-year period beginning January, 2000 and ending December, 2004. • retrospective study

  3. A total of 34,764 surgical specimens were received during period • 3,929 were breast lesions, • i.e 11.3% of all surgical pathology cases seen.

  4. SEX DISTRIBUTION • 3793 (96.5%) females and 136 (3.5%) males • female: male ratio of 28:1 • Breast lesions are mainly dx of females

  5. The range of the ages is 10-91years. • The mean age is 33.5 (+/-15.47) years.

  6. In the female, 79.1% of the total lesions are benign lesions and malignant neoplasms are 20.9%. • In the males 81.25% of the lesions are benign and 18.75% are malignant.

  7. BENIGN BREAST LESIONS • The age range of benign lesions is 10-88years, • mean 27.5 (+/-12.7) years, • median 24years and • mode 20years.

  8. The commonest tumour/tumour-like lesion is • fibroadenoma (44.4% of all breast lesions and 56.0% of benign lesions); this is followed by • fibrocystic change (13.1% of all breast lesions and 16.5% of benign lesions), • duct ectasia (1.5%), lipoma (1.4%), and others.

  9. TABLE V: AGE DISTRIBUTION OF BENIGN NEOPLASTIC (AND TUMOUR-LIKE) BREAST LESIONS.

  10. MALIGNANT NEOPLASM • constitutes 20.9% of all breast lesions, • and 24.0% of all tumours/tumour-like lesions of the breast. • The age range is 14-91years. • The median is 48years, • mode 60years..

  11. The ratio of ductal to lobular carcinoma is 23.1:1. • Lobular carcinoma constitutes 3.9% of all the malignancies, and • ductal carcinoma 90.1%.

  12. TABLE VI: SEX DISTRIBUTION OF MALIGNANT LESIONS

  13. TABLE VII: MALIGNANT LESIONS WITH ITS PERCENTAGES/CONFIDENCE LIMITS

  14. HISTOGRAM OF AGE DISTRIBUTION OF MALIGNANCIES

  15. AXILLARY LYMPH NODE METASTASES • The lymph node status of 358 of the malignant cases was reported. • 67.0% of the cases had metastases to the axillary lymph node, and • 33.0% had no metastases to the nodes implying that • two-thirds of all malignant breast lesions with known nodal status are at an advanced stage at the time of diagnosis.

  16. Of the 748 cases of primary breast malignancies graded, • 26.1% are Grade I, • 36.5% Grade II, and • 37.5% Grade III. • This means that 74.0% of all primary breast malignancies are high grade (II and III) • and 26.0% are low grade

  17. COMMONEST BREAST LESIONS

  18. AGE VERSUS BENIGN AND MALIGNANT LESIONS

  19. MALE BREAST LESIONS • The ratio of female to male lesions is 28.1:1. • Male lesions are only 3.4% of all breast lesions and • male benign lesions constitute 4.2% of the total benign lesions, • malignant lesions are 2.9% of all breast malignancies.

  20. The commonest male lesion is gynaecomastia which is 99.96% of all the benign lesions and • Other benign lesions include lipomas, normal breast and mastitis /abscess

  21. Of the 821 total cancers • 24 were from males (2.9%), • giving a female: male ratio of 33.2:1 • Ductal carcinoma and its variants constituted 87.5% • No lobular carcinoma was seen in the present study. • Others were a case of SCC, and two Lymphomas.

  22. DISCUSSION & CONCLUSION • The commonest breast lesion is fibroadenoma constitutes • 56.6% of all benign lesions. • In 1977, Anim had 33.1% all lesions (and 43.6% of benign lesions) to be fibroadenomas. • Ohene-Yeboah, also had fibroadenoma as commonest as well • Ihekwaba had 55.6% (of benign lesions) in a study from Ibadan, • Adesunkanmi and Agbakwuru had 46.2% in Ile Ife, and • Ajayi and Adekunle had 39.5% of non-malignant breast masses in Ibadan,

  23. Asumanu et al, and Baako had fibrocystic change as commonest breast lesion • Studies not backed by histo-/cyto • Ajayi and Adekunle Ibadan, all their cases were confirmed by histology and they wrote • “this eliminated the guesswork of clinical examination whereby ‘nodularity’ is equated with mammary dysplasia”

  24. Studies in black and African women from • Nigeria, Trinidad and India show that fibroadenoma is the commonest breast tumour as opposed to Caucasian women who have fibrocystic change as the most common breast tumour. • The reason for this racial difference is not apparent.

  25. cancer Most breast cancers present • at an advanced stage and • they are of high grades at the time of diagnosis in Ghana.

  26. Breast cancer in the Ghanaian women will have poorer prognostic and predictive factors, • which implies poorer outcomes in management in these women. • (Tripple Negative immuno-stain )

  27. The study further confirms that breast cancer in Ghanaian women occur at younger ages, a decade or more earlier than in Caucasians.

  28. Most breast lesions in the male are benign lesion, and are • mostly gynaecomastia. • Male breast malignancies are less than 3% of all breast cancers. • The findings are similar to those seen in Ghana in previous studies and to those from the sub-region.

  29. TABLE XII: MALE BREAST CANCER IN PRESENT STUDY VERSUS OTHER STUDIES IN GHANA/NIGERIA

  30. Need for extensive and intensive education on breast diseases/cancer so that they can be detected earlier to prevent distant metastases and make management easier.

  31. suggested that women in particular should be taught Self Breast Examination (SBE). • Clinical Breast Examination (CBE) and Self Breast Examination (SBE) alone are not enough lifesaving screening methods.

  32. Widespread screening methods (esp mammography/ultrasonography) essential If not feasible, screening can begin in • institutions, • city or region, or by • targeting screening of women at highest risk

  33. THANK YOU

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