DISEASES OF THE BREAST IN DISEASES OF THE BREAST IN ACCRAACCRA

Solomon E. Quayson Solomon E. Quayson MSc(Lond).,DIC.,FWACP MSc(Lond).,DIC.,FWACP

Study period: 5-year period Study period: 5-year period beginning January, 2000 and ending beginning January, 2000 and ending December, 2004.December, 2004.

retrospective study retrospective study

A total of 34,764 surgical specimens A total of 34,764 surgical specimens were received during periodwere received during period

3,929 were breast lesions, 3,929 were breast lesions, i.e 11.3% of all surgical pathology i.e 11.3% of all surgical pathology

cases seen. cases seen.

SEX DISTRIBUTIONSEX DISTRIBUTION 3793 (96.5%) females and 136 3793 (96.5%) females and 136

(3.5%) males(3.5%) males female: male ratio of 28:1female: male ratio of 28:1 Breast lesions are mainly dx of Breast lesions are mainly dx of

femalesfemales

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

years.years.

In the female, 79.1% of the total In the female, 79.1% of the total lesions are benign lesions and lesions are benign lesions and malignant neoplasms are 20.9%. malignant neoplasms are 20.9%.

In the males 81.25% of the lesions In the males 81.25% of the lesions are benign and 18.75% are are benign and 18.75% are malignant. malignant.

BENIGN BREAST BENIGN BREAST LESIONSLESIONS

The age range of benign lesions is The age range of benign lesions is 10-88years, 10-88years,

mean 27.5 (+/-12.7) years, mean 27.5 (+/-12.7) years, median 24years and median 24years and mode 20years.mode 20years.

The commonest tumour/tumour-like The commonest tumour/tumour-like lesion is lesion is

fibroadenoma (44.4% of all breast fibroadenoma (44.4% of all breast lesions and 56.0% of benign lesions); lesions and 56.0% of benign lesions); this is followed by this is followed by

fibrocystic change (13.1% of all breast fibrocystic change (13.1% of all breast lesions and 16.5% of benign lesions), lesions and 16.5% of benign lesions),

duct ectasia (1.5%), lipoma (1.4%), and duct ectasia (1.5%), lipoma (1.4%), and others. others.

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

BENIGN BENIGN LESION/AGE GROUP LESION/AGE GROUP

0-90-9 10-1910-19 20-2920-29 30-3930-39 40-4940-49 50-5950-59 >60>60 NOT NOT STATESTATEDD

FIBROADENOMAFIBROADENOMA 00 566566 827827 218218 9696 1717 66 1414

FIBROCYSTIC FIBROCYSTIC CHANGECHANGE

00 5454138138 7070 185185 4343

2121 66

PHYLLODESPHYLLODES 00 22 00 44 44 33 11 00

LACTATING LACTATING ADENOMAADENOMA

00 222323 55 22

0011

00

LIPOMA LIPOMA 00 11 44 1111 1414 1212 1010 00

PAPILLOMAPAPILLOMA 00 11 66 55 1212 66 22 00

PLEOMORPHIC PLEOMORPHIC ADENOMAADENOMA

00 0000

11 00 00 00 00

TUBULAR ADENOMATUBULAR ADENOMA 00 2020 1212 33 11 00 00 11

DUCT ECTASIADUCT ECTASIA 00 22 55 2222 1515 88 77 00

GYNAECOMASTIAGYNAECOMASTIA 00 1010 2626 2020 1616 99 1212 00

OTHERSOTHERS 00 00 33 44 55 22 00 00

TOTALTOTAL 00 658658 10441044 363363 350350 100100 6060 2121

MALIGNANT NEOPLASMMALIGNANT NEOPLASM

constitutes 20.9% of all breast constitutes 20.9% of all breast lesions, lesions,

and 24.0% of all tumours/tumour-and 24.0% of all tumours/tumour-like lesions of the breast. like lesions of the breast.

The age range is 14-91years. The age range is 14-91years. The median is 48years, The median is 48years, mode 60years.. mode 60years..

The ratio of ductal to lobular The ratio of ductal to lobular carcinoma is 23.1:1. carcinoma is 23.1:1.

Lobular carcinoma constitutes 3.9% Lobular carcinoma constitutes 3.9% of all the malignancies, and of all the malignancies, and

ductal carcinoma 90.1%. ductal carcinoma 90.1%.

TABLE VI: SEX DISTRIBUTION OF MALIGNANT LESIONS

SEX/TYPE OF MALIGNANCYSEX/TYPE OF MALIGNANCYFEMALEFEMALE MALEMALE TOTAL TOTAL

LOBULARLOBULAR 3232 00 3232

DUCTAL (NOS)DUCTAL (NOS) 673673 1919 692692

MUCINOUSMUCINOUS 2121 11 2222

PAPILLARYPAPILLARY 88 11 99

MEDULARYMEDULARY 77 00 77

COMEDOCOMEDO 22 00 22

TUBULARTUBULAR 22 00 22

PAGET’S DISEASEPAGET’S DISEASE 1313 00 1313

SQ. CELL CARCINOMASQ. CELL CARCINOMA 1010 11 1111

MALIGNANT PHYLLODESMALIGNANT PHYLLODES 77 00 77

NHLNHL 66 11 77

HODGKINSHODGKINS 11 00 11

OTHERSOTHERS 1414 11 1515

TOTALTOTAL 797797 2424 821821

TABLE VII: MALIGNANT LESIONS WITH ITS PERCENTAGES/CONFIDENCE LIMITS

SEX/TYPE OF MALIGNANCYSEX/TYPE OF MALIGNANCYFREQUENCYFREQUENCY PERCENTAGEPERCENTAGE 95% CONFIDENCE LIMITS95% CONFIDENCE LIMITS

LOBULARLOBULAR 3232 3.93.9 2.7 – 5.42.7 – 5.4

DUCTAL (NOS)DUCTAL (NOS) 692692 77.377.3 54.0 – 79.854.0 – 79.8

MUCINOUSMUCINOUS 2222 2.52.5 1.2 – 3.61.2 – 3.6

PAPILLARYPAPILLARY 99 1.11.1 0.0 – 2.10.0 – 2.1

MEDULARYMEDULARY 77 0.90.9 0.4 – 1.80.4 – 1.8

COMEDOCOMEDO 22 0.20.2 0.0 – 1.00.0 – 1.0

TUBULARTUBULAR 22 0.20.2 0.0 – 1.00.0 – 1.0

PAGET’S DISEASEPAGET’S DISEASE 1313 1.61.6 0.9 – 2.70.9 – 2.7

SQ. CELL CARCINOMASQ. CELL CARCINOMA 1111 1.51.5 0.8 – 2.60.8 – 2.6

MALIGNANT PHYLLODESMALIGNANT PHYLLODES 77 0.90.9 0.4 – 1.80.4 – 1.8

NHLNHL 77 0.90.9 0.4 – 1.80.4 – 1.8

HODGKINSHODGKINS 11 0.10.1 0.0 – 0.80.0 – 0.8

OTHERSOTHERS 1515 1.81.8 1.0 – 3.01.0 – 3.0

TOTALTOTAL 821821 100.0100.0

HISTOGRAM OF AGE HISTOGRAM OF AGE DISTRIBUTION OF DISTRIBUTION OF

MALIGNANCIESMALIGNANCIES

AXILLARY LYMPH NODE AXILLARY LYMPH NODE METASTASESMETASTASES

The lymph node status of 358 of the The lymph node status of 358 of the malignant cases was reported. malignant cases was reported.

67.0% of the cases had metastases to 67.0% of the cases had metastases to the axillary lymph node, and the axillary lymph node, and

33.0% had no metastases to the nodes 33.0% had no metastases to the nodes implying that implying that

two-thirds of all malignant breast two-thirds of all malignant breast lesions with known nodal status are at lesions with known nodal status are at an advanced stage at the time of an advanced stage at the time of diagnosis.diagnosis.

Of the 748 cases of primary breast Of the 748 cases of primary breast malignancies graded, malignancies graded,

26.1% are Grade I, 26.1% are Grade I, 36.5% Grade II, and 36.5% Grade II, and 37.5% Grade III. 37.5% Grade III. This means that 74.0% of all primary breast This means that 74.0% of all primary breast

malignancies are high grade (II and III) malignancies are high grade (II and III) and 26.0% are low grade and 26.0% are low grade

COMMONEST BREAST COMMONEST BREAST LESIONSLESIONS

AGE VERSUS BENIGN AND AGE VERSUS BENIGN AND MALIGNANT LESIONS MALIGNANT LESIONS

MALE BREAST LESIONSMALE BREAST LESIONS

The ratio of female to male lesions is The ratio of female to male lesions is 28.1:1. 28.1:1.

Male lesions are only 3.4% of all Male lesions are only 3.4% of all breast lesions and breast lesions and

male benign lesions constitute 4.2% of male benign lesions constitute 4.2% of the total benign lesions, the total benign lesions,

malignant lesions are 2.9% of all malignant lesions are 2.9% of all breast malignancies.breast malignancies.

The commonest male lesion is The commonest male lesion is gynaecomastia which is 99.96% of gynaecomastia which is 99.96% of all the benign lesions and all the benign lesions and

Other benign lesions include Other benign lesions include lipomas, normal breast and lipomas, normal breast and mastitis /abscessmastitis /abscess

Of the 821 total cancersOf the 821 total cancers

24 were from males (2.9%),24 were from males (2.9%), giving a female: male ratio of 33.2:1 giving a female: male ratio of 33.2:1 Ductal carcinoma and its variants Ductal carcinoma and its variants

constituted 87.5% constituted 87.5% No lobular carcinoma was seen in the No lobular carcinoma was seen in the

present study. present study. Others were a case of SCC, and two Others were a case of SCC, and two

Lymphomas. Lymphomas.

DISCUSSION & DISCUSSION & CONCLUSIONCONCLUSION

The commonest breast lesion is fibroadenoma The commonest breast lesion is fibroadenoma constitutes constitutes

56.6% of all benign lesions. 56.6% of all benign lesions. In 1977, Anim had 33.1% all lesions (and 43.6% of In 1977, Anim had 33.1% all lesions (and 43.6% of

benign lesions) to be fibroadenomas.benign lesions) to be fibroadenomas. Ohene-Yeboah, also had fibroadenoma as Ohene-Yeboah, also had fibroadenoma as

commonest as well commonest as well Ihekwaba had 55.6% (of benign lesions) in a study Ihekwaba had 55.6% (of benign lesions) in a study

from Ibadan, from Ibadan, Adesunkanmi and Agbakwuru had 46.2% in Ile Ife, Adesunkanmi and Agbakwuru had 46.2% in Ile Ife,

and and Ajayi and Adekunle had 39.5% of non-malignant Ajayi and Adekunle had 39.5% of non-malignant

breast masses in Ibadan, breast masses in Ibadan,

Asumanu et al, and Baako had fibrocystic Asumanu et al, and Baako had fibrocystic change as commonest breast lesionchange as commonest breast lesion

Studies not backed by histo-/cytoStudies not backed by histo-/cyto Ajayi and Adekunle Ibadan, all their Ajayi and Adekunle Ibadan, all their

cases were confirmed by histology and cases were confirmed by histology and they wrotethey wrote

“ “this eliminated the guesswork of this eliminated the guesswork of clinical examination whereby ‘nodularity’ clinical examination whereby ‘nodularity’ is equated with mammary dysplasia”is equated with mammary dysplasia”

Studies in black and African women Studies in black and African women fromfrom

Nigeria, Trinidad and India show Nigeria, Trinidad and India show that fibroadenoma is the commonest that fibroadenoma is the commonest breast tumour as opposed to breast tumour as opposed to Caucasian women who have Caucasian women who have fibrocystic change as the most fibrocystic change as the most common breast tumour. common breast tumour.

The reason for this racial difference The reason for this racial difference is not apparent. is not apparent.

cancercancer

Most breast cancers present Most breast cancers present at an advanced stage and at an advanced stage and they are of high grades at the time they are of high grades at the time

of diagnosis in Ghana. of diagnosis in Ghana.

Breast cancer in the Ghanaian Breast cancer in the Ghanaian women will have poorer prognostic women will have poorer prognostic and predictive factors, and predictive factors,

which implies poorer outcomes in which implies poorer outcomes in management in these women.management in these women.

(Tripple Negative immuno-stain ) (Tripple Negative immuno-stain )

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

Most breast lesions in the male are Most breast lesions in the male are benign lesion, and are benign lesion, and are

mostly gynaecomastia. mostly gynaecomastia. Male breast malignancies are less Male breast malignancies are less

than 3% of all breast cancers. than 3% of all breast cancers. The findings are similar to those The findings are similar to those

seen in Ghana in previous studies seen in Ghana in previous studies and to those from the sub-region. and to those from the sub-region.

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

AUTHOR (REF) CITY/COUNTRY PERIOD OF STUDY

NO. OF YEARS

NO. OF CASES

RATIO (M:F)/%

CURRENT STUDY ACCRA /GHANA 2000-2004 5 24 1:33.2/2.9

AKOSA ET AL ACCRA /GHANA 1980-1996 17 18 1:41/2.4

AJAYI ET AL LAGOS/NIGERIAN 1971-1980 10 12 1:42/2.4

IHEKWABA IBADAN/NIGERIAN

1971-1990 20 73 1:26/3.75

ADENJI ILE-EFE/ NIGERIAN

1977-1996 19 10 1:50/2.0

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

suggested that women in particular suggested that women in particular should be taught Self Breast should be taught Self Breast Examination (SBE). Examination (SBE).

Clinical Breast Examination (CBE) Clinical Breast Examination (CBE) and Self Breast Examination (SBE) and Self Breast Examination (SBE) alone are not enough lifesaving alone are not enough lifesaving screening methods. screening methods.

Widespread screening methods Widespread screening methods

(esp mammography/ultrasonography) (esp mammography/ultrasonography) essentialessential

If not feasible, screening can begin in If not feasible, screening can begin in institutions, institutions, city or region, or by city or region, or by targeting screening of women at targeting screening of women at

highest risk highest risk

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