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ORIGINAL ARTICLE
Year : 2014  |  Volume : 17  |  Issue : 2  |  Page : 50-53

Management of breast lumps in Maiduguri, Nigeria


1 Department of Surgery, College of Medical Sciences, University of Maiduguri, University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria
2 Department of Histopathology, College of Medical Sciences, University of Maiduguri, University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria

Date of Web Publication13-Jun-2014

Correspondence Address:
Ali Nuhu
Department of Surgery, University of Maiduguri Teaching Hospital, P. M. B. 1414, Maiduguri, Borno State
Nigeria
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DOI: 10.4103/1118-8561.134475

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  Abstract 

Background: Reported changes in the demography, modes of presentation and histological variants of tumors of the breast have been published in developed and some developing countries. Although benign lesions have persistently accounted for most breast tumors, the incidence of malignant breast lesion in young women in sub-Saharan Africa has been disturbingly high. We reviewed the demographics, pattern and management of breast lumps excised at University of Maiduguri Teaching Hospital (UMTH) over a 6 year period. Patients and Methods: A retrospective study of patients with breast lumps at UMTH was carried out between January 2005 and December 2010. Details of their bio-data, clinical, and histopathology details were analyzed using descriptive statistics. Results: A total of 913 patients, comprising 887 females (97.2%) and 26 males (2.8%) were reviewed. The mean age was 33.1 ± 14.6 years (range: 12-80 years) and the mean duration of symptoms was 8 ± 2.14 months (range: 2-23 months). 359 (39.3%) were malignant and 577 (63.2%) were benign. The mean ages of women and men with invasive carcinomas of the breast were 45.58 ± 13.22 and 49.75 ± 18.28 years, respectively. The mean age of women with benign breast disease was 28.4 ± 10.0 for fibrocystic disease and 21.8 ± 5.31 years for fibroadenoma. Mode of presentations included ulcers (8.7%), axillary lymph node enlargement (30.0%), nipple discharge (13.0%) and breast pain (21.7%). The most common histological diagnoses were carcinoma of the breast, N = 340 (37.2%), fibroadenoma, N = 276 (30.2%) and fibrocystic disease, N = 199 (21.8%). The least common pathology was tuberculosis of the breast, N = 6; (0.7%). Conclusion: Though benign diseases are still more common, a high percentage of breast lumps in Maiduguri are due to malignant disease and this is frequent in younger women.

Keywords: Benign, breast lumps, malignant, North-Eastern Nigeria


How to cite this article:
Nuhu A, Aliyu S, Musa AB. Management of breast lumps in Maiduguri, Nigeria. Sahel Med J 2014;17:50-3

How to cite this URL:
Nuhu A, Aliyu S, Musa AB. Management of breast lumps in Maiduguri, Nigeria. Sahel Med J [serial online] 2014 [cited 2020 Jul 4];17:50-3. Available from: http://www.smjonline.org/text.asp?2014/17/2/50/134475


  Introduction Top


Lumps in the breast is the most common presentation of breast diseases in both males and females. [1],[2] Malignant transformation of breast lump has severe psychological and physical impacts in both males and females. Though most breast lumps are benign, [3] the true nature of a lump cannot be made from its clinical features alone. There are features that strongly suggest a lump may be benign, but a definite diagnosis is made with absolute certainty only on tissue biopsy and histology. Many patients in Northern Nigeria as in other parts of the country present with neglected breast lumps that are ulcerated, have multiple matted axillary lymphadenopathy, destroyed nipples and other features of advanced malignancy, mainly out of ignorance and poverty. [4],[5] Early detection and treatment of breast cancer reduces mortality and saves patients from the more expensive treatment of advanced stages. [5],[6]

We reviewed 913 patients treated by general surgery units of the University of Maiduguri Teaching Hospital (UMTH) to reveal their clinical and histopathological features. It is hoped that the generated data would be useful for patients' counseling/education, especially the need for screening for early detection of breast cancer.


  Patients and methods Top


During the period of months between January 2005 and December 2010, a retrospective study of all patients (males and females) with discrete breast lumps treated at UMTH was carried out. Relevant demographic, clinical and histopathological details of excised lumps were extracted from each patient's hospital records. Breast biopsies were fixed in 10% formalin and sent to the pathology laboratory for processing. Tissues were fixed and stained in hematoxylin and eosin for reporting. Only those with complete tissue diagnosis were included in the study. Data were analyzed using SPSS Version 16.0 for Windows (Chicago, IL).


  Results Top


A total of 913 patients comprising 887 (97.2%) females and 26 (2.8%) males with breast lumps, were reviewed. The mean age was 33.1 ± 14.6 years (range: 12-80 years) and the mean duration of symptoms was 8 ± 2.1 months (range: 2-23 months). All (100%) patients had lumps in the breast of which, 85 (9.3%) were bilateral 359 (39.3%) were malignant and 577 (63.2%) were benign. The mean ages of women and men with invasive carcinomas of the breast were 45.6 ± 13.2 and 49.8 ± 18.3 years, respectively. The mean age of women with benign breast disease was 28.4 ± 10.0 years for fibrocystic disease and 21.8 ± 5.31 years for fibroadenoma. A total of 656 (73.9%) women with breast lumps were 40 years of age and below [Table 1]. There were 489 women below the age of 30 years, of which 31 (6.3%) had invasive cancers. The youngest woman with invasive carcinoma of the breast was 20 years old. The breast lumps were painless in 668 (73.2%) patients. Other clinical features are outlined in [Table 2]. The mean size of the lumps on clinical breast examination at presentation was 8.38 ± 6.65 cm, (range: 2-30 cm). Nearly 64% of the lumps were excised under local anesthesia (1% plain xylocaine) and 36% under general anesthesia. These were patients with multiple deep seated lumps and those with malignant lumps. The three most common causes of breast lumps were carcinoma, fibroadenoma and fibrocystic disease of the breast accounting for 37.2%, 30.2% and 21.8%, of breast lumps, respectively. Other histological variants included phyllodes tumor, ductal carcinoma in situ (DCIS), and breast abscesses. [Table 3] summarizes the histological variants of breast lumps in Maiduguri while [Table 4] relates these to patients' age.
Table 1: Age and sex distribution of breast lumps

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Table 2: Clinical presentation of patients with breast lumps

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Table 3: Histopathology of breast lumps in Maiduguri

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Tuberculous mastitis was the least common pathology accounting for 0.7% of cases. Of the 26 lumps in males, there were 9 (34.6%) gynecomastia, 11 (42.3%) invasive ductal carcinoma, one each of invasive lobular and DCIS with background fibrocystic change, and 2 each of fibrocystic disease and fibroadenoma.
Table 4: Age and histological types of breast lumps

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The main histological type of breast cancer was invasive ductal carcinoma, which was seen in 303 (33.2%) cases. There were 19 (2.1%) cases of DCIS and 32 (3.5%) invasive lobular carcinoma. Four young (1.0%) women with bilateral breast lumps had Burkitt's lymphoma. The total number of patients with malignant breast disease was 349 (38.2%), while 564 (61.8%) had benign breast lumps. Majority 336 (96.3%) of patients with cancer of the breast were females, presenting with ulcerating masses in 89 (26.5%). Mastectectomies were carried out for 217 (64.6%) of patients with carcinoma. Lumpectomies were done for those with lesions confined to the breast, to establish the histological diagnosis. More than 80% of the breast lumps were found in women aged 40 years and younger.


  Discussion Top


Many studies in the West African sub-region have shown a wide range of breast lesions in both males and females. [7],[8]

The findings in the current study are consistent with previous ones [9],[10] which showed that benign breast lumps are more common than malignant ones studies. Olu-Eddo and Ugiagbe [11] have reported that 72.4% of all breast lumps in Benin City, Nigeria were benign. This is higher than our figure of 63.2% in Maiduguri. We observed that cancer of the breast is the single most common histological variant of breast lumps in the current report. This may be because our study is hospital-based.

The mean age of patients with fibroadenoma is in keeping with other studies; [10],[12] This is a lesion of younger women mostly below the age of 20 years, with a peak incidence at age 15-21 years. [12] Many reports have shown very large sizes of fibroadenoma described as a giant lesion in young girls beyond the 5 cm size. [12],[13] Reports from African countries have mean sizes up to 10-13 cm in juveniles/teenagers. [10]

This study shows a low incidence of breast cancer among males, with their mean age at presentation being only slightly higher than females with breast cancer. This is in contrast to what is well-known that there is usually about a decade age differential in favor of the males. [14] Our data shows that females with breast cancer are younger than their western counterparts and there is especially a high incidence in young women in their early third decade of life. These findings and their underlying factors deserve further investigation. The American Cancer Society considers women that are <40 years of age as "young" in terms of breast cancer occurrence. [15] This contrasts to higher proportions of females in this age group that are increasingly diagnosed with invasive, aggressive histological types of breast cancer in West Africa with attendant poor prognosis. In Ibadan, Nigeria [16] 29% of patients with invasive carcinoma were young females, which is lower than 38.4% in the current report. In America, [15] Australia, [17] and Korea, [18] the comparative figures of females in the same age group with breast cancer are 5%, 6%, and 9.6%, respectively. This is partly probably because these countries have more aged populations compared with sub-Saharan Africa where life expectancy is low.

Though conflicting opinions exist concerning the evolution, pathology and prognosis of breast cancer in young women, the roles of pregnancy and lactation, birth order, (more common in the first daughter), BRCA1 and 2 gene (mutations), family history of invasive cancer at younger ages have all been advanced as reasons for breast cancer in young women. [19]

The histopatological pattern of breast biopsies in this study showed malignant breast lesions to account for 39.3%, which is lower than 47.3% observed in Nnewi, Nigeria. [20] Benign breast diseases accounted for 60.7% of our series, which is lower than reports from other studies in Nigeria. [20],[21] The most common causes of a lump in the breast in this series were invasive ductal carcinoma (33.2%), closely followed by fibroadenoma (30.2%) and fibrocystic disease of the breast (21.8%). Many studies have reported fibroadenoma to be the single most common cause of a lump in the breast followed by fibroadenosis or fibrocystic disease. [22] A similar pattern to this series has been reported from other referral centers where there seems to be a pool of cancer cases. [4]


  Conclusion Top


Breast lumps occur in all age groups with the single most common histological variant being invasive ductal carcinoma while benign diseases are the overall most common lesions in the study population. Females with malignant breast lesions were comparatively younger and present at more advanced stages than in the developed countries.

 
  References Top

1.Sharma A, Bandari R, Gilbert D, Sharma AK. Benign and malignant breast disease presenting to Bhaktapur Cancer Hospital. Kathmandu Univ Med J (KUMJ) 2005;3:384-7.  Back to cited text no. 1
    
2.Goehring C, Morabia A. Epidemiology of benign breast disease, with special attention to histologic types. Epidemiol Rev 1997;19:310-27.  Back to cited text no. 2
    
3.Kumar R. A clinicopathologic study of breast lumps in Bhairahwa, Nepal. Asian Pac J Cancer Prev 2010;11:855-8.  Back to cited text no. 3
    
4.Anyanwu SN. Breast cancer in eastern Nigeria: A ten year review. West Afr J Med 2000;19:120-5.  Back to cited text no. 4
    
5.Ohene-Yeboah MO. An audit of excised breast lumps in Ghanaian women. West Afr J Med 2005;24:252-5.  Back to cited text no. 5
    
6.Anderson BO, Braun S, Lim S, Smith RA, Taplin S, Thomas DB, et al. Early detection of breast cancer in countries with limited resources. Breast J 2003;9 Suppl 2:S51-9.  Back to cited text no. 6
    
7.Nggada HA, Yawe KD, Abdulazeez J, Khalil MA. Breast cancer burden in Maiduguri, North eastern Nigeria. Breast J 2008;14:284-6.  Back to cited text no. 7
    
8.Oluwole SF, Freeman HP. Analysis of benign breast lesions in blacks. Am J Surg 1979;137:786-9.  Back to cited text no. 8
    
9.Otu AA. Benign breast tumours in an African population. J R Coll Surg Edinb 1990;35:373-5.  Back to cited text no. 9
    
10.Bewtra C. Fibroadenoma in women in Ghana. Pan Afr Med J 2009;2:11.  Back to cited text no. 10
    
11.Olu-Eddo AN, Ugiagbe EE. Benign breast lesions in an African population: A 25-year histopathological review of 1864 cases. Niger Med J 2011;52:211-6.  Back to cited text no. 11
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12.Adesunkanmi AR, Agbakwuru EA. Benign breast disease at Wesley Guild Hospital, Ilesha, Nigeria. West Afr J Med 2001;20:146-51.  Back to cited text no. 12
    
13.Ng WK, Mrad MA, Brown MH. Juvenile fibroadenoma of the breast: Treatment and literature review. Can J Plast Surg 2011;19:105-7.  Back to cited text no. 13
    
14.Dogo D, Gali BM, Ali N, Nggada HA. Male breast cancer in north eastern Nigeria. Niger J Clin Pract 2006;9:139-41.  Back to cited text no. 14
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15.American Cancer Society, author. Breast Cancer Facts and Figures 2007-2008. Atlanta: American Cancer Society Inc. 2007-2008.  Back to cited text no. 15
    
16.Ntekim A, Nufu FT, Campbell OB. Breast cancer in young women in Ibadan, Nigeria. Afr Health Sci 2009;9:242-6.  Back to cited text no. 16
    
17. Connell S, Patterson C, Newman B. Issues and concerns of young Australian women with breast cancer. Support Care Cancer 2006;14:419-26.  Back to cited text no. 17
    
18.Kim JK, Kwak BS, Lee JS, Hong SJ, Kim HJ, Son BH, et al. Do very young Korean breast cancer patients have worse outcomes? Ann Surg Oncol 2007;14:3385-91.  Back to cited text no. 18
    
19.Tabbane F, el May A, Hachiche M, Bahi J, Jaziri M, Cammoun M, et al. Breast cancer in women under 30 years of age. Breast Cancer Res Treat 1985;6:137-44.  Back to cited text no. 19
    
20.Egwuonwo OA, Anyanwu SN, Chianakwana GU, Ihekwoaba EC. Breast lumps in NAUTH, Nnewe: A 5 year review. Niger J Surg 2009;15:6-9.  Back to cited text no. 20
    
21.Irabor DO, Okolo CA. Outcome of one hundred and forty-nine consecutive breast biopsies in Ibadan, Nigeria. Breast Dis 2011;33:109-14.  Back to cited text no. 21
    
22.Aslam HM, Saleem S, Shaikh HA, Shahid N, Mughal A, Umah R. Clinico-pathological profile of patients with breast diseases. Diagn Pathol 2013;8:77.  Back to cited text no. 22
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]


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