|Year : 2014 | Volume
| Issue : 2 | Page : 50-53
Management of breast lumps in Maiduguri, Nigeria
Ali Nuhu1, S. Aliyu1, A. B. Musa2
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 Publication||13-Jun-2014|
Department of Surgery, University of Maiduguri Teaching Hospital, P. M. B. 1414, Maiduguri, Borno State
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
| Introduction|| |
Lumps in the breast is the most common presentation of breast diseases in both males and females. , Malignant transformation of breast lump has severe psychological and physical impacts in both males and females. Though most breast lumps are benign,  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. , Early detection and treatment of breast cancer reduces mortality and saves patients from the more expensive treatment of advanced stages. ,
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|| |
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|| |
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.
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.
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|| |
Many studies in the West African sub-region have shown a wide range of breast lesions in both males and females. ,
The findings in the current study are consistent with previous ones , which showed that benign breast lumps are more common than malignant ones studies. Olu-Eddo and Ugiagbe  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; , This is a lesion of younger women mostly below the age of 20 years, with a peak incidence at age 15-21 years.  Many reports have shown very large sizes of fibroadenoma described as a giant lesion in young girls beyond the 5 cm size. , Reports from African countries have mean sizes up to 10-13 cm in juveniles/teenagers. 
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.  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.  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  29% of patients with invasive carcinoma were young females, which is lower than 38.4% in the current report. In America,  Australia,  and Korea,  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. 
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.  Benign breast diseases accounted for 60.7% of our series, which is lower than reports from other studies in Nigeria. , 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.  A similar pattern to this series has been reported from other referral centers where there seems to be a pool of cancer cases. 
| Conclusion|| |
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.
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[Table 1], [Table 2], [Table 3], [Table 4]
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