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

Study period: 5-year period beginning January, 2000 and ending December, Study period: 5-year period beginning January, 2000 and ending December, retrospective study retrospective study

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

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

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

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

BENIGN BREAST LESIONS The age range of benign lesions is 10-88years, The age range of benign lesions is 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 lesion is The commonest tumour/tumour-like lesion is fibroadenoma (44.4% of all breast lesions and 56.0% of benign lesions); this is followed by 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), fibrocystic change (13.1% of all breast lesions and 16.5% of benign lesions), duct ectasia (1.5%), lipoma (1.4%), and others. duct ectasia (1.5%), lipoma (1.4%), and others.

TABLE V: AGE DISTRIBUTION OF BENIGN NEOPLASTIC (AND TUMOUR-LIKE) BREAST LESIONS. BENIGN LESION/AGE GROUP >60 NOT STATE D FIBROADENOMA FIBROCYSTIC CHANGE PHYLLODES LACTATING ADENOMA LIPOMA PAPILLOMA PLEOMORPHIC ADENOMA TUBULAR ADENOMA DUCT ECTASIA GYNAECOMASTIA OTHERS TOTAL

MALIGNANT NEOPLASM constitutes 20.9% of all breast lesions, constitutes 20.9% of all breast lesions, and 24.0% of all tumours/tumour-like lesions of the breast. and 24.0% of all tumours/tumour-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 carcinoma is 23.1:1. The ratio of ductal to lobular carcinoma is 23.1:1. Lobular carcinoma constitutes 3.9% of all the malignancies, and Lobular carcinoma constitutes 3.9% of all the malignancies, and ductal carcinoma 90.1%. ductal carcinoma 90.1%.

TABLE VI: SEX DISTRIBUTION OF MALIGNANT LESIONS SEX/TYPE OF MALIGNANCY FEMALEMALETOTAL LOBULAR32032 DUCTAL (NOS) MUCINOUS21122 PAPILLARY819 MEDULARY707 COMEDO202 TUBULAR202 PAGET’S DISEASE SQ. CELL CARCINOMA MALIGNANT PHYLLODES 707 NHL617 HODGKINS101 OTHERS14115 TOTAL

TABLE VII: MALIGNANT LESIONS WITH ITS PERCENTAGES/CONFIDENCE LIMITS SEX/TYPE OF MALIGNANCY FREQUENCYPERCENTAGE 95% CONFIDENCE LIMITS LOBULAR – 5.4 DUCTAL (NOS) – 79.8 MUCINOUS – 3.6 PAPILLARY – 2.1 MEDULARY – 1.8 COMEDO – 1.0 TUBULAR20.2 PAGET’S DISEASE – 2.7 SQ. CELL CARCINOMA – 2.6 MALIGNANT PHYLLODES – 1.8 NHL70.9 HODGKINS – 0.8 OTHERS – 3.0 TOTAL

HISTOGRAM OF AGE DISTRIBUTION OF MALIGNANCIES HISTOGRAM OF AGE DISTRIBUTION OF MALIGNANCIES

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

Of the 748 cases of primary breast malignancies graded, Of the 748 cases of primary breast 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 malignancies are high grade (II and III) This means that 74.0% of all primary breast malignancies are high grade (II and III) and 26.0% are low grade and 26.0% are low grade

COMMONEST BREAST LESIONS

AGE VERSUS BENIGN AND MALIGNANT LESIONS

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

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

Of 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 constituted 87.5% Ductal carcinoma and its variants constituted 87.5% No lobular carcinoma was seen in the present study. No lobular carcinoma was seen in the present study. Others were a case of SCC, and two Lymphomas. Others were a case of SCC, and two Lymphomas.

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

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

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

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

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

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

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

TABLE XII: MALE BREAST CANCER IN PRESENT STUDY VERSUS OTHER STUDIES IN GHANA/NIGERIA AUTHOR (REF)CITY/COUNTRYPERIOD OF STUDY NO. OF YEARS NO. OF CASES RATIO (M:F)/ % CURRENT STUDYACCRA /GHANA :33.2/2.9 AKOSA ET ALACCRA /GHANA :41/2.4 AJAYI ET ALLAGOS/NIGERIAN :42/2.4 IHEKWABAIBADAN/NIGERIA N :26/3.75 ADENJIILE-EFE/ NIGERIAN :50/2.0

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. 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.

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

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

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