A Profile of Female Breast Cancer Patients in a Kenyan Urban Private Hospital
Authors: Riogi B MBChB, Odhiambo K MBChB, M.Med (Surgery), Affiliation: Kisii Level 5 hospital, Kenya, Correspondence: Bahaty Riogi Email: email@example.com
Introduction: Bre ast cancer is one of the commonest cancers in Kenya withvery devastating outcomes due to poor screening and low aware- ness amongst women. In Kenya outsi de Nai robi there are no org anized bre ast care cli nics in public hospit als which can help to easen the bre ast disease burden. It was in view of this that department of surg ery decided to set up a breast cli nic at Kisii Level 5 Hospital to cater for the popula- tion in the south western Kenya region.An audit was done to assess the pro gress of the clinic.Result s: 103 patie nts were seen over a three month period with anaverage of 10.3 patie nts per cli nic vis it. Benign breast conditio ns were commonest condition with 27% of this being fibroadenomas. Twenty twopercent of patients had malignant disease with 79% presenting in stage 3and 4. Challenges encountered in clu ded lack of ra dio therapy and chemotherapy. Conclusion: Breast disease in resource limited facilities is sizeable and central ized breast management centers is neces sa ry and possib le . Mentorship and supportof newly developing bre ast clinics is essential for their success.
Breast cancer accounts for 23% of all female cancers world- wide (1). It is the commonest cause of death and disabil- ity, especially among young women living in low income countries (2). Most patie nts present at advanced stage of breast disease (3). This may be attributed to poor access to breast care. In Kenya, breast care is establis hed in central health fa- cilities such as Kenyatta National Hospital where most patie nts are unable to access due to geogra phical and fi- nancial constrain ts. Further, the few breast care facilities cannot handle the overwhelming cases of breast disease in the country due to the limita tio ns in terms of infrastr ucture and adequately trained personnel.In view of this, establis hing breast clin ics in the rural towns will aid alleviate the breast burden in health care. Early di- agnosis and screening of breast cancer will improve health services. With this in mind, a breast clin ic was started in Kisii level 5 Hospita l. This artic le highlights the experience in this clinic.
Hospital profile : Kisii level 5 hospital (KL5H) is a gov- ernment facilit y in Kisii County, Nyanza Province. It is a referral centre for Nyamira, Homabay, Migori, Kisii, Trans- mara counties. Patie nts from Tarime district in neighbour- ing country of Tanzania are also treated at KL5H. It serves a population of 4,613,174 (4). The hospital has several consulta ntledunits which include surgical, medical, pae- diatric, obstetrics and gynaecology, out-patie nt and psychi- atry. It has a bed capacity of four hundred and sixty three patie nts and serves as an internship training facility for nursing offi cers, clin ical officers, pharmacists and medicaloffi cers. Initiativ e to start breast clin ic: An observation was made that sizeable number of breast patie nts were scattered in different clin ics and in in-patient wards with in the hos- pita l which translated to poor patie nt follow up. Most of the patie nts were seen at advanced stage of breast disease. The initiative to start a breast clinic was aimed at centralis- ing the management of breast patie nts, documentation of breast burden, to institute uniformity in management of breast disease and to improve follow up of patie nts. Dis- cussions were held with heads of surgical, radiology, out- patie nt, obstetrics and gynaecology and medicine units. Consultation with breast specialis ts in Kenyatta National Hospita l was made. It was agreed to have the breast clinic run once a week by the surgical team. Patie nt follow up was achieved through a data base with mobile numbers of pa- tie nts, their close relatives or neighbours. This helped when patie nts missed their appointments. Analysis: An analysis of the breast clin ic was done six months after the clin ic started. The aim of this was to assess the profile of patie nts seen and the success of the clinic All patients seen at th e breast clinic over a period of three months wer e assessed, data were collected in an excelspread sheet an d analysed.
The total number of patients seen at th e breast clinic over three months was onehundred an d three. This included new patients, re-visits an d post-operative follow ups. The number of new cases was eighty five patients (85) with 77 females (91%) an d 8 males(9%).The av erage number of patients seen per visit was 10.3. The diagnosis of cases seen at th e breast clinic is shown in tables1-2. The mean age of th e male patients was 25.98 years. Half of them presented with gynaecomastia.Nineteen patients had breast cancer (17 females, 2 males). The age at presentation of breast cancer 27-86 years with a mean of 48.6 years. Most cancers wer e stage three (table 2). Overall, 79% of patients presented to the clinic in late stage of breast cancer (stage 3 and 4) having varied reasons (Table 3).
The figures seen at th e breast clinic in Kisii level 5 Hospital are comparable to those reported for Kenyatt a National Hospital (5). The av erage number of patients seen per visit in KNH is 11 which is similar to 10.3 in KL5H. The female gender preponderance of 91% is consistent with worldwide rates. For males, as is th e case with KNH (5) an d Saudi Ara- bia (6), gynaecomastia was th e commonest condition. The mean age at presentation of 48.6 years also mirrors th e av- erage of 47 years at th e national referral hospital (7). Majority of patients presented at ad vanced stage of breast disease. A similar trend characterises th e disease in African an d Arab countries (8-10). In Nigeria 75% of patients pres-en t at stage III an d IV(8). Lack of a breast protocol in pe- ripheral health facilities may explain th e lat e presentation at diagnosis. Patients ar e treated an d reassured of a breast lump being benign without benefit of a biopsy. Efforts aimed at early diagnosis may improve stage at diagnosis an d potentially improve probability of survival an d cure (3).The challenges faced in our breast clinic included lack of mammography unit in th e hospital an d th e wider county. Patients hav e to tr avel over 130 kilometres to have a mam- mogram done. There was no chemotherapy or radiother- apy being offered at KL5H or provincial hospital. We still referred patients to th e national referral hospital. This leads to overcrowding of th e services an d long waiting time for th e patients leading to inefficient services renderedand some patients giving up al l together. In conclusion, th e burden of breast disease in th e periph-
Click to view table 1
Click to view table 2
Click to view table 3
eral health facilities is sizeable. Centralised an d organized management of breast disease is essential an d possible in resource limited health facilities. We recommend periodic breast care training of medical officers an d clinical of- ficers working in peripheral health facilities to enhance deliver y. Mentorship an d support in terms of funding is es - sential in encouraging newly developing breast clinics.
Saghir NS, Khalil MK, Eid T. Trends in epidemiology and management of breast cancer in developing Arab coun- tries: a literature and registry analysis. International J. Surg.200 7;5(4):225–233
Porter P. “Westernizing” women’s risks? Breast cancer in low- er-income countries. New Eng J. Med. 2008;358(3):213–21
Arafat T. Breast Cancer in Low- and Middle-Income Coun- tries: An Emerging and Challenging Epidemic J Oncol.2010;2010: 490631.
Keny a demographic survey- 200 9
Otieno ES, Kimende SK, Micheni JN. Patterns of breast dis- ease at Keny att a National Hospital. Ann Afri 2008; 2:97-101
Chiedozi LC, El-Hag IA, Kollur SM; Breast Diseases in the northern region of Saudi Arabia. Saudi Med J; 2003;6:623-7
Otieno ES.Delayed presentation of breast cancer patients. EAMJ April 2010; 87(4) 147-50.
Anyanwu SNC. Temporal trends in breast cancer pres-entation in the third world. J. Experimental Clin Ca Res. 2008;27(1):17
Elattar I, Zaghloul M, Omar A, Mokhtar N. Breast cancer in Egypt. Cairo, Egypt: NCI Cairo Pub
Abdel-Fattah M, Lotfy NS, Bassili A. Current treatment modalities of breast-cancer patients in Alexandria, Egypt. Breast. 2001;10(6):523–529