Breast cancer is a very common disease in Nigeria. It is often associated with a poor
prognosis for a variety of reasons. This study was designed to investigate the challenges,
severity, outcome and factors influencing the outcome of the management of breast
cancer in a Nigerian Teaching Hospital with a view to finding ways to improve the
current dismal outlook for patients with the disease. The clinical records of patients
seen with breast cancer over an 8-year period (1996-2003) in the two units of the
Teaching hospital were reviewed. The two units serve the urban, semi-urban and rural
communities of some parts of southwestern Nigeria. Two hundred and twelve patients
with breast cancer were seen over the 8-year period of the study. The mean age was
48 years (23-85 years). There were 211 female and one male. One hundred and three
patients (48.7%) had either postprimary or tertiary education. A proportion of 66.7%
were premenopausal, 79.2% had pregnancy early in life and were multi-parous. These
also gave a history of prolonged breast-feeding of their children. The tumour was
self-detected in 195 (92%). The mean duration of symptoms was 11.2 months (9 days-7
years). Pain in 100 patients (47%) was the most common symptom and the cancer was
in the left breast in 113 (53.3%). Localized cancer was in the upper outer quadrant
in 85 (40%), whereas the whole breast was involved in 55 patients (26%). Loco-regional
features of advanced cancer were seen in 157 patients (74%). The tumour was fungating
in 83 (39%) and there was clinical evidence of systemic metastasis in 28 patients
(13%). One hundred and seventy-four (80.6%) patients had advanced disease (stages
3 and 4). Definitive surgery was possible in 185 patients (87.3%), neoadjuvant chemotherapy
was required in 65 (30.6%), postoperative adjuvant chemotherapy in 178 (84%; drug
combinations were CMF-cyclophosphamide, methotrexate, 5-fluorouracil, CMFP-CMF plus
prednisone, and CAF-cyclophosphamide, adriamycin, 5-fluorouracil), tamoxifen was administered
in all the patients. Only 70 (33.2%) patients were known to have received radiotherapy
among those referred to the Radiotherapy unit, with associated fair treatment compliance
after surgery. Outpatient clinic attendance was also very poor, only 27 (12.7%) were
still being seen in the clinic, 83 patients (39%) were known to be dead and 102 patients
were lost to follow-up. The mean follow-up period was 8.4 months (1 week-6 years).
In conclusion, breast cancer is very common in our area of practice in Nigeria; the
majority of our patients were young and premenopausal women presenting in the advanced
stages of cancer. Treatment compliance was very poor. The majority of the patients
were dead or lost to follow-up within a year of diagnosis.