Abideen Olayiwola Oluwasola

Level of awareness of mammography among women attending outpatient clinics in a teaching hospital in Ibadan, South-West Nigeria

BackgroundMammography has been used in developed countries with considerable success but very little is known about this imaging modality in low resource settings. This study examined the level of awareness of mammography and determined factors influencing the level of awareness.MethodsWe conducted a hospital based cross sectional study to investigate the level of awareness of mammography among 818 randomly selected women attending the General Outpatient clinics (GOP) of the University College Hospital (UCH), Ibadan, Nigeria. Independent predictors of level of awareness of mammography were identified using multiple logistic regression analysis.ResultsThe proportion of women who ever heard of mammography was 5%, and they demonstrated poor knowledge of the procedure. Those with primary or secondary levels of education were about three times less likely to be aware of mammography when compared with those with tertiary level of education (OR = 0.3, 95% CI, 0.12 – 0.73). Also, participation in community breast cancer prevention activities (OR = 3.4, 95% CI, 1.39 – 8.36), and previous clinical breast examination (OR = 2.34, 95% CI, 1.10 – 4.96) independently predicted mammography awareness. Newspapers and magazines appeared to be the most important sources of information about mammography screening.ConclusionThe level of awareness of mammography is poor among women attending outpatient clinics in the studied population. Interventions promoting awareness of this screening procedure should give particular attention to the illiterate and older women while clinicians performing breast examinations should utilize the opportunity to inform women about the mammography procedure. Promotion of educational articles on breast cancer and its screening methods via media remains vital for the literate.

Neo-adjuvant capecitabine chemotherapy in women with newly diagnosed locally advanced breast cancer in a resource-poor setting (Nigeria): efficacy and safety in a phase II feasibility study.

The majority of clinical trials of neo‐adjuvant therapy for breast cancer have been conducted in resource‐rich countries. We chose Nigeria, a resource‐poor country, as the major site for a phase II feasibility open‐label multicenter clinical trial designed to evaluate the efficacy, safety, and tolerability of neo‐adjuvant capecitabine in locally advanced breast cancer (LABC). Planned treatment consisted of 24 weeks of capecitabine at a dose of 1,000 mg/m2 twice daily (2,000 mg/m2 total per day). The primary endpoints were overall, partial, complete clinical response rate (OCR, PCR, CCR) and complete pathologic response (cPR). A total of 16 patients were recruited from August 2007 to April 2010. The study was terminated early as a result of slow accrual. After the first three cycles of therapy, PCR were seen in five of 16 patients (31%; 95% CI 11–59%). Of the remaining 11 patients, eight had no response (NR) or stable disease (SD), and three had progressive disease (PD). Seven patients proceeded with further therapy of which had SD. OCR at the end of eight cycles was 44% (95% CI 20–70%). Clinical response and radiologic response by ultrasonomammography were highly concordant (spearman correlation 0.70). The most common adverse effect was Grade 1 hand–foot syndrome, which was seen in 75% of patients. Despite several limitations, we successfully carried out this phase II feasibility study of neo‐adjuvant capecitabine for LABC in Nigeria. Capecitabine monotherapy showed good overall response rates with minimal toxicity and further studies are warranted.

Mammographic parasitic calcifications in South West Nigeria: prospective and descriptive study

Introduction Lymphatic filariasis caused by nematode parasite Wuchereria bancrofti and Brugia Malayi is endemic in the tropics. In Nigeria, 25% of the population is infected. Lymph edema and elephantiasis are the predominant manifestations. Its infrequent manifestation is in the breast. This paper discusses the epidemiology, reviews literature, imaging options and mammographic appearances of these parasitic nematodes. Methods This prospective descriptive study reports on 39 cases of parasitic calcifications seen during mammography in the Radiology Department, University College Hospital between 2006 and 2012 in Ibadan, South West Nigeria. Each mammogram was reported by MO and ATS: assigned a final Bi-RADs category. Parasitic calcifications were further evaluated for distribution, and types of calcification. Results A total of 527 women had mammography done between 2006 and 2012. Thirty-nine women (7.4%) had parasitic breast calcifications. The ages of the women ranged between 38-71 years - mean of 52.36±8.72 SD. Twenty-three (59%) were post-menopausal, 16(41%) were pre-menopausal. The majority (31; 79.5%) were screeners while 8(20.5%) were follow up cases. Approximately half (51.3%) of the women had no complaints. Pain (23.1%) was the commonest presentation in the remaining half. Solitary calcifications were predominant (20) while only 3 cases had 10 calcifications. Left sided calcifications (53.8%) were the majority. Calcifications were subcutaneous in 2/3rds of the women (66.7%) while the Yoruba tribe (84.6%) was principal. Conclusion Parasitic breast calcifications can be misdiagnosed on mammography for suspicious micro-calcification. This publication should alert radiologists in a tropical country like Nigeria to increase diagnostic vigilance thereby preventing unnecessary anxiety and invasive work-up procedures.

Association between langerhans cells population and histological grade of oral squamous cell carcinoma.

Context: Langerhans cells (LCs) are a unique population of antigen processing cells in the epidermis and mucous membrane, which may play a role in the defence mechanism against epithelial tumors. Aims: To compare the distribution of LCs in oral squamous cell carcinomas (OSCC) and normal oral epithelium; and to determine whether the population of LCs in OSCC has any correlation with histological grading of these malignancies. Settings and Design: A cross-sectional immunohistochemical analysis of OSCC cases. Materials and Methods: Forty-eight randomly selected paraffin tissue blocks of OSCC cases and 30 cases of normal oral epithelium were included. Hematoxylin and eosin-stained sections of the OSCC cases were reviewed and categorized as high-grade malignant tumors or low-grade malignant tumors. Tissue sections were analyzed for density of LCs using CD1a antibody expression. Statistical Analysis Used: Data are expressed as percentages compared by Chi-square statistics; mean ± standard deviation, compared by Mann-Whitney-U test and Spearmans correlation tests. Results: LCs population was significantly higher in normal oral epithelium when compared with OSCC cases (P = 0.001). There was also a significant difference in the number of LCs per millimetre square area of tissue section between well-differentiated tumors and poorly-differentiated tumours (P = 0.03). There was a negative correlation between the population density of LCs and the grade of OSCC. Conclusions: These findings suggest that oral mucosal LCs are involved in immune-surveillance and immunologic impairment may characterize invasive OSCC. In addition, LCs density characterizes histological grades of OSCC, which may be of a prognostic value.

Cranial computed tomographic findings in Nigerian women with metastatic breast cancer

Introduction: Brain metastases (BM) occur in up to one-fifth of patients with metastatic breast cancer (MBC). Imaging plays a key role in diagnosis. The pattern and distribution of these changes are also crucial to their management. These patterns have not been fully studied in Nigerian women. Materials and Methods: Retrospective analysis of the findings on the cranial Computed Tomography (CT) scans performed in 59 breast cancer patients with suspected BM treated at the University Teaching Hospital in Ibadan, between 2005 and 2010. The imaging features were evaluated in relation to their clinical characteristics. Results: In the 59 patients studied (mean age 50.9 years ± 11.75 SD), headache (40.7%) and hemiparesis/hemiplegia (16.9%) were the commonest clinical presentation. Lytic skull lesions were seen in 15 patients (25.4%), most commonly in the parietal bones. Thirty-nine patients (66.1%), had parenchymal brain lesions, and only 8 (20.5%) of these were single lesions. Most of the lesions were isodense (19/39; 51.4%) the parietal lobe was the most common site with 50.8% (30/59) occurrence and the leptomeninges the least with 13.6% (8/59). Orbital or sellar region involvement occurred in only two patients. The size of the lesions, was <2 cm in 17 (28.8%), 2-5 cm in 14 (23.7%) and >5 cm in 5 patients. Sixteen (27.1%) patients were free of any lesion either in the skull or brain. Patient presenting with multiple brain lesions were more likely to have skull lesions though this was not statistically significant (P = 0.584). Conclusion: The brain continues to be a sanctuary site for breast cancer metastases and CT imaging remains an invaluable tool in the clinical evaluation and therapeutic management of Nigerian women with BM from MBC. It also appears that the demographic and imaging findings in these patients are similar to other racial groups.

Screening mammography in Ibadan: Our experience

Background: Early detection is an essential step in decreasing the mortality and morbidity of breast cancer. Mammography is a proven effective tool for early breast cancer detection. It has high sensitivity and specificity and remains the gold standard for breast cancer screening. This study aims at describing the findings at screening mammography in women in Ibadan, South-West Nigeria. Materials and Methods : A prospective descriptive single centre study of 568 asymptomatic women who had screening mammography over a 5 year period (2006–2011) in the Department of Radiology, University College Hospital, Ibadan, Nigeria. Two views; the cranio-caudal and the medio-lateral oblique views were obtained. Mammographic findings were reported using the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) lexicon and assigned a final BI-RADS category according to overall findings. Data was analysed using Statistical Package for the Social Science SPSS Inc. Released 2008. SPSS Statistics for Windows, Version 17.0. Chicago USA: SPSS Inc. Results: A total of 568 women participated in the study with age range from 22 to 82 years (mean 47.8 years). About a third (35.6%) of the women were post-menopausal; and a positive family history of breast cancer was reported in 28 (6.2%) women. The most frequent mammographic breast pattern was BI-RADS I (fatty replaced) in 181 (36.5%) women. Two hundred and twenty women had final BI-RADS category of two (benign), with 49% being fibroadenomas. Over 70% of 164 women called back for diagnostic work up absconded for various socioeconomic and religious factors. Nine women with suspicious breast masses were detected and had treatment constituted immediately. Conclusion : Mammography is just gaining ground in Nigeria; future increased patronage by women is anticipated with intense advocacy and widespread breast cancer awareness.

Ultrasound-guided core biopsy of breast lesions in Ibadan: Our initial experience

Background and Objectives: Ultrasound-guided core needle or  tru-cut biopsy is a new concept in breast cancer diagnosis and treatment in developing countries, including Nigeria. A tru-cut biopsy is less invasive surgery, replacing diagnostic surgical biopsies in many institutions. It has a known sensitivity of 94-100%, whether performed with ultrasound or stereotactic guidance. The technique is reliable, simple, reproducible, and relatively cheap. Aims: This is a premier report of ultrasound- guided core biopsy of the breast in Nigeria. This study will evaluate the sampling adequacy and diagnostic accuracy of sonomammographic-guided tru-cut biopsies in determining the nature of a breast lump sent for histopathological analysis. Materials and Methods: A prospective study involving 40 women with clinical suspicion of breast cancer and/or Breast Imaging-Reporting and Data System (BI-RADS) category 3-5 referred for breast imaging at the Department of Radiology of the University College Hospital, Ibadan. Core biopsy was performed with a manual BARD Magnum™ gun, a General Electric GE Logiq P5 ultrasound unit with a high frequency linear transducer. Statistical Package for social sciences [SPSS] Software version 17.0 was used for statistical analysis. Results: Forty core needle biopsies (CNB) were performed on palpable masses. Histopathology confirmed cancer in 24 (60%), while 10 (25%) were benign. Invasive ductal carcinoma accounted for 88% of cancers. Sensitivity and specificity of the core biopsies was found to be 100% and 80%, respectively. Conclusion: Ultrasound-guided biopsy for breast lesion assessment in our center shows high accuracy in determining the nature of a breast lump. Its routine use in countries with limited resources is recommended.

Use of Web-based training for quality improvement between a field immunohistochemistry laboratory in Nigeria and its United States-based partner institution

The importance of hormone receptor status in assigning treatment and the potential use of human epidermal growth factor receptor 2 (HER2)-targeted therapy have made it beneficial for laboratories to improve detection techniques. Because interlaboratory variability in immunohistochemistry (IHC) tests may also affect studies of breast cancer subtypes in different countries, we undertook a Web-based quality improvement training and a comparative study of accuracy of immunohistochemical tests of breast cancer biomarkers between a well-established laboratory in the United States (University of Chicago) and a field laboratory in Ibadan, Nigeria. Two hundred and thirty-two breast tumor blocks were evaluated for estrogen receptors (ERs), progesterone receptors (PRs), and HER2 status at both laboratories using tissue microarray technique. Initially, concordance analysis revealed κ scores of 0.42 (moderate agreement) for ER, 0.41 (moderate agreement) for PR, and 0.39 (fair agreement) for HER2 between the 2 laboratories. Antigen retrieval techniques and scoring methods were identified as important reasons for discrepancy. Web-based conferences using Web conferencing tools such as Skype and WebEx were then held periodically to discuss IHC staining protocols and standard scoring systems and to resolve discrepant cases. After quality assurance and training, the agreement improved to 0.64 (substantial agreement) for ER, 0.60 (moderate agreement) for PR, and 0.75 (substantial agreement) for HER2. We found Web-based conferences and digital microscopy useful and cost-effective tools for quality assurance of IHC, consultation, and collaboration between distant laboratories. Quality improvement exercises in testing of tumor biomarkers will reduce misclassification in epidemiologic studies of breast cancer subtypes and provide much needed capacity building in resource-poor countries.

Inherited Breast Cancer in Nigerian Women

Purpose Among Nigerian women, breast cancer is diagnosed at later stages, is more frequently triple-negative disease, and is far more frequently fatal than in Europe or the United States. We evaluated the contribution of an inherited predisposition to breast cancer in this population. Patients and Methods Cases were 1,136 women with invasive breast cancer (mean age at diagnosis, 47.5 ± 11.5 years) ascertained in Ibadan, Nigeria. Patients were selected regardless of age at diagnosis, family history, or prior genetic testing. Controls were 997 women without cancer (mean age at interview, 47.0 ± 12.4 years) from the same communities. BROCA panel sequencing was used to identify loss-of-function mutations in known and candidate breast cancer genes. Results Of 577 patients with information on tumor stage, 86.1% (497) were diagnosed at stage III (241) or IV (256). Of 290 patients with information on tumor hormone receptor status and human epidermal growth factor receptor 2, 45.9% (133) had triple-negative breast cancer. Among all cases, 14.7% (167 of 1,136) carried a loss-of-function mutation in a breast cancer gene: 7.0% in BRCA1, 4.1% in BRCA2, 1.0% in PALB2, 0.4% in TP53, and 2.1% in any of 10 other genes. Odds ratios were 23.4 (95% CI, 7.4 to 73.9) for BRCA1 and 10.3 (95% CI, 3.7 to 28.5) for BRCA2. Risks were also significantly associated with PALB2 (11 cases, zero controls; P = .002) and TP53 (five cases, zero controls; P = .036). Compared with other patients, BRCA1 mutation carriers were younger (P < .001) and more likely to have triple-negative breast cancer (P = .028). Conclusion Among Nigerian women, one in eight cases of invasive breast cancer is a result of inherited mutations in BRCA1, BRCA2, PALB2, or TP53, and breast cancer risks associated with these genes are extremely high. Given limited resources, prevention and early detection services should be especially focused on these highest-risk women.

Hormone-receptor expression status of epithelial ovarian cancer in Ibadan, South-western Nigeria

Introduction Epidemiological evidence strongly suggests that steroid hormones are implicated in the pathogenesis of ovarian cancer. Estrogen receptor (ER) and Progesterone receptor (PR) are prognostic indicators for a number of epithelial tumors and may play the same role in ovarian cancers. This study aims to evaluate the expression of ER and PR in epithelial ovarian cancer (EOC) in an African population and compare it with other prognostic factors such as age, International Federation of Gynaecology and Obstetrics (FIGO) stage, grade and histological subtype. Methods Ninety cases of histologically confirmed EOC were reviewed. Immunohistochemistry was used to assess their ER and PR expression status and was then compared with other demographic variables using statistical methods, with level of significance set at p < 0.05. Results 30.2% and 8.3% of serous and mucinous carcinomas respectively were ER positive while 41.2% and 22.5% of both tumour types were PR positive. One of the two endometrioid carcinomas showed PR expression but neither were positive for ER. The only case of Brenner tumour in the series was ER positive but negative for PR. There was a significant association between ER and the histological subtypes (p = 0.042) while no significant association was found between PR expression and histological subtypes (p = 0.650). No significant association was found between hormone receptor status, age and stage of the EOC. Conclusion The study showed a lower ER expression in serous carcinoma compared to large cohorts from developed countries. Future translational studies could be used to determine response of EOC to endocrine therapy.