Authors: Joshua Tambe, Yannick Onana, Maggy Mbede, Wilfried Mosse, Paul Mobit, Emilienne Guegang, Boniface Moifo, Odile F. Zeh
Introduction: Breast cancer is the most frequent cancer among women in sub-Saharan Africa and the second leading cause of cancer-related deaths. Late diagnosis at advanced stage of disease is a prevailing problem, and the presence of metastatic disease is a significant prognostic factor. The aim of this study was to determine the burden of metastatic breast disease and to describe the pattern of spread in a sub-Saharan African population.
Methods: Data was extracted from eligible reports of CT scans of the thorax, abdomen and pelvis (CT-TAP) of patients with histologically proven breast cancer during an 18-month study period. Independent categorical variables were assessed for statistical association with metastatic breast disease, and a Sankey diagram used to illustrate the pattern of metastatic disease.
Results: Breast cancer represented 35.84% of all cancers in the study setting. The sex ratio of patients with breast cancer was 1:155 and the median age 41 years (range: 16 to 68 years). Sixty-five percent of the primary cancers occurred at the left breast (101/155) whilst 34.84 % (54/155) occurred at the right. Out of 156 eligible CT-TAP reports assessed, 99 had evidence of either locally invasive, regional or distant tumor spread (63.46%). There was metastatic disease in 65.85% of baseline studies and 63.16% of follow-up scans. Common sites for distant metastatic disease were the pleurae (20.00%), bones (18.71%), lung (16.13%) and liver (11.26%). While left breast cancers were more locally invasive and showed increased tropism for the pleurae and bones, right breast cancers showed increased tropism for the lungs and liver.
Conclusion: The burden of metastatic breast disease is high with diagnosis at advanced stage and differential metastatic tropism. Screening and early diagnosis strategies should be given priority, whilst follow-up planning adapted based on anticipated pattern of spread.
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