Pattern of Breast Cancer Distribution in Ghana: A Survey to Enhance Early Detection, Diagnosis, and Treatment

Abstract

Background. Nearly 70% of women diagnosed with breast cancer in Ghana are in advanced stages of the disease due especially to low awareness, resulting in limited treatment success and high death rate. With limited epidemiological studies on breast cancer in Ghana, the aim of this study is to assess and understand the pattern of breast cancer distribution for enhancing early detection and treatment. Methods. We randomly selected and screened 3000 women for clinical palpable breast lumps and used univariate and bivariate analysis for description and exploration of variables, respectively, in relation to incidence of breast cancer. Results. We diagnosed 23 (0.76%) breast cancer cases out of 194 (6.46%) participants with clinically palpable breast lumps. Seventeen out of these 23 (0.56%) were premenopausal (<46.6 years) with 7 (0.23%) being below 35 years. With an overall breast cancer incidence of 0.76% in this study, our observation that about 30% of these cancer cases were below 35 years may indicate a relative possible shift of cancer burden to women in their early thirties in Ghana, compared to Western countries. Conclusion. These results suggest an age adjustment for breast cancer screening to early twenties for Ghanaian women and the need for a nationwide breast cancer screening to understand completely the pattern of breast cancer distribution in Ghana.

Figure 1

Population distribution of study participants by region. The 3000 female participants in the study were selected based on population density of the region, willingness of participants, and accessibility to treatment facilities for referrals. Percentages shown here were calculated as a fraction of participants in every region over total number of participants recruited.

Figure 2

Pre- and postmenopausal classification of study participants. Study participants were categorized as premenopausal or postmenopausal based on the calculated menopause age of 46.6 years (broken line). Seventy-one (71) participants corresponding to 2.36% overall were within the 45–46.6-year group. The number of participants within each age group is shown in Table 1. Percentages shown for each age group were calculated as a fraction of participants within that group over the total participants recruited.

Figure 3

Incidence of breast cancer and breast mass in pre- and postmenopausal participants. Incidence of breast cancer and breast mass is shown in the various age groups in pre- and postmenopausal participants. Notably, most of the participants diagnosed with breast cancer were premenopausal with a mean age of 38 years and seven (7) participants diagnosed were below 35 years. A single benign mass case was observed in the 71 participants between 45 and 46.6 years. More details including histological classifications of the cases are shown in Table 1. Percentages shown for each age group were calculated based on number of breast disease cases diagnosed in each group over total number of participants. P < 0.005.

Figure 4

Regional incidence of breast cancer and breast mass in study participants. Incidence and distribution of breast cancer in the five regions under study are shown. Notably, Volta Region had the highest case burden followed by Greater Accra Region. Histological classifications per region are shown in Table 2. The percentages were calculated based on the total number of diagnosed cases per region over total participants recruited. P < 0.005.

Figure 5

Age specific distribution of menarche among the study participants. The average female in Ghana experiences menarche at 15 years. Participants below 15 years were classified as early menarche and above 15 years were classified as late menarche.

Figure 6

Incidence of breast cancer and breast mass relative to menarche. Study participants assessed for relationship between onset of menstruation and breast cancer are shown. Notably, participants who experienced early menarche were at a greater risk of breast disease. Table 3 further shows the corresponding histological classifications. P < 0.005.

Figure 7

Comparison of perception and determination of breast anomalies among study participants. Participants were asked to examine and report any adverse findings in the breasts (perception) and the results were compared with clinical breast examination by qualified personnel (determined). The differences between the perceived and the determined suggest intensification of the campaign message.

Figure 8

Overall summary of incidence of breast lesions. Various percentages of breast lesion incidences are shown. ANDI: Aberrations of Normal Development and Involution; AIM: Abscesses, Infections, and Mastitis; and NAD: No Abnormalities Detected. The incidence of breast cancer in Ghana is 0.76%, which is predicted to increase with time.