Abstract:
Background
Breast cancer is the most common cancer among women, with more than 1.1 million women newly diagnosed globally every year. Death from breast cancer accounts for 1.6% of female deaths every year worldwide. In Tanzania, 90.7% of patients with breast cancer present with advanced disease by the time they reach a tertiary care institution. There is no documented data on breast cancer survival following surgical treatment in Tanzania.
Objective
The main objective was to determine the five-year survival among patients who underwent mastectomy at Muhimbili National Hospital during the period January 2007 to June 2010.
Methods
A hospital-based retrospective cohort study conducted in Dar es Salaam. A structured checklist was used to collect data from 337 patient’s case files and theatre operation register books, from Muhimbili National Hospital as well as medical records of Ocean Road Cancer Institute. All patients' records, irrespective of their co-morbidities, performance status, breast cancer stage, histological type, grade and treatment modalities were included. Survival at 5 years was estimated by using Kaplan Meier method. Factors associated with survival were examined using Cox proportional Hazards model. Ethical clearance was sought from the MUHAS review board and ORCI ethical committee.
Results
A total of 337 patients who underwent mastectomy were analyzed. One hundred thirty nine (41.2%) of the participants were aged between 46-60 years. The overall five-year breast cancer survival for the entire cohort of 204 stage II and III patients after excluding stage IV patients was 66% (95% CI=54% to 75%). The five year breast cancer survival for stage II patients was 84% and stage III was 65%. The common surgical treatments performed were MRM (modified radical mastectomy) and Toilet mastectomy. The most frequently used adjuvant therapy was chemotherapy (43.4%) followed by hormonal therapy (36.0%) and radiotherapy (18.5%). The least used adjuvant treatment was immunotherapy (2.1%). Factors such as age, pathological grade and stage of the disease were found to be significant predictors of breast cancer survival post mastectomy.
Conclusion
Good survival rate is achieved for patients with early disease i.e. stage II. Age and pathological grade of the tumor influence survival rate in breast cancer patients. The common surgical treatments performed were MRM (modified radical mastectomy) and Toilet mastectomy followed by adjuvant therapies; chemotherapy, hormonal, radiotherapy and immunotherapy respectively.
Recommendation
These findings call for strengthening health education and promote early health seeking behavior and advocate on screening for early detection of breast cancer for good survival rate.
