Assessment of reproductive and family history risk factors in patients with primary breast cancer attending ORCI histological diagnosed from 2008 - 2014.

Abstract

Background. Breast cancer is the 2nd commonest malignancy after cancer of the cervix among Tanzanian women. A lot of risk factors are associated with breast cancer and most have been researched in the western world. This research aim at assessment of reproductive and family history risk factors of primary breast cancer among female patients attending ocean road cancer institute. Most of the reproductive risk factors are hypothesized to be caused by oestrogen hormone. It has been postulated that cumulative ovarian activities causes increased risk of breast cancer by causing cumulative effect of oestrogen on mammary glands. Oestrogen causes increased risk of neoplasia through two hypothesis;1);by increasing mitotic activity in breast tissue hence increasing probability of errors in cell division eg DNA copying errors, chromosomal translocation etc).2);by altering normal embryological development of primitive germ cells. Oestrogen cause developmental arrest of fetal germ cells which then remain dormant until puberty. At puberty gonadotropins from the pituitary stimulate both normal and dormant oestrogen arrested cells, stimulation of dormant oestrogen arrested cells can produce a germ cell neoplasia. In this case oestrogen serves as a initiator and gonadotropins as a 2nd stage promoters. Family history of primary breast cancer among family members has shown to increase the risk of breast cancer in the same family members or members of the next generation. This due to a genetic mutation of tumour suppressor genes BRAC1 and BRAC 2 mutation and p53 genes. Broad Objective To assess reproductive and family history as risk factors among female patients with primary breast cancer histologically diagnosed from 2008-2014 attending ORCI. Methodology This study was hospital based case control study one to one age matched where by cases were female patients with primary breast cancer histologically deign 2014 with age of 20-85yrs who gave consent. Were relatives / escorted of female patients who were diagnosed with primary cancer of the Cervix. Patients who didn’t give consent or were too weak to be interviewed were excluded. There were 92 cases and 92 controls to sum up to a total of 184 people. The study was conducted at ORCI a specialized cancer center in Tanzania. Cases and controls were recruited in the hospital as they were attending/escorting patients to the clinics and were interviewed through a structured questionnaire age. Socio demographic characteristics, pathological subtypes and cancer risk factors were clearly reported. Logistic regression, crude and adjusted odds ratio with their 95% CI were used for analysis and control of confounders Results This study had a total of 184 people,92 patients were cases with primary breast cancer while 92 were controls .Among the cases the larger age group constituted of patients who were between 36-45 years (33.7%),with the least number of patients being more than 65 years(4.3%). The mean age was 48.5+/- 10.7yrs, with larger percent (23.9) from the city of Dar es salaam. Among risk factors which were assessed, the risk which showed statistical significant was having less than three full term pregnancies, risk was three times more than for those having more than three parities with OR 3.3(CI 1.5-7.3), P value 0.003.A family history of breast cancer showed to be a risk factor for breast cancer with a p value of 0.004 but didn’t show increased risk whether the relative affected was 1st,2nd or 3rd degree relative. KEYWORDS; BRCA1& BRCA2 (Breast cancer genes 1 and 2), ORCI (Ocean road cancer institute) used from 2008