Breast cancer is a significant cause of mortality worldwide, with a prevalence that is estimated to be 1,000,000 annually. In African women, the diagnosis is often made between 35 and 45 years of age. This is fifteen years earlier than women in Europe and North America. One study showed the mean age of diagnosis in black patient was 57.6 years with large tumor size compared to 62.6 years in white patients. The overall incidence was lower in black women although for patients younger than 40 years the incidence was higher by 20% in black women. The estimated age standardized rates for breast cancer incidence in sub-Saharan Africa range from 15 to 53 per 100, 000 women, which is lower than what is seen in Western countries. The mortality rate tends to be high among women in sub-Saharan Africa as tumors tend to be very aggressive with short periods of time between the onset of symptoms and diagnosis.
In Tanzania, breast cancer accounted for 8.1% of all female cancers in years 1974-1987, and most of the patients were under 30 years of age. A study done in Dar-es-Salaam on 50 patients showed that most patients presented with advanced stage with no single patient in stage I, and the the majority were in stage IIIB. In other parts of the world older women are at high risk, where approximately 77% of the breast cancer occurs in women over 50 years, but this trend is somehow different in Africans where the disease is common at young age. In sub Saharan Africa, the disease is seen commonly in women below 30 years of age.
Few studies have shown that breast cancer in Africans tends to present at a young age with advanced aggressive disease with a poor prognosis compared to Western white females[4, 9, 10]. Furthermore, breast cancer in Africa shows the trend of rapid increase.
Several factors have been implicated in the prognosis of the patients with breast cancer. Age has been shown to be an important factor in the prognosis of breast cancer, where by disease presentation at young age has shown a worse prognosis than in older age. This has been explained by the fact that cancer at young age tends to be more aggressive and biological behavior could be different. In Africans, breast cancer tends to present at young age and this could be a reasons for bad prognosis in these patients [4, 8–10].
The clinical stage of the disease at presentation is important for the outcome of the patient with breast cancer. In most African patients, especially at young age, the disease present at an advanced stage [3, 8]. This can be explained by delay in seeking medical services, poor medical service with no screening programs for breast cancer. The staging of the patient in conjunction with histological grade can be used to determine the prognosis of the patient. Whereas stage I disease has about 96% 5-year survival, this can be as low as 18% 5-year survival rate in stage IV. By using histological grade alone, histological grade I has about 93% 5-year survival. Stage I disease with histological grade I has shown a 99% 5-year survival compared to only 13% 5-year survival in stage IV with histological grade III[13–15]. Histological grade used is that described by Bloom & Richardson.
One less common histological type of breast cancer called centrally necrotizing carcinoma of the breast has shown to be more aggressive by having early metastasis and rapid clinical progression and it was found to be good for determining prognosis in pre-menopausal women [17, 18]. This study was therefore, carried to describe clinical and pathological features of patients with breast cancer in this region and compare the trends with other regions.