Frequency of breast disease among patients attending breast clinic in tripoli central hospital, Tripoli, Libya

Fatma Alsharif; Sarah Abdulrazik; Inas Alhudiri; Adem Elzagheid; Faisal Ismail

doi:10.4103/ljms.ljms_12_21

ORIGINAL ARTICLE

Year : 2021 | Volume : 5 | Issue : 4 | Page : 144-147

Frequency of breast disease among patients attending breast clinic in tripoli central hospital, Tripoli, Libya

Fatma Alsharif¹, Sarah Abdulrazik², Inas Alhudiri², Adem Elzagheid², Faisal Ismail³
¹ Department of Physiotherapy, Faculty of Medical Technology, Tripoli University, Tripoli, Libya
² Department of Genetic Engineering, Biotechnology Research Centre, Tripoli, Libya
³ Department of Laboratory, Faculty of Medical Technology, University of Tobruk; National Centre of Disease Control, Tobruk; Libyan Medical Research Centre, Kambut, Libya

Date of Submission	22-Feb-2021
Date of Acceptance	11-Sep-2021
Date of Web Publication	28-Feb-2022

Correspondence Address:
Dr. Faisal Ismail
Department of Laboratory, Faculty of Medical Technology, University of Tobruk, Tobruk
Libya

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ljms.ljms_12_21

Abstract

Background and Aims: Breast cancer is the most common cancer in women in the world. This study is aiming to assess the frequency of breast cancer and other breast diseases in Libyan women attending breast clinic in Tripoli Central Hospital. Materials and Methods: A cross-sectional survey was obtained through interview questionnaires after having obtained ethical approval. Four hundred patients seeking medical consultation in the outpatients' breast clinic of Tripoli Central Hospital, Libya, from August to October 2019 were included in this study. Results: Women aged 35–50 years were the most visiting age group to the breast clinic (53.3%), followed by women older than 50 years and the age group of < 35 years old was the least with about (26%). According to this study, the most common presentation was breast mass (71.8%), the second was breast pain then a nipple discharge with only 8.3%. Patients diagnosed with breast cancer represent 27.5% of patients who attended the clinic, and the majority was having benign conditions. Conclusion: The majority of breast lumps are benign and cancer cases represent <1/3^rd of cases attending the breast clinic at Tripoli Central Hospital, Tripoli, Libya. Public health education and awareness campaigns regarding the early detection of breast cancer are needed to reduce cancer mortality.

Keywords: Breast cancer, breast disease, cancer, Libya, Tripoli

How to cite this article:
Alsharif F, Abdulrazik S, Alhudiri I, Elzagheid A, Ismail F. Frequency of breast disease among patients attending breast clinic in tripoli central hospital, Tripoli, Libya. Libyan J Med Sci 2021;5:144-7

How to cite this URL:
Alsharif F, Abdulrazik S, Alhudiri I, Elzagheid A, Ismail F. Frequency of breast disease among patients attending breast clinic in tripoli central hospital, Tripoli, Libya. Libyan J Med Sci [serial online] 2021 [cited 2023 Mar 27];5:144-7. Available from: https://www.ljmsonline.com/text.asp?2021/5/4/144/338628

Introduction

Breast diseases, both benign and malignant, are common; however, breast cancer in women is the most commonly diagnosed cancer and the leading cause of cancer-associated death worldwide.^[1] Breast cancer is a curable disease in ~70%–80% of patients with early stage,^[2],[3] however, its rates are increasing in developing countries including Libya. Breast cancer is the most common cancer in women both in the developed and less developed countries. It is estimated that worldwide, over 508,000 women died in 2011 due to breast cancer. Although breast cancer is thought to be a disease of the developed country, almost 50% of breast cancer cases and 58% of deaths occur in less developed countries.^[4] It is generally attributed to the aging of the population, delay in the time of first pregnancy, decrease in the number of children, and breastfeeding to the high-calorie diets.^[5],[6],[7]

Breast cancer represents 10% of all cancers diagnosed annually and the second principal cause of cancer deaths in women worldwide.^[8] The incidence of new cases is expected to rise from 10 million in 2002 to 15 million by 2025, with 60% of those cases occurring in developing countries. Data from the Arab world have placed breast cancer at the first position with almost half of cases occurring in women under the age of 50.^[9]

Conducting research to estimate the pattern of breast cancer is vital for each country to understand the burden of the disease in the community. Therefore, this study aims to estimate the frequency of breast cancer and other breast diseases in the Libyan females who attending the breast clinics in Tripoli Central Hospital, Tripoli, Libya.

Materials and Methods

A cross-sectional survey was conducted through interview questionnaires collected from patient-seeking medical consultation in the outpatient's breast clinic of Tripoli Central Hospital, Libya, from August to October 2019. Tripoli Central Hospital is a tertiary teaching hospital in Libya with a capacity of more than 1200 beds. The majority of cases of tumors from the Western part of the country attend to this hospital for medical consultation. The used questionnaire contains patient personal and demographic data as well as medical history and medical examination result of the patients; these data include age, educational level, main complain, examination result, marital status, occupation, address (place of living), family history, and diagnosis [Figure 1].

Figure 1: Study questionnaire

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Ethical approval

The study conformed to the ethical guidelines of the 1975 Declaration of Helsinki, and the study plan was approved by the Ethical Committee for Scientific Research at Biotechnology Research Centre. All Patients were informed about the research procedure and signed a written informed consent form agreeing to the collection of their data. The demographic and medical data of patients were anonymous, and the patient's data cannot be correlated to the results obtained.

Statistical analysis

Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 22 (SPSS Inc., Chicago, IL, USA). Descriptive statistics were obtained for all continuous and categorical variables as appropriate.

Results

This study investigated the frequency of breast cancer and other breast diseases in 400 Libyan women attending breast clinic in Tripoli Central Hospital, Tripoli, Libya. The study found that the middle-aged women (35–50 years old) were the most visited age group to the breast clinics (53.3%), followed by older age group (more than 50 years old). The youngest age group (<35 years old) was the least with about just only 26%. The most common presentation was breast mass (71.8%), the second was a breast pain then a nipple discharge with only 8.3%. Patients diagnosed with breast cancer represent that 27.5% of patients who attended the clinic, and the majority was having benign conditions. Only 11.5% of those women were attending the clinics with no complain but just for screening purposes. The visiting women to the breast clinic according to diagnosis are illustrated in [Figure 2]. About 40% of the Libyan women who visited the breast clinics had their menarche between 12 and 15 years old, also it has been observed that about 13% of them had relatively late menarche at 16 years old and older.

Figure 2: Distribution of breast disease among patients attending breast clinic in Tripoli Central Hospital

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The most common presenting complaint was a breast mass (71.8%), the second was beast pain then nipple discharge with only 8.3%. Nearly 87% of all those women were sought for a medical consultation directly in Tripoli Central Hospital without seeing primary health care or any other health sector.

Importantly, this study showed no relation between education level and breast diseases awareness, where the university graduating women were the least attending the outpatient department. As expected, this study revealed that widow and divorced women were the least attending breast clinic (6.5% and 5.5%, respectively). A substantial number of the women (36.3%) who were in their twenties of age gave birth to their first child, whereas only 15% of women who were at their thirties did. Furthermore, there was no relation between the employment statement and the rates of visiting to breast clinic.

Nearly 24.8% of participants have a prior family history of breast cancer, whereas 21.8% have a prior personal history of breast cancer, and 24.2% of the participants done their mammography at age of younger than 35 years.

Majority of the women with breast cancer had a breast biopsy before, while few of them the diagnosis was based on imaging results that showed findings consistent with highly suspected breast cancer, and the breast biopsy was needed for confirmation.

Some limitations of this study include; due to the cross-sectional nature of this study and the absence of a population registers for cancer, the incidence of breast cancer per year could not be determined in addition some cases were diagnosis based on imaging results only and need to be confirmed by breast biopsy.

Discussion

The frequency of breast cancer and other breast diseases in Libyan women attending the breast clinic in Tripoli Central Hospital from August 2019 to October 2019 was studied. The present study demonstrated a considerable rate in breast cancer frequency in Western Libya during the study period, particularly among older women. The study reported that women aged from 35 to 50 years were the most visiting group to the breast clinic (53.3%), followed by women older than 50 years. These findings are compatible with the rate of breast data from some Arab countries such as Lebanon, Jordan, Palestinians, and Egypt, which found that the age at presentation is around 50 years and there were increased percentages of younger-aged groups at presentation.^[10]

In Egypt, breast cancer is the most prevalent cancer among Egyptian women and constitutes 29% of National Cancer Institute cases.^[11] Studies reported a higher incidence rate in developed countries, however; this rate may reflect affecting women to the factors that contribute to the increasing occurrence of breast cancer.^[12],[13] Factors that contribute to the increasing occurrence of breast cancer are not fully understood, however, several studies linked late childbearing, having fewer children, use of menopausal hormone therapy, consumption of calorie-dense food, physical inactivity, and obesity to the occurrence of the disease.^{[14],[15],[16]}

Although breast cancer in the early stage is treatable and survivable, there is a large mortality trend in several developing countries. For example, only 40% of women in Campinas (Brazil) and Setif (Algeria) survive 5 years after a diagnosis of breast cancer^[17] compared with 89% of women in the USA and more than 82% of women in Northern and Central Europe.^[18]

The community awareness of early signs and symptoms and screening by clinical breast investigations in addition to the availability of treatment and the availability of modern equipment including radiotherapy machines are the only practical options to increase the rate of survival of this disease in developing countries including Libya.^[19]

Conclusion

The majority of breast lumps are benign and cancers represent <1/3^rd of cases attending the breast clinic at Tripoli Central Hospital, Tripoli, Libya.

Implementation of an effective early detection program is essential so that cases detected at an early stage have a greater chance of cure and recovery.

Furthermore, awareness-raising programs, to educate patients, family, and community members about the cancer risk factors and the need for taking preventive measures to avoid developing breast cancer is also imperative.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018;68:394-424.
2.	Harbeck N, Gnant M. Breast cancer. Lancet 2017;389:1134-50.
3.	Harbeck N, Penault-Llorca F, Cortes J, Gnant M, Houssami N, Poortmans P, et al. Breast cancer. Nat Rev Dis Primers 2019;5:66.
4.	WHO. Breast Cancer: Prevention and Control; 2020. Available from: https://www.who.int/cancer/detection/breastcancer/en/inde×1.html. [Last accessed on 2020 Jul 20].
5.	Jemal A, Center MM, DeSantis C, Ward EM. Global patterns of cancer incidence and mortality rates and trends. Cancer Epidemiol Biomarkers Prev 2010;19:1893-907.
6.	Gómez-Dantés H, Lamadrid-Figueroa H, Cahuana-Hurtado L, Silverman-Retana O, Montero P, González-Robledo MC, et al. The burden of cancer in Mexico, 1990-2013. Salud Publica Mex 2016;58:118-31.
7.	Porter P. “Westernizing” women's risks? Breast cancer in lower-income countries. N Engl J Med 2008;358:213-6.
8.	Wilson CM, Tobin S, Young RC. The exploding worldwide cancer burden: The impact of cancer on women. Int J Gynecol Cancer 2004;14:1-11.
9.	El Saghir NS, Khalil MK, Eid T, El Kinge AR, Charafeddine M, Geara F, et al. Trends in epidemiology and management of breast cancer in developing Arab countries: A literature and registry analysis. Int J Surg 2007;5:225-33.
10.	Ibrahim AS, Khaled HM, Mikhail NN, Baraka H, Kamel H. Cancer incidence in Egypt: Results of the national population-based cancer registry program. J Cancer Epidemiol 2014;2014:437971.
11.	Omar S, Khaled H, Gaafar R, Zekry AR, Eissa S, el-Khatib O. Breast cancer in Egypt: A review of disease presentation and detection strategies. East Mediterr Health J 2003;9:448-63.
12.	Parkin DM, Fernández LM. Use of statistics to assess the global burden of breast cancer. Breast J 2006;12 Suppl 1:S70-80.
13.	Zahl PH, Maehlen J, Welch HG. The natural history of invasive breast cancers detected by screening mammography. Arch Intern Med 2008;168:2311-6.
14.	Popkin BM. Global nutrition dynamics: The world is shifting rapidly toward a diet linked with noncommunicable diseases. Am J Clin Nutr 2006;84:289-98.
15.	Berghöfer A, Pischon T, Reinhold T, Apovian CM, Sharma AM, Willich SN. Obesity prevalence from a European perspective: A systematic review. BMC Public Health 2008;8:200.
16.	Prentice AM. Obesity in emerging nations: Evolutionary origins and the impact of a rapid nutrition transition. Nestle Nutr Workshop Ser Pediatr Program 2009;63:47-54.
17.	Coleman MP, Quaresma M, Berrino F, Lutz JM, De Angelis R, Capocaccia R, et al. Cancer survival in five continents: A worldwide population-based study (CONCORD). Lancet Oncol 2008;9:730-56.
18.	Sant M, Allemani C, Santaquilani M, Knijn A, Marchesi F, Capocaccia R, et al. EUROCARE-4. Survival of cancer patients diagnosed in 1995-1999. Results and commentary. Eur J Cancer 2009;45:931-91.
19.	Anderson BO, Yip CH, Smith RA, Shyyan R, Sener SF, Eniu A, et al. Guideline implementation for breast healthcare in low-income and middle-income countries: Overview of the breast health global initiative global summit 2007. Cancer 2008;113 Suppl 8:2221-43.