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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 31  |  Issue : 5  |  Page : 540-543

Pattern of benign breast diseases in Abakaliki, South Eastern Nigeria, A 5 year retrospective study


1 Department of Morbid Anatomy, Alex-Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi, Nigeria
2 Department of Anatomic Pathology and Forensic Medicine, Nnamdi Azikiwe University, Awka, Anambra, Nigeria
3 Department of Haematology, Alex-Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi, Nigeria
4 Department of Surgery, Division of Plastic Surgery, Alex-Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi, Nigeria

Date of Submission16-May-2022
Date of Decision18-Sep-2022
Date of Acceptance21-Sep-2022
Date of Web Publication29-Nov-2022

Correspondence Address:
Dr. Ngozi Immaculata Ugwu
Department of Haematology, Alex-Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/NJM.NJM_60_22

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  Abstract 


Background: There is a rise in the trend of benign breast diseases (BBDs) currently; this is made possible through public awareness of the disease. Aim: To determine the pattern of BBDs in a 5-year retrospective study was the aim of this study. Materials and Methods: A 5-year retrospective study and all histopathologically proven BBDs from January 2015 to December 2020 were reviewed. Software, version 21 of the statistical package for the social sciences (SPSS) was used for data analysis. Results: Cases of BBDs diagnosed within the study period were 143 and were made up of 5 (3.5%) males and 138 (96.5%) females, with a ratio of 1: 28. Among the females, the most commonly affected age group was 21–30 years contributing 57.8% (80/138), followed by ≤20 years contributing 36.2% (50/138). Among males ≤20 years of age group are mostly affected and contributing 60% (3/5). Fibroadenoma accounted for 62.9% (90/143), followed by fibrocystic disease (FCD) contributing 16.8% (24/143). The less common breast diseases in this study were fat necrosis, lipoma, granulomatous mastitis, periductal mastitis, and cysticercosis accounting for 0.7% each. Conclusion: Fibroadenoma remains the most common BBD although higher than in the earlier study, followed by FCD in our centre. Females constituted most of the affected individuals (21–30 years). The practice of breast self-examination should be encouraged to detect and treat lumps which may be malignant early enough to reduce morbidity and mortality.

Keywords: Benign breast disease, fibroadenoma, fibrocystic disease, Nigeria


How to cite this article:
Edegbe FO, Uzoigwe JC, Ndukwe CO, Nwachukwu AA, Ugwu NI, Nnachi OC, Agada UN, Nnadozie UU. Pattern of benign breast diseases in Abakaliki, South Eastern Nigeria, A 5 year retrospective study. Niger J Med 2022;31:540-3

How to cite this URL:
Edegbe FO, Uzoigwe JC, Ndukwe CO, Nwachukwu AA, Ugwu NI, Nnachi OC, Agada UN, Nnadozie UU. Pattern of benign breast diseases in Abakaliki, South Eastern Nigeria, A 5 year retrospective study. Niger J Med [serial online] 2022 [cited 2023 Jan 28];31:540-3. Available from: http://www.njmonline.org/text.asp?2022/31/5/540/362198




  Introduction Top


The level of awareness of breast cancer in Nigeria has been increased, thus encouraging women to always palpate their breasts to check for the presence of a lump. Once this, lump is noticed by the patients, it is a great source of concern and creates tension among patients. This is a result of increasing knowledge of breast cancer created by public awareness; currently, it is the most common female malignancy in Nigeria.[1] However, benign breast disease (BBD) is of high preponderance.[2],[3],[4],[5],[6] BBDs, comprise a different sets of diseases, which are as follows: congenital abnormalities, proliferative diseases epithelial and stromal components of the breast, inflammatory lesions, and neoplasm.[7]

It had been on records from the majority of studies, that breast lumps are mostly benign, and are described as nonproliferative epithelial lesions, few others indicate that proliferative epithelial lesions are premalignant, hence increasing the risk of cancer. According to studies by researchers, the risk of developing a mitotic lesion is high in patients with proliferative breast lesions.[8],[9],[10] However, studies have also indicated that there is an elevated risk for breast cancer associated with proliferative breast lesions within 10–15 years of diagnosis.[11],[12],[13],[14]

It is therefore important for multidisciplinary approach involving histopathologists, radiologists, and medical and surgical oncologists, to not only identify and differentiate BBDs from malignant breast disease but also to have a sound idea of the pattern of the disease presentation and epidemiology.

There is a paucity of studies on BBDs in Nigeria, in addition to an earlier study done in our centre,[4],[15],[16],[17] hence the need for more studies in our centre. To determine the histopathologic pattern of BBDs seen in Abakaliki, Ebonyi State, was the aim of the study, and also to examine whether there has been any change in the pattern of BBDs after 10 years of an earlier study.


  Materials and Methods Top


A 5-year retrospective study and all breast specimens received in our centre within the period ranging from 2015 to 2020 were used in this study. BBDs were concentrated on as a focus for the study.

Biodata and clinical history or details of the patients were obtained from the surgical cutup registrar. In most instances, slides were obtained from the departmental archives or new slides were made from formalin-fixed, paraffin-embedded blocks, and the diseases were categorized.

Analysis of data obtained was done using software version 21 of the statistical package for the social sciences (SPSS Chicago Inc., IL, USA). To compute proportion, percentages, mean and standard deviation, descriptive statistics were used. Results were presented in tables and charts.

Research and Ethics Committee of Alex-Ekwueme Federal University Teaching Hospital, Abakaliki provided ethical clearance as required by law. Consent was not applicable in this study.


  Results Top


A total of 143 of BBDs were diagnosed during the 5-year review period and comprised 5 (3.5%) males and 138 (96.5%) females, with a ratio of 1: 28 [Figure 1]. Among the females, the most commonly affected age group was 21–40 years contributing 57.8% (80/138), followed by ≤20 years contributing 36.2% (50/138). Among males, the most commonly affected age group was ≤20 years contributing 60% (3/5) [Table 1].
Figure 1: Bar chart showing the frequency distribution of benign breast diseases

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Table 1: Age and sex distribution of benign breastdiseases

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Of the 143 of BBDs diagnosed during the 5-year review period, fibroadenoma was the most common accounting for 62.9% (90/143), followed by fibrocystic disease (FCD) which contributed 16.8% (24/143). The less common breast lesions in this study were fat necrosis, lipoma, granulomatous mastitis, periductal mastitis, and cysticerciosis accounting for 0.7% each.

The age and sex distribution of BBDs are shown in [Table 1], [Table 2], [Table 3] illustrated the age group distribution of the various histological types of BBDs. Benign phyllodes tumor and other fibroepithelial tumors in the series comprised 3 (2.1%) cases occurring predominantly in the second decade with a mean age of 25.5 years. Fibrocystic change, the second-most common lesion, accounted for 24 (16.8%) cases with a mean age of 25.5 ± 14.2 years, the age range of 21–30 years, and a peak incidence in the second decade.
Table 2: Age and sex distribution of inflammatory breast diseases

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Table 3: Age and sex distribution of benign fibroepithelial/stromal lesions of the breast

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Inflammatory lesions accounted for 15 (10.5%) cases. Of these, duct ectasia, fat necrosis, chronic mastitis, breast abscess, granulomatous mastitis, periductal mastitis, and acute mastitis accounted for 2 (1.4%), 1 (0.7%), 3 (2.1), 2 (1.4%), 1 (0.7%), 1 (0.7%), and 2 (1.4%) cases, respectively. A case of cysticercosis was seen in a 25-year-old female. No inflammatory lesion was observed among males [Table 2]. Stromal tumors comprised 0.8% of cases and were predominantly lipomas (1.4%) [Table 3].

In five cases of BBDs recorded in our study four were gynaecomastia, representing 2.8%. The age range of patients with gynaecomastia was 21–30 years, with a mean of 25.5 ± 14.2 years and a peak in the second decade. FCD (1 [0.7%] case) was also seen in males [Table 3].


  Discussion Top


Public enlightenment and increased awareness of breast cancer have posed a lot of tension and unsettled minds in patients with breast lump, hence making it virtually possible for them to seek health care. The practice of breast self-examination is also being encouraged to enhance early detection of breast lump and subsequent presentation to health facilities for histological diagnosis.

A high incidence of BBDS noted in the study could be as a result of the awareness created.

Previous reports in some other studies done in Nigeria indicated that the incidence of BBDs much higher than that of malignant breast disease.[15],[16] In Bayelsa, Enugu, Kano, Calabar, and Ibadan, BBDs accounted for 68.3%, 68.8%, 66.1%, 73.4%, and 89.4% of all cases of breast lumps recorded.[15],[16],[17],[18],[19] According to our records here, fibroadenoma was the most common BBD representing 62.9% of cases. Fibroadenoma was also reported as the most common BBD in most studies done in the past in Nigeria.[15],[16],[18] In Enugu, Ilesha, Port Harcourt, and Ife, fibroadenoma represented 44%, 46.2%, 51%, and 59.1% of cases of BBDs, respectively.[16],[20],[21],[22] In other African countries like Ghana and even outside Africa such as the USA, fibroadenoma was also the commonest representing 54% and 68% of BBDs respectively.[23],[24] However, in India,[25] fibroadenoma was recorded as the second-most common BBDs representing 20%, a similar with reports from Pakistan where fibroadenoma represented 11.5% was also noted.[26] The difference may be due to their study population which was made up of main adolescents and young adults while this study also included elderly people. In addition, Africans are susceptible to fibroadenoma which has been previously documented may also have accounted for the higher occurrence of fibroadenoma in this study and other African studies.[15]

An earlier prospective study done in our center over 10 years ago to assess the clinicopathologic features of breast lumps reported fibroadenoma as the most common breast lump which contributed 33.8%, followed by invasive ductal carcinoma and FCD which contributed 32.8% and 17.2%, respectively.[4] This study has shown that not much difference in the trend has occurred after 10 years as fibroadenoma has remained the most common breast lump, although higher in this study compared to the earlier study. The higher value of 62.9% of fibroadenoma found in this study may be due to the fact that this study examined only BBDs while the earlier study assessed all breast lumps, both benign and malignant cases.

Fibrocystic change in our study represented 16.8% of cases, this is lower than 22.9% and 27.7% recorded in a study done at Enugu and Port Harcourt, respectively.[16],[20] A rise in figure of 42.2% was, however, reported in Ilesha. A study done in Pakistan by Memon et al.[26] showed preponderance of fibrocystic change to the tone of 66.3%.

Fibrocystic change consists of several components ranging from cystically dilated ducts to adenosis.[26] The predominant age range of patients with fibrocystic change in our study was 21–30 years, which was similar to that documented in Kano, Ibadan, and Ife.[17],[19],[22]

In this study, gynaecomastia was the most common among the BBD in males constituting 2.8% of all cases. This is similar to the 1% reported in caucasians and can be compared to the 1.4% and 3.8% recorded in Kano and Ife, respectively.[17],[22] A tremendous figure of 14% reported in a study from Port Harcourt is similar to the 12% recorded in Ghana.[21],[23] Gynaecomastia in this study showed a mean age of 25.5 years, with a peak incidence in the third decade and ages ranging from 21 to 30 years. However, this was not observed in this study. In Kano, no case of gynaecomastia was documented in the elderly patients as also noted in this study. However, four cases of gynaecomastia observed in this study were between the young age group of 21–30 years. In this study, three cases of benign phyllodes are recorded and they were seen in the young age groups with the peak of 21–30 years and a mean age of 25.5 years. In contrast to the study done at Enugu, 3.9% of benign phyllodes was documented.[16] Meanwhile, is seen more in the fourth and fifth decades of life as seen in some literature with definite paucity in childhood and adolescence in Western countries.[8],[9] In Ibadan, Benign phyllodes are seen more in the young age groups, with the average age of 18.8 years.[19] Therefore, this study and some other studies done in Nigeria showed preponderance of benign phyllodes occurs in a younger population, thus the need for further research. Similar study in Pakistan, benign phyllodes also occurred mostly in adolescents.[26]

Inflammatory lesions accounted for 10.5% of cases of BBDs in this study, slightly higher than the 4.6% and 6% recorded in Kano and Port Harcourt, respectively.[17],[21] It is slightly lower than the 14.8% documented in Ife.[22] Similar to other previous studies done in Nigeria and other parts of the world,[2],[3],[4],[5],[6],[16],[18],[24] stromal tumors were rarely encountered, accounting for only 1 (0.7%) out of 143 cases of benign breast lesions was recorded in this work. This is also seen in a study done in Pakistan, which recorded 0.68% of stromal tumors.[26]


  Conclusion Top


Fibroadenoma has remained the most common benign breast lesion in our environment although higher than in the earlier study, followed by FCD, with the prevalence of 62.9% and 16.8%, respectively. Females constituted most of the affected individuals and the most commonly affected age group was 21–30 years, followed by <20 years. The practice of breast self-examination should be encouraged to detect breast lumps early. More so, histological diagnosis of all breast lumps is also recommended as this will help in the prompt detection and prompt treatment of premalignant lesions to reduce morbidity and mortality associated with malignant breast lesions.

Acknowledgment

The authors wish to appreciate the staff of the Department of Morbid Anatomy, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State Nigeria for their assistance during data collection.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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