EVALUATION OF CHEMOTHERAPEUTIC OUTCOME OF BREAST CANCER AT AHMADU BELLO UNIVERSITY TEACHING HOSPITAL, ZARIA
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ABSTRACT
Cancers are abnormal cells growing uncontrollably at the same time to invade other body cells. Breast cancer is a malignant proliferation of the epithelia tissues / cells of the milk duct and lobules occurring in both men and women with high global deaths. The main aim of this study was to evaluate the outcomes of the chemotherapeutic management of breast cancer patients who attended the Oncology and Radiotherapy clinic of Ahmadu Bello University Teaching Hospital (ABUTH), Zaria over a five-year study period (January 2005 to December 2009) retrospectively. The disease index cards, registers and folders of patients from the National Cancer Registry of the Oncology and Radiotherapy Department of this study centre was retrieved and the total number of the various cancer types diagnosed in the five year study period including the number of breast cancer cases diagnosed in each of the 5 year study period together with relevant information for each patient as stipulated in a detailed data capturing form was extracted. Data obtained was then analyzed to examine the prevalence, incidence, associated risk factors, response pattern to chemotherapeutic regimens used as well as outcomes of treatment amongst others. The results revealed breast cancer as the most common documented type of cancer with a steady / progressive increase in incidence over the five year study period and a male to female ratio of 1:27 with a peak incidence of occurrence at 36-45 years. Of the two hundred and eight women in this study, 43.3% reported their age at menarche within 13-16 years, 56.7% had pre-menopausal status and 40.4% responded negatively to the use of oral contraceptives. Non-preventable risk factor (age at menarche, contraceptive use and menopausal status) was demonstrated for the ix increase in incidence of breast cancer amongst the female patients. 12.0% had a positive first degree familial history for breast cancer. Late presentation was the norm with obvious evidence of metastasis to the body’s vital organs irrespective of age at presentation and educational level of the patient. Drug regimen preferences were Cyclophosphamide, Adriamycin (Doxorubicin) and 5-Flourouracil (CAF) and Cyclophosphamide, Methotrexate and 5-Flourouracil (CMF) prior to presentation at ABUTH, Zaria. Other popular drugs regimens encountered include Paclitaxel monotherapy and 5-Flourouracil, Epirubicin and Cyclophosphamide (FEC) regimens after presentation. No added advantage was observed in overall survival of breast cancer patients placed on the newer / more costly regimens (Paclitaxel 4.6%) as against FEC (12.5%). Only 31 patients (14.4%) of the study population had a disease free interval of ≥ 5 years with a mean time to progression of 18months (±6months). Calculated percentage death and loss to follow-up was 36.5% and 49.1% respectively. It may not be possible to ascertain the pathological complete remission (pCR) of the patients that maintained disease free interval (DFI) at the end of the 5 year study. However, the complete response (disease remission) obtained at stage I and early stage II as well as the progression free survival (PFS) of 2-5 years in late presentation from these commonly prescribed chemotherapeutic regimens may suffice for good therapeutic outcomes.
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