Prognostication of Breast Cancer in Ghanaian Women Receiving Modified Radical Mastectomy: A Retrospective Histopathological Study at Korle-Bu Teaching Hospital, Accra, Ghana

Main Article Content

Edmund Muonir Der
Richard Kwasi Gyasi
Edwin Kwame Wiredu


Nottingham Prognostic Index, Stratification, Prognostication, Ghanaian women, Breast cancer, Mastectomy


Background: Making prognosis and identifying the patients at higher risk of mortality are important issues in breast cancer (BC) treatment. The aim of this study was to stratify BC case receiving mastectomy into prognostic risk categories using the Nottingham Prognostic Index (NPI).
Methods: This was a retrospective review from January 2002 to December 2014.
Results: Approximately 35% of all BCs diagnosed in our institution had undergone mastectomy. The mean age was 51.9 years. The mean size of the primary breast tumor was 5.8 cm and showed significant association with the histologic grade (P = 0.001), nodal involvement (P < 0.001), positive tumor margins (P = 0.027), and the cancer stage (P < 0.001). Based on the NPI sores, 1.5% of the cases would have an excellent prognosis, 10.8% a good prognosis, 55.8% a moderate prognosis, and 31.9% a poor prognosis.
Conclusion: The current study found that 87.7% of the women with breast had moderate to poor prognosis at the time of diagnosis. Patients are found to present late when the disease is advanced.


1. Ghafoor A, Jemal A, Ward E, Cokkinides V, Smith R, Thun M. Trends in breast cancer by race and ethnicity. CA Cancer J Clin. 2003;53(6):342-55.
2. Bray F, Ren JS, Masuyer E, Ferlay J. Global estimates of cancer prevalence for 27 sites in the adult population in 2008. Int J Cancer. 2013;132(5):1133-45.
3. Calys-Tagoe BN, Yarney J, Kenu E, Amanhyia NAKO, Enchill E, Obeng I. Profile of cancer patients’ seen at Korle Bu teaching hospital in Ghana (A cancer registry review). BMC research notes. 2014;7(1):577.
4. Quartey-Papafio J, Anim J. Cancer of the breast in Accra. 1980.
5. Ekanem VJ, Aligbe JU. Histopathological types of breast cancer in Nigerian women: a 12-year review (1993-2004). Afr J Reprod Health. 2006;10(1):71-5.
6. Clegg-Lamptey J, Hodasi W. A study of breast cancer in korle bu teaching hospital: assessing the impact of health education. Ghana Med J. 2007;41(2):72-7.
7. Albain KS, Allred DC, Clark GM. Breast cancer outcome and predictors of outcome: are there age differentials? Journal of the National Cancer Institute Monographs. 1994(16):35-42.
8. Nixon AJ, Neuberg D, Hayes DF, Gelman R, Connolly JL, Schnitt S, et al. Relationship of patient age to pathologic features of the tumor and prognosis for patients with stage I or II breast cancer. J Clin Oncol. 1994;12(5):888-94.
9. Clegg-Lamptey J, Aduful H, Yarney J, Adu-Aryee N, Vanderpuye V, Kyereh M, et al. Profile of breast diseases at a self-referral clinic in Ghana. West Afr J Med. 2009;28(2):114-7.
10. Anyanwu SN. Breast cancer in eastern Nigeria: a ten year review. West Afr J Med. 2000;19(2):120-5.
11. Ohene-Yeboah MO. An audit of excised breast lumps in Ghanaian women. West African journal of medicine. 2005;24(3):252-5.
12. Eble JN, Tavassoli FA, Devilee P. Pathology and Genetics of Tumours of the Breast and Female Genital Organs: Iarc; 2003.
13. Haybittle JL, Blamey RW, Elston CW, Johnson J, Doyle PJ, Campbell FC, et al. A prognostic index in primary breast cancer. Br J Cancer. 1982;45(3):361-6.
14. Todd JH, Dowle C, Williams MR, Elston CW, Ellis IO, Hinton CP, et al. Confirmation of a prognostic index in primary breast cancer. Br J Cancer. 1987;56(4):489-92.
15. Rampaul RS, Pinder SE, Elston CW, Ellis IO, Nottingham Breast T. Prognostic and predictive factors in primary breast cancer and their role in patient management: The Nottingham Breast Team. Eur J Surg Oncol. 2001;27(3):229-38.
16. D'Eredita G, Giardina C, Martellotta M, Natale T, Ferrarese F. Prognostic factors in breast cancer: the predictive value of the Nottingham Prognostic Index in patients with a long-term follow-up that were treated in a single institution. Eur J Cancer. 2001;37(5):591-6.
17. Nggada HA, Yawe KDT, Abdulazeez J, Khalil MA. Breast cancer burden in Maiduguri, North eastern Nigeria. The breast journal. 2008;14(3):284-6.
18. Corbex M, Bouzbid S, Boffetta P. Features of breast cancer in developing countries, examples from North-Africa. European Journal of Cancer. 2014;50(10):1808-18.
19. Vorobiof DA, Sitas F, Vorobiof G. Breast cancer incidence in South Africa. J Clin Oncol. 2001;19(18 Suppl):125S-7S.
20. Machiavelli M, Leone B, Romero A, Perez J, Vallejo C, Bianco A, et al. Relation between delay and survival in 596 patients with breast cancer. Oncology. 1989;46(2):78-82.
21. Neave LM, Mason BH, Kay RG. Does delay in diagnosis of breast cancer affect survival? Breast cancer research and treatment. 1990;15(2):103-8.
22. DeVita VT, Hellman S, SA. R. Cancer: Principles & Practice of Oncology Review: Lippincott Williams & Wilkins; 2008.
23. NHSBSP. Annual review, expanding our reach-The extended age pilot scheme. 2009.
24. Macarthur C, Smith A. Delay in breast cancer and the nature of presenting symptoms. The Lancet. 1981;317(8220):601-3.
25. Burgess C, Ramirez A, Richards M, Love S. Who and what influences delayed presentation in breast cancer? British journal of cancer. 1998;77(8):1343.
26. Dennis CR, Gardner B, Lim B. Analysis of survival and recurrence vs. patient and doctor delay in treatment of breast cancer. Cancer. 1975;35(3):714-20.
27. Fisher ER, Redmond C, Fisher B. A perspective concerning the relation of duration of symptoms to treatment failure in patients with breast cancer. Cancer. 1977;40(6):3160-7.
28. Carter CL, Allen C, Henson DE. Relation of tumor size, lymph node status, and survival in 24,740 breast cancer cases. Cancer. 1989;63(1):181-7.
29. Fisher B, Slack N, Katrych D, Wolmark N. Ten year follow-up results of patients with carcinoma of the breast in a co-operative clinical trial evaluating surgical adjuvant chemotherapy. Surgery, gynecology & obstetrics. 1975;140(4):528-34.
30. Wo JY, Chen K, Neville BA, Lin NU, Punglia RS. Effect of very small tumor size on cancer-specific mortality in node-positive breast cancer. Journal of Clinical Oncology. 2011;29(19):2619.
31. Adjei E. Breast cancer in Kumasi, Ghana. Ghana medical journal. 2012;46(1).
32. Edmund DM, Naaeder SB, Tettey Y, Gyasi RK. Breast cancer in Ghanaian women: what has changed? Am J Clin Pathol. 2013;140(1):97-102.
33. Bloom H. Histologic grading and prognosis in breast cancer. Br J Cancer. 1957;11:655-69.
34. Henson DE, Ries L, Freedman LS, Carriaga M. Relationship among outcome, stage of disease, and histologic grade for 22,616 cases of breast cancer. The basis for a prognostic index. Cancer. 1991;68(10):2142-9.
35. Bloom H. Further studies on prognosis of breast carcinoma. British journal of cancer. 1950;4(4):347.
36. Bloom H. Prognosis in carcinoma of the breast. British journal of cancer. 1950;4(3):259.
37. Stark A, Kleer CG, Martin I, Awuah B, Nsiah‐Asare A, Takyi V, et al. African ancestry and higher prevalence of triple‐negative breast cancer: findings from an international study. Cancer. 2010;116(21):4926-32.
38. Wilson R, Donegan W, Mettlin C, Natarajan N, Smart CR, Murphy G. The 1982 national survey of carcinoma of the breast in the United States by the American College of Surgeons. Surgery, gynecology & obstetrics. 1984;159(4):309-18.
39. Giuliano AE, Hunt KK, Ballman KV, Beitsch PD, Whitworth PW, Blumencranz PW, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. Jama. 2011;305(6):569-75.
40. Vinh-Hung V, Burzykowski T, Cserni G, Voordeckers M, Van De Steene J, Storme G. Functional form of the effect of the numbers of axillary nodes on survival in early breast cancer. Int J Oncol. 2003;22(3):697-704.
41. Smith JA, 3rd, Gamez-Araujo JJ, Gallager HS, White EC, McBride CM. Carcinoma of the breast: analysis of total lymph node involvement versus level of metastasis. Cancer. 1977;39(2):527-32.
42. Russo J, Frederick J, Ownby HE, Fine G, Hussain M, Krickstein HI, et al. Predictors of recurrence and survival of patients with breast cancer. Am J Clin Pathol. 1987;88(2):123-31.
43. Fisher ER, Anderson S, Redmond C, Fisher B. Pathologic findings from the National Surgical Adjuvant Breast Project protocol B-06. 10-year pathologic and clinical prognostic discriminants. Cancer. 1993;71(8):2507-14.
44. Fisher B, Bauer M, Wickerham DL, Redmond CK, Fisher ER, Cruz AB, et al. Relation of number of positive axillary nodes to the prognosis of patients with primary breast cancer. An NSABP update. Cancer. 1983;52(9):1551-7.
45. Jatoi I, Hilsenbeck SG, Clark GM, Osborne CK. Significance of axillary lymph node metastasis in primary breast cancer. J Clin Oncol. 1999;17(8):2334-40.
46. Donegan WL. Cancer of the breast. Staging methods, primary treatment options and end results. Major Probl Clin Surg. 1979;5:221-301.
47. Merkel DE, Osborne CK. Prognostic factors in breast cancer. Hematology/Oncology Clinics. 1989;3(4):641-52.
48. Ferguson DJ, Meier P, Karrison T, Dawson PJ, Straus FH, Lowenstein FE. Staging of breast cancer and survival rates: an assessment based on 50 years of experience with radical mastectomy. Jama. 1982;248(11):1337-41.
49. Rosen PR, Groshen S, Saigo PE, Kinne DW, Hellman S. A long-term follow-up study of survival in stage I (T1N0M0) and stage II (T1N1M0) breast carcinoma. J Clin Oncol. 1989;7(3):355-66.
50. Sheikh F, Rebecca A, Pockaj B, Wasif N, McCullough AE, Casey W, et al. Inadequate margins of excision when undergoing mastectomy for breast cancer: which patients are at risk? Annals of surgical oncology. 2011;18(4):952-6.
51. Walters S, Maringe C, Butler J, Rachet B, Barrett-Lee P, Bergh J, et al. Breast cancer survival and stage at diagnosis in Australia, Canada, Denmark, Norway, Sweden and the UK, 2000-2007: a population-based study. British journal of cancer. 2013;108(5):1195.
52. Clarke DH, Le MG, Sarrazin D, Lacombe MJ, Fontaine F, Travagli JP, et al. Analysis of local-regional relapses in patients with early breast cancers treated by excision and radiotherapy: experience of the Institut Gustave-Roussy. Int J Radiat Oncol Biol Phys. 1985;11(1):137-45.
53. Goldstein NS, Kestin L, Vicini F. Factors associated with ipsilateral breast failure and distant metastases in patients with invasive breast carcinoma treated with breast-conserving therapy. A clinicopathologic study of 607 neoplasms from 583 patients. Am J Clin Pathol. 2003;120(4):500-27.
54. Fisher ER, Anderson S, Redmond C, Fisher B. Ipsilateral breast tumor recurrence and survival following lumpectomy and irradiation: pathological findings from NSABP protocol B-06. Semin Surg Oncol. 1992;8(3):161-6.
55. Fisher B, Anderson S, Fisher ER, Redmond C, Wickerham DL, Wolmark N, et al. Significance of ipsilateral breast tumour recurrence after lumpectomy. Lancet. 1991;338(8763):327-31.
56. Burke HB, Henson DE. Criteria for prognostic factors and for an enhanced prognostic system. Cancer. 1993;72(10):3131-5.
57. Gakwaya A, Kigula-Mugambe JB, Kavuma A, Luwaga A, Fualal J, Jombwe J, et al. Cancer of the breast: 5-year survival in a tertiary hospital in Uganda. Br J Cancer. 2008;99(1):63-7.
58. Kene TS, Odigie VI, Yusufu LM, Yusuf BO, Shehu SM, Kase JT. Pattern of presentation and survival of breast cancer in a teaching hospital in north Western Nigeria. Oman Med J. 2010;25(2):104-7.
59. Swaminathan R, Lucas E, Sankaranarayanan R. Cancer survival in Africa, Asia, the Caribbean and Central America: database and attributes. IARC Sci Publ. 2011(162):23-31.
60. National Cancer Institute of Canada (NCIC) Canadian cancer statistics 2006. NCIC. 2006.
61. American Cancer Society (ACS) Cancer facts and figures. 2006.