Temporal trends in breast cancer presentation in the third world

Background

Third world breast cancer is characterized by late presentation, occurrence at relatively young ages and dismal mortality. This poor outcome has encouraged patients to patronize quacks and alternative healers. Public control measures have targeted mainly public education and provision of screening facilities. Recent reports from the developed world indicate a high association with obesity, tobacco and alcohol, habits which though not currently very popular in the third world are nevertheless increasingly accepted.

Methods

A prospective study initiated in 1985 for all breast cancer patients attending 4 hospitals located in the Eastern Nigeria heartland where the author practiced. On attendance to hospital detailed epidemiological data including social habits were collected from patients.

Results

Reports from our first series [1987–97] showed some improvement in terms of earlier presentation compared to a historical control of earlier reports from the sub-region. Reports from the present study showed that this improvement has not been maintained probably as a result of diversion of public health campaign finances to HIV/AIDS. However there is an increasing mean age of presentation due to a higher representation of above 70 years age group and a significant reduction in parity. Alcohol intake and smoking have remained at low levels among the patients.

Conclusion

There is need to take another look at cancer public health campaign mechanisms in the face of competing demands from HIV. Public control measures should include among others teaching of Breast Self Examination [BSE] to patients, Clinical Breast Examination [CBE] to health workers and opportunistic CBE to all patients. Strenuous efforts should be made to break the vicious cycle of late presentation, poor treatment outcome and reluctance of patients to present to health facilities because of poor outcome.     

Ankylosing spondylitis in a Malawian

I report a case of ankylosing spondylitis in a Malawian patient. I believe this is the first reported case of ankylosing spondylitis in a Malawian. Ankylosing spondylitis is rare in black Africans when compared with the Caucasian population. The clinical features of this disease are also different in these different racial groups. I will present a brief clinical history and a review of ankylosing spondylitis with special reference to the black African.     

Paraneoplastic Syndrome in Hawai‘i: A Case of Dermatomyositis Associated with Endometrial Cancer

Dermatomyositis as a paraneoplastic consequence of gynecological malignancy has rarely been reported in literature and never been reported in Honolulu. This case report describes a local Honolulu resident who was diagnosed with endometrial adenocarcinoma upon presenting with acute dermatomyositis symptoms.     

MDR1-mRNA在原发性大肠癌中定量测定及临床意义

探讨大肠癌ｍｄｒ１基因与肿瘤生物学行为的关系及ｍｄｒｌ基因表达分级标准制定的临床意义。方法采用ＲＴ－ＰＣＲ方法检测了６５例大肠腺癌患者肿瘤组织中ｍｄｒｌ基因表达水平并进行程度分级。结果ｍｄｒｌ基因表达水平与大肠腺癌分化程度相关，但与肿瘤侵袭程度、淋巴结转移程度及远处转移与否无关。     

Knowledge,attitude, and skills regarding sports medicine among football players and team doctors in the football super league in Malawi

A study was conducted among football players and team doctors in the football super league in Malawi to determine the level of knowledge, skills and attitude in sports medicine. One hundred football players and thirteen team doctors were involved in the study. Standardised questionnaires were used to collect data in an interview format. Among the players 37% had completed tertiary education and 60% had finished secondary school education. Most players had poor knowledge on prevention of injuries; had poor advice on diet; used illicit drugs or knew of fellow players using illicit drugs and believed in the role of magic in sports. All 13 team ‘doctors’ worked full-time in paramedical fields: 3 were orthopaedic clinical officers, 2 were physiotherapists and the rest were in various fields, such as dental technician, pharmacy assistant, medical assistant and dermatology technician, where trauma is not part of their basic training. Most team “doctors” were aware of the impact of HIV/AIDS on sports but few had good knowledge of the role of nutrition in sports and the effect of performance enhancing drugs in sports. Most believed in the role of magic in sports. Recommendations are made on the basis of these findings.