Knowledge of the Spectrum of Breast Disease Presenting at a Public, Tertiary Hospital in Johannesburg, South Africa is Critical to Ensuring Holistic Care

Abstract

Introduction: Most breast-related research focuses on cancer. However, it is critical to understand the  total burden of breast diseases for service planning, especially in resource-constrained settings. Objectives/Aims: To characterize the presentation and management of breast disease at a large, public hospital offering comprehensive breast-related services in Johannesburg, South Africa. Methods: A retrospective file review was performed. Patients were eligible if they were ≥18 years, had their first visit between April 2011-June 2012, and had a file available for review. All eligible men were included; women were selected using a systematic random sample. Data were collected from first visit through 12 months of follow-up. Results: 4836 individuals attended the clinic during the study period; 330 (326 women) were included in the sample. The median (IQR) age was 42.8 (30.1-53.8) years. 72% were Black/African, and 9% had a recorded HIV-positive status. Having a mass (51%) and/or pain (27%) were the most common presenting symptoms. 78% required radiological assessment. 25% and 4% required histological or lab-related testing/diagnostics respectively. Breast cancer was diagnosed in 13.9% of patients. Other diagnoses included fibroadenoma (15.2%), breast pain (14.2%), infections (5.2%), duct ectasia (3.6%), and other benign conditions (13.3%). 1.8% underwent breast reduction. 50% of the men presented with gynecomastia. Most patients (23.6%) had no detected abnormalities. Conclusions: Benign conditions far outweighed cancer diagnoses for this population. As breast cancer awareness increases, facilities offering breast care must be prepared to manage an extensive range of benign breast disease and screening, in addition to their focus on cancer care.

Conference: SIS conference 2014, Orlando, Florida, USA