Harouna Zouladeny, M.D.

Epidemiologic and Clinical Profiles of Breast Cancer in Niger

Background:
The World Health Organization (WHO) reported that, the population of Niger Republic was estimated at 15,512,000 in 2009.  In 2009, Niger’s Gross national income per capita was $720 and the total expenditure on health per capita was $37. The country use 5.2% of it GDP on health expenditure in 2010 which is less than the 10% recommended by WHO in order to improve the access and the quality of health care delivery system (1).
According to WHO, Niger has one of the worst maternal and child mortality rates in the world. One in every 23 Nigerien women will die during pregnancy or child birth (compared to 1 in 42 for the Africa Region), only a fifth of births are attended by skilled health workers, and only 46% of pregnant women will benefit from antenatal care. In addition, one in every seven children risks dying before their 5th birthday.In light of such startling statistics, in 2005, the government of Niger introduced a free healthcare policy for women and children 0- 5 years old. Under this initiative, women get access to free contraceptive services, antenatal care, deliveries including caesarean sections, and free treatment for breast and gynecological cancers (2).
According to Niger cancer registries data from the College of Medicine of University Abdou Moumouni de Niamey, 7031 cases of cancer were diagnosed, from 1992 to 2009. Among them, the proportion of breast cancer is by far the most important within female population with 1161 cases reported. The incidence is 16.51 % of all cancers (3). It has been reported that the mean age was relatively young, 44 years old and the aspect of cancer was so aggressive which rose up the question of the hereditary or triple negative nature of the diseases, because even with adjuvant therapy the outcome is very poor.
Other data from Globocan figures stipulated that breast cancer is responsible for 31.5% of all new cancer cases in Nigerien women, with an age-standardized incidence of 31.9 new cases/100,000 people at risk (4).
Treatment of breast cancer in Niger includes mastectomies/lumpectomies, radiation, and various forms of chemotherapy. In spite of free access to women’s health, many patients remained unreported, thus limited information is available on the proportion of patients who begin or complete necessary treatment for breast cancer in Niger.

Study Aims:
1. To determine the proportion of all breast cancer cases in Niamey that was diagnosed at Niamey National Hospital in the last 3 years and eight months.
2. To investigate the proportion of patients diagnosed with inflammatory and triple negative breast cancer.-To identify the proportion of patients who received lumpectomies, mastectomies and adjuvant therapy (i.e.; chemotherapy, radiotherapy, hormone treatment).
3. To investigate the frequency of initiating neo-adjuvant therapy prior to surgery and most common therapy provided.
4. To determine the time interval between diagnosis and initiation of treatment (surgery or neo adjuvant therapy).
5. To determine the proportion of patients those don’t return for treatment after being diagnosed.To identify any alternative approaches patients may seek for treating cancer.
6. To estimate the proportion of patients who began adjuvant therapy and also finished the recommended regimen.

References: 
1.Observatory, G. H. (2009). Niger. Retrieved 12 25, 2012, from World Health organization International: http://www.who.int/countries/ner/en/
2.Saidou, I. (2012). Construction of a cancer center in Niamey. Retrieved 04 04, 2013, from LeSahel: http://lesahel.org/index.php?option=com_k2&view=item&id=1573
3.Boukar, H. (2012). Free healthcare initiative in Niger makes health gains but many challenges remain. Retrieved 01 12, 2013, from Global Health Check: http://www.globalhealthcheck.org/?p=1060
4.GloboCan. (2008). Fast Stats. Retrieved 2012, from International Agency for Cancer Research: http://globocan.iarc.fr/factsheet.asp

Harouna Zouladeny, M.D.
Harouna Zouladeny Picture

I graduated from the University of Mali, college of medicine in 1999. I worked as general practitioner from 1999-2001 in Niamey, Niger (West Africa) at a private hospital.  In 2006, I passed the United States Medical Licensing Examination (USMLE) and received the Educational Commission for Foreign Medical Graduate (ECFMG) Certification. I plan to graduate with an MPH in Public Health Administration in the Spring of 2014 from the University Of Nebraska Medical Center College of Public Health. 

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