Metastatic patterns of breast cancer: a retrospective study in a Teaching Hospital in Ghana

Background: Breast cancer is the most prevalent cancer among Sub-Saharan African women. In Ghana, there is an increasing incidence of breast cancer with a cumulative 5-year survival of 48%. The low survival has been attributed to the late stage of presentation, delays with diagnosis and limited treatment options. Breast cancer-associated morbidity and mortality are generally related to the clinical stage of the disease and are worse in metastatic disease. Objective: This study determined the time to metastases from the initial diagnosis of breast cancer and the patterns of metastases in a teaching hospital in Ghana. Methods: This study retrospectively reviewed consecutive cases of breast cancer managed from January 2009 to December 2011 at the Korle Bu Teaching Hospital, Accra, Ghana. Patient case records were reviewed, and data was extracted. Results: The median age of the patients was 50 years in the non-metastatic group and 51 years in the metastatic group. The median duration from diagnosis to detection of first metastasis was 10.5 months. Fifty-eight percent of participants had metastasis involving 1 site only and the rest had 2-5 sites of metastases. The most common sites of metastases were the lungs and pleura (41%), bones (31%), liver (23%) and brain (12%). Triple-negative and HER 2 enriched breast cancers were significantly associated with liver metastases. Breast cancer grade was significantly associated with multiple metastatic sites. Conclusion: The median time to metastases from initial diagnosis was less than 1 year, and two-fifths of patients had more than one site of metastases. It would be useful if clinicians aggressively monitor indications for metastases, especially in the common sites, and for patients at high risk of metastases, both at the initial breast cancer diagnosis and in the early post-treatment period.