Profile of breast diseases at a self-referral clinic in Ghana

BACKGROUND: Breast cancer is a common malignancy in Ghana, and many patients are referred with advanced disease and long duration of symptoms. OBJECTIVE: To determine the spectrum of breast disease diagnosed through patient self-referral in Ghana. METHODS: Abreast clinic, where patients could walk in without referral, was started in the Korle Bu Teaching Hospital in 2001. A team of surgeons, radiation oncologists, oncology nurses, a clinical psychologist and a clinical pharmacist sat in conference once a week to see and discuss self-referred patients. RESULTS: Seven hundred and forty eight patients, mean age 38.6 (range 8-85) years, were seen during a four-year period. There were 741 females and seven males. The main complaints were pain 450(50.2%), lump 257(28.7%) and nipple discharge 62(8.3%). Fifty (5.6%) came for check-up; 139(18.6%) had more than one complaint. The mean (S.D.) duration of symptoms was; for nipple discharge 14.1(10.5) months, lump 11.9(7.7) months, and pain 113(8.9) months. The main diagnoses were: Normal breasts 192(27.7%), mastalgia 135(18.1%), fibroadenosis 114(15.2%), fibroadenomas 84(11.2%), breast cancer 58(7.8%), suspected breast cancer 25(3.3%), galactorrhea 9(1.2%), mastitis 8(1.1 %), musculoskeletal pain 8(1.1%), duct ectasia 8(1.1%), mondor's disease 7(0.94%) and recurrent breast cancer 6(0.8%). In patients with breast cancer, 42(66%) had advanced disease, 6(9.4%) had recurrent disease and 4(6.3%) had metastatic disease. CONCLUSION: The number of self-referrals, detected breast cancers and duration of symptoms justify the need for self-referral clinics in Ghana.