Recurrence rate after surgery in patients diagnosed with and treated for breast cancer at Kenyatta national hospital, Nairobi, Kenya
Otieno, Edwin S
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Background: Recurrence of breast cancer after initial definitive surgery is considered an adverse event that affects the quality of life of a survivor and predicts overall survival. This study set out to establish the general outcome of these patients after initial surgery in the local setting in terms of the rate of loco-regional recurrence and distant spread. In addition the study tried to identify independent variables that determine the observed pattern of recurrence. Objective: To determine the recurrence rate after surgery in patients diagnosed with and treated for breast cancer at Kenyatta National Hospital (KNH) between the 151 of January 1998 and 31 st December 2002. Study design: A retrospective cohort study. Study setting: Kenyatta National Hospital, which is a University Teaching and National Referral facility in the capital city, Nairobi. Kenya. Study population: All patients with proven cytological and/or histological diagnosis of breast cancer and treated at KNH between the 151 of January 1998 and 31 SI December 2002. Results: During the study period 449 underwent surgery at KNH for breast cancer. 98.4% had mastectomy and 1.1% had breast conservation surgery. A total of 286 (63%) were lost to follow up, leaving 153 (34.5%) who developed recurrence within 5 years of surgery and 10 (2.2%) who were recurrence free at 5 years. This gives a 5 year recurrence period of93.9%. The 2 and 3 year recurrence rates were 79.5% and 82.3%. Over 56% of the recurrences occurred within 18 months of surgery with a peak annual recurrence rate between the first and second years. The distribution of the first site of recurrence was, local 16.1%, regional 30.8% and distant 53.2% (n=143). Age below 50, age distribution, and year of diagnosis were found to be associated either negatively or positively with recurrence. Conclusion: The 2, 3 and 5 year recurrence rate were comparable (0 other studies in the region but far inferior to those seen in developed countries. The utilization of chemotherapy as adjuvant treatment for breast cancer in this study was found to be very low Recommendation: Due to the high rate of loss to follow up a prospective study design is required in order to more accurately find out determinants that predict recurrence in our local setting.