Nashivai Kivuyo

Introduction: male breast cancer (MBC) is rare, but its incidence is increasing globally. In sub-Saharan Africa, breast cancer care has primarily focused on women, creating a gap in understanding MBC outcomes. This study aimed to examine the clinical characteristics and treatment outcomes of MBC patients at Tanzania´s National Hospital. Methods: this retrospective cohort study, conducted at Muhimbili National Hospital, included male patients aged 18 years and above with histologically confirmed breast cancer diagnosed between January 2018 and December 2024. Demographic and clinical data were extracted from treatment records and presented as frequencies, proportions, and means. Survival status, obtained from case notes or patient/next-of-kin interviews, was analyzed using the Kaplan-Meier method. Results: fifty-six MBC patients were identified, with a mean age of 60.6 ± 12.9 years. Most patients (71.1%) had T4 disease, and 26.8% had metastasis, primarily pulmonary (73%). Invasive ductal carcinoma accounted for 83.9% of cases. The most common molecular subtype was Luminal A (61.8%), followed by triple negative (20%). Nearly all patients (97%) underwent surgery, with modified radical mastectomy and simple mastectomy performed in 48% and 45%, respectively. Over 60% of patients treated with curative intent had recurrence within 15 months. The 5-year overall survival rate was 11.2%. Conclusion: advanced disease presentation was common among MBC patients, corresponding to poor overall survival. Additionally, early disease progression was noted among those treated with curative intent. These findings underscore gaps in healthcare-seeking behavior, screening, and referral systems. Addressing these challenges and optimizing treatment protocols are crucial for improving outcomes.

Background: Axillary lymph node yield (LNY) is a critical component of breast cancer staging and treatment planning. International guidelines recommend retrieving ≥ 10 lymph nodes during axillary lymph node dissection (ALND) to ensure adequate staging. This study assessed LNY and its association with pathological nodal burden among patients with breast cancer undergoing ALND at Muhimbili National Hospital (MNH), Tanzania. Materials and Methods: We conducted a retrospective analysis of female patients with breast cancer who underwent ALND between January 2018 and December 2024. Clinical and pathological data were abstracted from institutional records. LNY was categorized as < 5, five to nine, or ≥ 10 nodes. Ordinal logistic regression was used to identify factors associated with the pathological nodal stage (pN0–pN3). Results: Among 871 patients, only 27% had ≥ 10 lymph nodes retrieved. Median LNY was 7 (IQR: 4–10). Higher LNY was strongly associated with higher pN category (aOR for five to nine nodes: 2.33; 95% CI: 1.67–3.26; aOR for ≥ 10 nodes: 8.93; 95% CI: 5.89–13.53; and p < 0.001). Additional independent predictors of higher nodal burden included tumor size (T2: aOR 2.34; 95% CI: 1.26–4.34; T3: aOR 2.54; 95% CI: 1.40–4.60; T4: aOR 3.34; and 95% CI: 1.84–6.09), histological grade 2 (aOR 1.63 and 95% CI: 1.09–2.45), and lobular histology (aOR 4.96 and 95% CI: 1.41–17.38). Neoadjuvant chemotherapy was associated with lower nodal burden category in univariate analysis but not after adjusting for LNY. Conclusion: Low LNY is prevalent and strongly associated with understaging of pathological nodal burden. Targeted quality improvement interventions are needed to optimize nodal evaluation and accurate staging to ensure appropriate treatment strategies in resource‐limited settings.

The quality and completeness of surgery remains critical for optimal oncological outcomes in breast cancer. A key indicator of surgical completeness is the resection margin status, which should ideally be negative, indicated by no ink on invasive tumor. However, such data is rarely reported from sub-Saharan Africa. This study aims to describe the clinical characteristics of women with non-metastatic breast cancer who underwent a mastectomy, and identify the factors influencing the resection margin status at a cancer hospital in Tanzania. This was a retrospective cohort study analyzing clinical and pathological data of female patients, with a histologically confirmed breast cancer at stage I-III, who underwent a mastectomy at Muhimbili National Hospital in Tanzania. Data were extracted from histopathology reports and clinical records, focusing on margin status and associated variables including age, tumor size (T-status), nodal involvement (N-status), histological subtype, grade, luminal subtype, laterality, and receipt of neo-adjuvant therapy. The primary outcome was margin status post mastectomy. Descriptive statistics were used to summarize patient characteristics, and chi-square tests were applied to assess associations between variables and margin status. Statistical significance was set at p < 0.05. Out of the 1,020 patients analyzed, margin status was documented for 976 cases. Among these, 801 patients (82.1%) had negative margins, while 175 (17.9%) had positive or close margins; of the latter, 88.6% were positive and 11.4% close. Most patients with margin involvement (88%) had only a single margin affected. The deep margin was most frequently involved in 87% of patients with involved margins, followed by the superior margin in 57%. Margin involvement was significantly higher among younger patients, particularly those under 30 years of age (p < 0.001), and was also strongly associated with advanced T-status (p < 0.001), especially T4 tumors, where 31.7% had involved margins. No significant associations were found with histological subtype, luminal classification, laterality, receipt of neoadjuvant therapy. This study revealed a high rate of margin positivity following mastectomy, largely driven by advanced tumor stage and young age at presentation. To improve surgical outcomes in low-resource settings, we recommend interventions to improve earlier diagnosis and expanded use of neoadjuvant therapy for patients with locally advanced disease.

Response to neoadjuvant treatment in breast cancer has been associated with good oncological outcomes. In Tanzania, a majority of breast cancer patients are diagnosed at stage III; hence, they almost always require neoadjuvant therapy. However, the response to neoadjuvant therapy in these patients remains unknown. This study examined the pathological responses in women with stage III breast cancer who underwent neoadjuvant therapy and identified sociodemographic and clinical predictors of the pathological response in this cohort. This hospital-based retrospective cohort study was conducted between December 2021 and April 2022. It included women with breast cancer who received neoadjuvant therapy and underwent surgery for breast cancer at Muhimbili National Hospital in Tanzania, from January 2018 through December 2021. Data analysis was performed using SPSS version 25. A complete pathological response was identified upon pathological review of the mastectomy specimen. Chi-square tests and Fischer’s exact tests were used to evaluate the factors associated with a complete pathological response, with a p value of less than 0.05 indicating statistical significance. Ethical approval was obtained from the Muhimbili University of Health and Allied Sciences Institutional Review Board. The study complied with the Helsinki Declaration on studies involving human subjects. A total of 181 breast cancer patients were recruited for the study, with a mean age of 51±12.6 (28–89) years. A complete pathological response to neoadjuvant therapy was observed in 40 (22.1%) patients which is relatively lower compared to studies from Western countries. Disease stage at diagnosis was associated with response to neoadjuvant therapy, with those at stage IIIA showing better complete response than those at stages IIIB and IIIC indicating a need to improve diagnostic strategies to capture patients in the earlier stages to improve outcomes.

Treatment outcomes and the associated factors among breast cancer patients in Tanzania: a retrospective cohort study Nashivai E Kivuyo, Daniel W Kitua, Mar

Introduction: Breast myofibroblastoma (MFB) is a relatively rare benign tumor that mimics the clinical presentation of malignant tumors of the breast. It has various morphologic variants that can be accurately diagnosed based on histopathology and immunohistochemistry staining. We report a case of MFB in a menopausal woman for pertinent clinical consideration and management. Case Presentation: We report a case of a 57‐year‐old Tanzanian woman, who presented with a huge right breast mass for 1 year. Initial radiological findings were inconclusive, however, the tissue specimen for histology and immunohistochemical (IHC) confirmed the diagnosis. A simple mastectomy was thereafter performed as a curative therapy. Conclusion: This case presentation underscores the importance of considering MFB as a potential differential for breast tumors especially in menopausal women. Tissue biopsy for histopathology and IHC staining form the cornerstone for accurate diagnosis and appropriate management.

Background: Pancreatic masses are challenging to diagnose and treat due to their indolent course. Despite the presence of both curative and palliative surgical services at Muhimbili National Hospital, there is a paucity of data on how these patients are investigated and managed. This study will enable clinicians to improve both their index of suspicion for pancreatic mass and their timely diagnosis to capture resectable disease for better outcomes. The study aimed to document the clinical characteristics, diagnosis, and management of patients with pancreatic masses at Muhimbili National Hospital. Methods: A retrospective cross-sectional study of patients treated for pancreatic masses at Muhimbili National Hospital between 2018 and 2019. Using the hospital’s electronic medical system and inpatient registry, we identified all patients with a diagnosis of pancreatic mass. Individual patients’ case notes were retrieved from the medical records department. Patient clinical demographics, disease characteristics, types of investigations done, and treatment offered for management were collected. This information was entered into SPSS version 25 for analysis, whereby variables were summarized as means and frequencies. Ethical approval was obtained from the Muhimbili University of Health and Allied Sciences. The study complied with the Helsinki declaration on studies involving human subjects. Results: A total of 147 patients were identified as having pancreatic masses with a mean age of 60.1±13.6 (range, 27–89) years, with an equal male-to-female ratio. A computed tomography (CT) scan of the abdomen was done in 72.1% of the patients, while a histological diagnosis was made in 32.7% of the patients. Most patients were labeled to have advanced disease at presentation as either unresectable (20.2%) or metastatic (57.3%). The potentially resectable masses were 13.7%, with a resection rate of 6%. Conclusions: Patients with pancreatic masses present late with advanced disease. Most are under investigation and potentially assigned the wrong stage, leading to extremely low resection rates. Clinicians should standardize patients’ workups to offer every patient the same opportunity for curative intervention and survival.