CHAPTER ONE

INTRODUCTION

1.1              Background of study

Cancer is a group of diseases that cause cells in the body to change and grow out of control. Most types of cancer cells even­tually form a lump or mass called a tumor, and are named after the part of the body where the tumor originates (American Cancer Society, 2012).

Breast cancer refers to the growth which begins in breast tissue, which is made up of glands for milk production, called lobules, and the ducts that connect the lobules to the nipple. The remainder of the breast is made up of fatty, connective, and lymphatic tissue. Most masses are benign; that is, they are not cancerous, do not grow uncontrollably or spread, and are not life-threatening (American Cancer Society, 2012).

Some breast cancers are called in situ because they are confined within the ducts (ductal carcinoma in situ or DCIS) or lobules (lobular carcinoma in situ or LCIS) where they originated. Many oncologists believe that LCIS (also known as lobular neoplasia) is not a true cancer, but an indicator of increased risk for developing invasive cancer in either breast (American Cancer Society, 2012).

The majority of in situ breast cancers are DCIS, which accounted for about 83% of in situ cases diagnosed during 2004-2008 (American Cancer Society, 2012).

LCIS is much less common than DCIS, accounting for about 11% of female in situ breast cancers diagnosed during 2004-2008. Other in situ breast cancers have characteristics of both ductal and lobular carcinomas or have unspecified origins. Most breast cancers are invasive, or infiltrating. These cancers start in the lobules or ducts of the breast but break through the duct or glandular walls to invade the surrounding tissue of the breast (American Cancer Society, 2011).

Breast cancer incidence and death rates generally increase with age; 95% of new cases and 97% of breast cancer deaths occurred in women 40 years of age and older. During 2004-2008, among adult women, those 20-24 years of age had the lowest incidence rate, 1.5 cases per 100,000 women; women 75-79 years of age had the highest incidence rate, 421.3 cases per 100,000. The decrease in incidence rates that occurs in women 80 years of age and older may reflect lower rates of screening, the detection of cancers by mammography before 80 years of age, and/or incomplete detection.

In the U.K., the incidence of breast carcinoma in the 20–24 year age group is 1.2 per 100,000 women, and between 15–19 years of age the rate is 0.3 per 100,000 women (UK National Statistics Office, Kothari  2012).

The diagnosis and treatment of cancer have social, economic, physical, emotional/psychological, and sexual repercussions for individuals who receive this diagnosis and their families (Gomes, J. S.,  Lichtenfels, H. K., Kolankiewicz, A. C. B.  et al. 2011). Mammography is less sensitive and specific for breast cancer screening in women under the age of 35, due to the higher breast density (Bouzid et al., 2013). According to Johnson, K. C., Miller, A. B., Collishaw, N. E., Palmer, J. R., Hammond, S. K., Salmon, A. G., Cantor, K. P., Miller, M. D., Boyd, N. F., Millar, J. and Turcotte, F. (2011):  the mammography is normal in 90% of the breast cancers in young women. In the present study it was observed that younger women detect the cancer more frequently by the clinical examination (11.5%) compared to imaging tests (8.8%).  Trufelli, D., Miranda, V. and Santos, M. (2008) found that a palpable nodule is the main complaint of the consultation (75.4%). A survey of women with breast cancer under the age of 30 found that in 90% of cases the first signal was a clinically palpable nodule, with an average size of 3.5 cm (Vargas, E. B., Bau, A. R.  and Vargas, V. R. A. 2009).

1.2       Statement of the problem

Because there are only occasional cases of breast cancer reported in very young women aged 35 years and below, the presentation, tumor biology, behavior, and outcome of breast carcinoma in very young women are not known, and the rarity of breast malignancy within this age group could lead to diagnostic delays. In the U.K., the incidence of breast carcinoma in the 20–24 year age group is 1.2 per 100,000 women, and between 15–19 years of age the rate is 0.3 per 100,000 women (UK National Statistics Office, Kothari et al., 2012). However, many studies have been done as regards to the prevalence of breast cancer below 35 years in most developed and developing countries. This study would need to identify the specific risk factors associated with breast cancer in young women.

1.3       Research Question

To guide this study, the following research questions were presented;

1. What is the prevalence of breast cancer in young women ages 19-35 years in all breast cancer cases from January 2012 through December 2016 in ISTH?
2. Which breast is most affected with breast cancer among the young women during the period of study?
3. At what stage is the breast cancer at presentation by the young women during the period under study?

1.4       Aim

The aim of this study was to determine the prevalence and some characteristics of breast cancer in young women aged 19 – 35 years among breast cancer cases presented in Irrua Specialist Teaching Hospital from January 2012 through December 2016.

 1.5      Specific Objective

The specific objectives of this study include;

1. To investigate the prevalence of breast cancer in young women between 19 and 35 years in all breast cancer cases during the period under study.
2. To assess the most affected breast in young women between 19 and 35 years in all breast cancer cases during the period under study.
3. To assess the stage of breast cancer at presentation among young women between 19 and 35 years during the period under study.

1.6     Significance Of The Study

It is hoped that the findings and recommendation from this study will help create the necessary awareness thereby reducing the prevalence of breast cancer among young women in Irrua Specialist Teaching Hospital Community and the general public. This can be achieved through early detection of lumps and/or other breast changes. It will also assist in identifying possible predisposing factors to young women breast cancer so as to give proper counseling against them. Knowledge gained from this study will help the researcher in particular and other health workers in general to teach women and other members of the public breast self examination so as to achieve early diagnosis. This will result in breast cancer awareness which will eventually reduce the scourge of the deadly dreaded disease.

1.7       Scope Of The Study

This study is delimited to determining the prevalence of breast cancer among young women in Irrua Specialist Teaching Hospital, Irrua, Edo state. Also, in identifying affected breast at presentation from the histopathology laboratory, surgical and medical services of the hospital. The study is also delimited to women of ages 19-35 years that have had breast cancer within the years under review (2012-2016).

1.8       Operational definition of terms

Prevalence: The existing or registered number of breast cancer cases.

Breast cancer: A disease condition characterized by uncontrollable divisions of cells leading to manifestation of lumps on the breast.

Young women: Women aged 19-35 years.

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