Female Breast Cancer in Northern Ghana: A Retrospective Histopathological Study at the Department of Pathology of the Tamale Teaching Hospital (TTH) (2012 To 2021) Burden of breast cancer in northern Ghana

Edmund Der (1), Francis A. Abantanga (2)
(1) Department of Pathology, School of Medicine, University for Development Studies; PO Box TL Tamale; Department of Pathology, Tamale Teaching Hospital, Tamale, Ghana,
(2) Department of Surgery, School of Medicine, University for Development Studies, Tamale; Department of Surgery, Tamale Teaching Hospital, Tamale, Ghana


Background: Data on breast cancer (BC) in northern Ghana is scant. The aim of this study was to provide data on the clinicopathological, prognostic and molecular characteristics of BC in females of northern Ghana.

Methods: Data on breast cancer patients (n = 1,913) in the Department of Pathology of the Tamale Teaching Hospital (TTH) was collected from 1st January, 2012 to 31st December, 2021 and analysed at four levels: introduction, clinico-pathological features, prognostic stratification using the NPI score and the molecular subtypes of BC based on IHC Status. Associations between variables were determined by Fisher’s exact test.

Results: There were 1,191 (62.3%) benign and 722 (37.7%) malignant tumors. A gradual rise in the relative proportions of the female BCs over the period was observed. The mean age (years) of BCs diagnosed in small to medium size samples was 47.7±16.0, and 36.4% were aged <40 years. The commonest clinical presentation of BC was a palpable breast lump (65.5%). Majority of the BC patients presented 3 months after the onset of the illness. Invasive ductal carcinoma was the commonest subtype of BC (78.0%), and the great majority (93.1%) had a combined (II & III) high histological grade (P<0.0001). Stratifying women diagnosed with BC into prognostic categories using the NPI, 15.4% had excellent prognosis, compared to 49.2% with poor prognosis.

Conclusion: The study identified breast cancer as a common breast disease among women in the study area with advanced clinico-pathological features at presentation, and therefore, poor prognosis even at the time of diagnosis.

Full text article

Generated from XML file


Adesunkanmi AR, Lawal OO, Adelusola KA, Durosimi MA. The severity, outcome and challenges of breast cancer in Nigeria. Breast. 2006;15:399-409. doi: 10.1016/j.breast.2005.06.008.

Cancer Association of South Africa (CANSA) Fact Sheet on Breast Cancer November 2011.

Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC Cancer Base No. 11. 2013 Lyon, France: International Agency for Research on Cancer.

Bray F, Ren JS, Masuyer E, Ferlay J. Global estimates of cancer prevalence for 27 sites in the adult population in 2008. Int J Cancer, 2013;1325:1133–1145. doi: 10.1002/ijc.27711.

International Agency for Research on Cancer. Global Cancer Observatory. http://gco.iarc.fr/. Accessed 31 Aug 2020.

Calys-Tagoe BNL, Yarney J, Kenu E, Amanhyia NAKO, Enchill E, et al. Profile of cancer patients’ seen at Korle Bu teaching hospital in Ghana (A cancer registry review). BMC Research Notes. 2014;7:577. doi: 10.1186/1756-0500-7-577.

Cancer Registry 1977: Incidence of breast tumour in Accra for the period 1972-1975.

Biritwum RB, Gulaid J, Amaning AO. Pattern of diseases or conditions leading to hospitalization at Korle Bu Teaching Hospital, Ghana in 1996. Ghana Med J. 2000;34:197–205.

Der EM, Ibrahim MM, Buunaaim ADB, Naporo S, Tolgou NY, Yenli E, et al. Baseline Study of Cancer Patterns in the Department of Pathology of the Tamale Teaching Hospital, Northern Region of Ghana JAMMR 2018; 27: 1-14, 2018. doi: 10.9734/JAMMR/2018/43772.

Balekouzou, A., Yin, P., Pamatika, C.M. et al. Epidemiology of breast cancer: retrospective study in the Central African Republic. BMC Public Health 2016:16:1230. doi: 10.1186/s12889-016-3863-6.

Choe R, Konecky SD, Corlu A, Lee K, Durduran T, Busch DR, et al. Differentiation of benign and malignant breast tumors by in-vivo three-dimensional parallel-plate diffuse optical tomography. J Biomed Opt. 2009 Mar-Apr;14:024020. doi: 10.1117/1.3103325.

Edmund DM, Naaeder SB, Tettey Y, Gyasi RK. Breast cancer in Ghanaian women, what has changed? Am J Clin Pathol. 2013;140:97–102. doi: 10.1309/AJCPW7TZLS3BFFIU.

Umanah IN, Akhiwu W, Ojo OS. Breast tumours of adolescents in an African population. Afr J Paediatr Surg. 2010 May-Aug;7:78-80. doi: 10.4103/0189-6725.62849.

Pavdin PM, Cronin KA, Howlader N, Berg CD, Chlebowski RT, Feuer EJ et al The decrease in breast-cancer incidence in 2003 in the United States. N Engl J Med 2007;356:1670–1674. doi: 10.1056/NEJMsr070105.

Cronin KA, Ravdin PM, Edwards BK. Sustained lower rates of breast cancer in the United States. Breast Cancer Res Treat. 2009;117:223–224. doi: 10.1007/s10549-008-0226-8

Der EM, Gyasia RK, Wiredu EK. Prognostication of Breast Cancer in Ghanaian Women Receiving Modified Radical Mastectomy: A Retrospective Histopathological Study at Korle-Bu Teaching Hospital, Accra, Ghana. Arch Breast Cancer 2018;5: 129-137. doi: 10.19187/abc.201853129-137.

Der EM, Awal S, Sherif, M. Breast malignancies in Northern Ghana: A 7-year histopathological review at the Tamale Teaching Hospital (2013 – 2019). Postgraduate Medical Journal of Ghana. 2021;2:110 – 118.

Der EM, Ali W, Avorka JS, Salifu R, Azongo BT. Assessing the knowledge and attitude of tertiary students on the risk factors of breast cancer in the tamale metropolis. Ijmrps 2018;5. doi: 10.5281/zenodo.1214972.

Kocaöz S, Özçelik H, Talas MS, Akkaya F, Özkul F, Kurtuluş A, et al. The Effect of Education on the Early Diagnosis of Breast and Cervix Cancer on the Women's Attitudes and Behaviors Regarding Participating in Screening Programs. J Cancer Educ. 2018 Aug;33(4):821-832. doi: 10.1007/s13187-017-1193-8.

Ouyang YQ, Hu X. The effect of breast cancer health education on the knowledge, attitudes, and practice: a community health center catchment area. Journal of Cancer Education: the Official Journal of the American Association for Cancer Education. 2014;29:375-381. doi: 10.1007/s13187-014-0622-1.

Amoah AGB. Sociodemographic variations in obesity among Ghanaian adults. Public Health Nutr. 2003b;6:751-775. doi: 10.1079/phn.2003506.

Biritwum RB, Gyapong J, Mensah G. The Epidemiology of Obesity in Ghana. Ghana Med J. 2005; 39:82–85.

Prentice AM. The emerging epidemic of obesity in developing countries. Int J Epidemiol. 2006;35:93–99. doi: 10.1093/ije/dyi272.

Fezeu L, Minkoulou E, Balkau B, Kengne AP, Awah P, Unwin N, et al. Association between socioeconomic status and adiposity in urban Cameroon. Int. J. Epidemiol. 2005;35:105–111. doi: 10.1093/dijedyi214.

Mayosi BM, Flisher AJ, Lalloo UG, Sitas F, Tollman SM, Bradshaw D. The burden of non-communicable diseases in South Africa. Lancet. 2009;374:934–947. doi: 10.1016/S0140-6736(09)61087-4.

Hamid S, Groot W, Pavlova M. Trends in cardiovascular diseases and associated risks in sub-Saharan Africa: a review of the evidence for Ghana, Nigeria, South Africa, Sudan and Tanzania. The Aging Male. 2019;22:1-8. doi: 10.1080/13685538.2019.1582621.

Abdulrahman GO Jr, Rahman GA. Epidemiology of breast cancer in europe and Africa. J Cancer Epidemiol. 2012;2012:915610. doi: 10.1155/2012/915610.

Ijaduola TG, Smith EB. Pattern of breast cancer among white-American, African-American, and non-immigrant west-African women. J Natl Med Assoc. 1998 Sep;90:547-51.

Anim JT. Breast cancer in Accra. Ghana Med J. 1979; 18:161-168. doi: 10.314/jmbs3i3-4.

Quartey-Papafio JB, Anim JT. Cancer of the Breast in Accra. Ghana Med J.1980:159-162.

Der EM, Naaeder SB, Clegg-Lamptey JNA, Quayson SE, Wiredu EK, Gyasi RK. Positive tumour margins in wide local excisions (lumpectomies) biopsies: a 10-year retrospective study. African Journal of Pathology and Microbiology, Vol. 3 (2014), Article ID 235871, 5 pages. doi:10.4303/ajpm/235871.

Der EM, Clegg-Lamptey JNA, Wiredu EK. Patients age at diagnosis and the clinicopathological features of breast cancer in women: A comparative study at the Korle-Bu Teaching Hospital Accra. AMJ 2017;10:656–664. doi: 21767/AMJ.2017.2938.

Okobia MN, OSine U. Clinicopathological study of cancer of the breast in Benin city. Afr J Reprod Health. 2001;5:56-62.

Ekanem VJ, Aligbe JU. Histopathological types of breast cancer in Nigerian women: a 12-year review. Afr J Reprod Health. 2006;10:71-75.

Anyanwu SN. Breast cancer in Eastern Nigeria. A ten year review. West Afr J Med. 2000; 19:120-125.

Clegg-Lamptey JNA, Hodasi WM. A study of breast cancer in KBTH: assessing the impact of health education. Ghana Med J. 2007;41:72–77. doi: 10.4314/gmj.v41i2.55305

Hamza AA, Idris SA, Al-Haj MB, Mohammed AA. Prognostication of Breast Cancer Using Nottingham Prognostic Index in Sudanese Patients. International Journal of Public Health Research. 2014;2:1-5.

Kwon JS, Gutierrez-Barrera AM, Young D, Sun CC, Daniels MS, Lu KH, et al. Expanding the criteria for BRCA mutation testing in breast cancer survivors. J Clin Oncol. 2010 Sep 20;28(27):4214-20. doi: 10.1200/JCO.2010.28.0719.

Walters S, Maringe C, Butler J, Rachet B, Barrett-Lee P, Bergh J, et al. The ICBP module 1 working group. Breast cancer survival and stage at diagnosis in Australia, Canada, Denmark, Norway, Sweden and the UK, 2000-2007: A population-based study. British Journal of Cancer. 2013;108:1195–1208. doi: 10.1038/bjc.2013.6

Kene TS, Odigie VI, Yusufu LM, Yusuf BO, Shehu SM, Kase JT. Pattern of presentation and survival of breast cancer in a teaching hospital in north Western Nigeria. Oman Med J. 2010;25:104-107. doi: 10.5001/omj.2010.29

Gakwaya A, Kigula-Mugambe JB, Kavuma A, Luwaga A, Fualal J, Jombwe J, et al. Cancer of the breast: 5-year survival in a tertiary hospital in Uganda. Br J Cancer. 2008;99:63-67. doi: 10.1038/sj.bjc.6604435.

Swaminathan R, Lucas E, Sankaranarayanan R. Cancer survival in Africa, Asia, the Caribbean and Central America: database and attributes. IARC Sci Publ. 2011;162:23-31

Hjerkind KV, Johansson ALV, Trewin CB, Russnes HG, Ursin G. Incidence of breast cancer subtypes in immigrant and non-immigrant women in Norway. Breast Cancer Res. 2022 Jan 10;24(1):4. doi: 10.1186/s13058-021-01498-5.

Carey LA, Perou CM, Livasy CA, Dressler LG, Cowan D, Conway K, et al. Race, breast cancer subtypes, and survival in the Carolina Breast Cancer Study. JAMA. 2006;295(21):2492–2502. doi: 10.1001/jama.295.21,2492.

Stark A, Kleer CG, Martin I, Awuah B, Nsiah-Asare A, Takyi V, et al. African ancestry and higher prevalence of triple-negative breast cancer: findings from an international study. Cancer 2010;116:4926–4932. doi: 10.1002/cncr.25276.

Huo D, Ikpatt F, Khramtsov A, Dangou JM, Nanda R, Dignam J, et al. Population differences in breast cancer: survey in indigenous African women reveals overrepresentation of triple-negative breast cancer. J Clin Oncol 2009;27:4515–4521. doi: 10.1200/JCO/2008.19.6873.

Abdelkrim SB, Trabelsi A, Missaoui N, Beizig N, Bdioui A, Anjorin A, et al. Distribution of molecular breast cancer subtypes among Tunisian women and correlation with histopathological parameters: a study of 194 patients. Pathol Res Pract 2010;206:772–775. doi: 10.1016/j.prp,2010.07.012.

Bird PA, Hill AG, Houssami N. Poor hormone receptor expression in East African breast cancer: evidence of a biologically different disease? Ann Surg Oncol 2008;15:1983–1988. doi: 10.1245/s10434-008-9900-7.


Edmund Der
edmunder1869@gmail.com (Primary Contact)
Francis A. Abantanga
Der E, Abantanga FA. Female Breast Cancer in Northern Ghana: A Retrospective Histopathological Study at the Department of Pathology of the Tamale Teaching Hospital (TTH) (2012 To 2021): Burden of breast cancer in northern Ghana. Arch Breast Cancer [Internet]. 2023 Feb. 8 [cited 2024 Apr. 14];10(2):164-7. Available from: https://www.archbreastcancer.com/index.php/abc/article/view/641

Article Details