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Home > Risk Factors, Clinico-Pathologic Characteristics and Outcomes in Young Kenyan Female Patients With Breast Cancer in Akuh-N

Risk Factors, Clinico-Pathologic Characteristics and Outcomes in Young Kenyan Female Patients With Breast Cancer in Akuh-N

Thesis Info

Author

Mwikamba, Gilford Mutwiri

Department

Internal Medicine (East Africa)

Program

MMed

Institute

Aga Khan University

Institute Type

Private

City

Karachi

Province

Sindh

Country

Pakistan

Thesis Completing Year

2016

Thesis Completion Status

Completed

Subject

Medicine

Language

English

Added

2021-02-17 19:49:13

Modified

2024-03-24 20:25:49

ARI ID

1676728066911

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Background: Breast cancer in the young refers to a diagnosis of breast cancer in a female under the age of forty years. This is considered a distinct disease with different risk factors, biology, and prognosis. Young age at breast cancer diagnosis is reportedly more common among African-Americans. The highest proportion of breast cancer in the young has been reported in Africa. Early detection of breast cancer in Africa is hampered by lack of access to health care services, appropriate screening tools, and high cost of magnetic resonance imaging for the high risk groups. Despite a worse prognosis, management of breast cancer in the young has remained similar to that in the old females. Regional differences in the characteristics and outcomes of breast cancer in the young have been reported. There are no studies published on breast cancer in the young from the East African region. This study describes and compares the risk factors, clinicopathologic characteristics and outcomes of breast cancer in young females (<40 years>old) compared to the older females (>/= 40 years) at the Aga Khan University hospital, Nairobi (AKUH-N). Methods: We did a retrospective survey of all patients diagnosed with breast cancer at AKUH-N oncology unit between March 2012 and March 2015. We extracted data on age at diagnosis, clinical presentations, risk factors, tumour pathologic characteristics, and outcome. Results: A total of 228 breast cancer cases were diagnosed between March 2012 and March 2015, of whom 30% (69/228) were categorized as young while 70 % (159/228) were equal to or older than 40 years of age. The mean ages were 32 years, 52 years and 47 years for the young, old, and entire population of breast cancer cases respectively. All the young presented with a breast lump while 81.8% of the old had complained of a lump (P=0.001) at presentation. Compared to the old young females (54% vs. 46%, OR=2.489, P=0.045) presented earlier, and 5.5% had atypical hyperplasia (P=0.021). The young females with breast cancer had a lower weight (71kg vs. 75Kgs respectively, P=0.021). Though not statistically significant, the young females had more metastatic disease at presentation compared to the old (17.5% vs. 8.5% P=0.148). Compared to the old women, the young were more likely not to undergo surgery (21.9% vs. 5.8%, P=0.001), less likely to undergo modified radical mastectomy (31.2% vs. 54.2%, P=0.001) and preferred breast conserving (45.3% vs. 38.9%, p=0.001). Similarly, the tumours in the young
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Foreword One

The Qur’an is a Message that encompasses the essence of all the previous Divine Revelations since the beginning of time, and it will ring true till the end of time. The process of Divine Guidance was initiated with the inauguration of human existence on the earth and Prophet Muhammad (peace be upon him) was the last Messenger to be the savior of humanity, signaling the end of Divine Revelations and the Prophethood.

 

It may not be unfair to consider all former Divine Revelations a prologue for the Qur’an and all former Prophets being sent to prepare us for the arrival of Muhammad - the Seal and Gem of a Prophet - peace be upon him.

 

Millions of pages have been written to make the words of the Qur’an easily comprehensible by societies by and large in order to facilitate the use of The Book and the lessons it contains in all its wisdom and help humanity in the application of its lessons and verdicts to the capricious conditions of life.

 

In being the ultimate miracle of Allah – the Exalted and Merciful - and the abiding evidence of Allah’s Grace and Mercy, it unfolds the realities of the past and also miraculously guides human thought and action.

 

Its Message transcends the boundaries of space and time and will enter eschatological stages with mankind as a manifestation of Divine Communication with humanity.

 

It is a difficult task to bring about a comprehensive explanation of the Qur’an: an endeavor that has been a challenge for Muslim scholars since the time Shah Wali Allah first...

اسلامی اخلاقیات واقدار کے فروغ میں خاندانی ماحول کا کردار؛معاصرانہ چیلنجز اور لائحہ عمل The role of family environment in the development of Islamic ethics and values, Contemporary challenges, and action plan

Islamic rules and moral values are unique in all aspects. The members of Muslim Ummah have always tried to promote them. At the national level, this duty was carried out by people at different levels whether they were teachers, businessmen or lay man of the society. At international level, some rulers, business professionals and religious leaders played their role. Man's first relationship is with family. This relationship is the cornerstone in the development of a personality.  There has been a lot of change taken place in the family system. In the past, due to the limited necessities of life the financial responsibility was limited to a few people. Media was not that advanced and bold and family members were loving and respectful. With the beginning of advance era, human needs were widened and to satisfy them, women started participating in economic activities along with men. Due to which the child was shifted from his home to day care centre, while the media gave birth to the social media, the stories of compassion and care in home became the past. In the present era, there is a dire need to remove these barriers that hinder the development of Islamic values through balance between income and expenditure, positive and moderate use of media and positive attitude in family. These issues will be discussed under the answers to the following questions. What is the role of family in the development of Islamic ethics? What are the problems faced by the family in the development of Islamic moral values? What are the solutions to the present-day problems?  

Working Collaboratively With Teacher to Develop an Understanding About Linking School Mathematics and its Use in Children’S Daily Lives Experiences at Local Government School

This small-scale action research project explores the possibilities and challenges involved in facilitating a Mathematics Teacher in understanding the notion and practice of linking mathematics with students' real lives in their classroom contexts. The effort is based on the rationale that mathematics needs to be linked with real life in order to maximize the attainment of set curricular goals and objectives. However, the assumption is that in most cases the curricular goals and objectives are not satisfactorily met due to the teachers: a) limited access and understanding of curricular goals and objectives, and b) limited knowledge and expertise in effective implementation of the linking mathematics with students real lives. In this background, the project sees, linking mathematics with real life, as one of the important ways in assuring the attainment of goals and objectives of linking mathematics with students' real life experiences. To realize this aim, the action researcher worked with one secondary level secondary level mathematics teacher in a government school of Karachi, Pakistan. In this regard, the project studies the teachers existing perceptions and practice of linking mathematics with students' real lives. Subsequently, a strategic action plan was prepared and implemented to facilitate a teacher's understanding and practice of linking mathematics with real life. Subsequent planning and action remained responsive to any need for change arising out of the experiences of implementing the previous one. The data for the action process was collected through semi-structured interviews, lesson observations notes, the researcher's reflective journal and tape recordings. The gathered data was analyzed soon after each action step for reflection and further action. The study reports some possible strategies to facilitate a teacher in gaining an understanding about the notion of linking mathematics with real life. These are: 1) Using "input/training" session about "definition and theory" of linking mathematics with real life. 2) Sharing strategies for content, pedagogical and organizational linkage (i.e. mathematics with real life). For example, adding supplementary reading materials from sources other than the prescribed textbooks. At the same time and vein, the study also reports the challenges faced in the process; such as: time availability for action and its research and overemphasis on the theoretical input. The report concludes by presenting key learnings experienced as a teacher educator and an action researcher, and suggests a focus for further action research.