†<p>Adjusted for age at diagnosis or interview (categorical), ethnicity, education (categor... more †<p>Adjusted for age at diagnosis or interview (categorical), ethnicity, education (categorical), age at menarche (categorical), number of live births (categorical), age at first live birth (categorical), menopausal status, family history of breast cancer, benign breast disease, hormonal contraceptive use, BMI (continuous), and height (continuous);</p>‡<p>Adjusted for the above variables and study site.</p><p>Includes drinkers who drink a combination of alcoholic beverages.</p><p>Multivariable logistic regression analyses of alcohol consumption and breast cancer risk among women in Nigeria, Cameroon and Uganda, 1998–2013, using data after multiple imputation (N = 4727).</p
Background: The Nigerian Breast Cancer Study (NBCS) model is a new risk assessment tool developed... more Background: The Nigerian Breast Cancer Study (NBCS) model is a new risk assessment tool developed for predicting risk of invasive breast cancer in Nigeria. Its applicability outside of Nigeria remains uncertain as it has not been validated in other sub-Saharan Africa populations. Methods: We conducted a case–control study among women with breast cancer and controls ascertained in Cameroon and Uganda from 2011 to 2016. Structured questionnaire interviews were performed to collect risk factor characteristics. The NBCS model, the Gail model, the Gail model for Black population, and the Black Women's Health Study model were applied to the Cameroon and Uganda samples separately. Nigerian as well as local incidence rates were incorporated into the models. Receiver-Operating Characteristic analyses were performed to indicate discriminating capacity. Results: The study included 550 cases (mean age 46.8 ± 11.9) and 509 controls (mean age 46.3 ± 11.7). Compared with the other three models...
†<p>Among drinkers.</p><p>Includes drinkers who drink a combination of alcoholi... more †<p>Among drinkers.</p><p>Includes drinkers who drink a combination of alcoholic beverages, percentages may not add up to 100%.</p><p>Patterns of alcohol consumption among women in Nigeria, Cameroon and Uganda, 1998–2013</p
<p>Percentage of healthy controls who were current drinkers by age group in the three Afric... more <p>Percentage of healthy controls who were current drinkers by age group in the three African countries.</p
<p>*Adjusted for all other variables listed in this table as well as age at first live birt... more <p>*Adjusted for all other variables listed in this table as well as age at first live birth and study site.</p><p>Stratified analyses of alcohol consumption and breast cancer risk among women in Nigeria, Cameroon, and Uganda using data after multiple imputation, 1998–2013.</p
<p><b>Note</b>: Numbers in parentheses are proportions (%). SD: standard deviat... more <p><b>Note</b>: Numbers in parentheses are proportions (%). SD: standard deviation.</p>a<p>Proportions or means for the controls are adjusted values based on the age distribution of cases; <i>P</i>-values were also age-adjusted in logistic regressions.</p>b<p>Among parous women.</p><p>Demographics of women with invasive breast cancer (cases) and those without (controls) in Nigeria, Cameroon and Uganda, 1998–2013.</p
Background: Women of African ancestry across the diaspora have low risk of developing breast canc... more Background: Women of African ancestry across the diaspora have low risk of developing breast cancer compared to women of European ancestry. However, they suffer the highest mortality rates because of the disproportionate burden of young onset aggressive hormone receptor negative breast cancer. To implement strategies for early detection and prevention, it is critically important to develop better risk assessment tools. The Nigerian Breast Cancer Study (NBCS) model is a new risk assessment tool developed for the individual estimation of absolute risk of invasive breast cancer in Nigeria. Its applicability outside of Nigeria remains uncertain as it has not been validated in other Sub-Sahara African (SSA) populations. Methods: We conducted a case-control study among women with breast cancer and controls ascertained in Cameroon and Uganda from 2011 to 2016. Structured questionnaire interviews were performed to collect demographic and reproductive characteristics. The NBCS model, the Gai...
INTRODUCTION Reference values may vary significantly among populations and cultures for which die... more INTRODUCTION Reference values may vary significantly among populations and cultures for which dietary intakes may be different. Each laboratory is expected to investigate the transferability of the expected values to its own patient population and if necessary determine its own reference ranges. This study sought to establish Folic acid and Vitamin B(12) reference values for young Ugandan adults, which reference values could be used as baseline information for future research, especially related to their role in breast cancer prevention. METHODS A cross sectional study in which 200 undergraduate student volunteers were enrolled. The minimum sample size was 126 using the Open Epi version 2. Relevant demographics and physical examination parameters were taken as well as blood samples for laboratory tests. Prior ethical approval was granted. RESULTS The levels of folic acid were 4.17 - 20 ng/ml and remained constant over the age cohorts. The vitamin B(12) range was 117-1158 pg/ml. Both...
Background: Breast cancer is the third commonest cancer in women in Uganda. The majority of breas... more Background: Breast cancer is the third commonest cancer in women in Uganda. The majority of breast cancer patients in Uganda present with advanced disease. Many studies show that metastatic lesions frequently lodge in bones, lung and liver. Tumour hormone receptor status correlates with site of metastatic lesions and survival among breast cancer patients. Objective : To determine the sites of metastatic breast lesions and how they relate to the hormonal receptor status. Methods: In this cross sectional descriptive study, 71 women with histologically confirmed incident breast cancer with metastases were analysed, their hormonal receptor status was determined. All patients underwent a chest X-ray, an abdominopelvic ultrasound scan and a bone scan. The χ² and t tests were used to compare variables for statistical differences. Results: The mean age of participants was 45 years. Most metastases were to bone 56% (40/71), of these 45% (32/71 ) tumours were exclusive to bone and 94% of thes...
Background: Most studies on thyroid dysfunction have been on patients refereed for treatment, lit... more Background: Most studies on thyroid dysfunction have been on patients refereed for treatment, little is known about the prevalence in the general populations. The importance of knowing such prevalence data lies in that fact that subclinical thyroid dysfunction is an important risk on development of heart disease, osteoporosis, hypercholesterolemia and mental illness. This study set out to determine thyroid dysfunction prevalence in a health young adult population. Methods: A cross sectional study carried out at the College of Health Sciences, Makerere University enrolled 100 Undergraduate medical students by invitations through notices and announcements. Informed consent was sought after approval from research ethics committee. Results: Of the 100 students enrolled and the samples drawn; 83 tests for TSH and 82 tests for FT4 were successfully run. Three results were abnormal making a prevalence of 3.6% for thyroid dysfunction; a high TSH (5.71) with a normal fT4 (19.2), a normal TSH...
Cancer Epidemiology, Biomarkers & Prevention, 2019
Background: Sub-Saharan Africa (SSA) has a high proportion of premenopausal hormone receptor nega... more Background: Sub-Saharan Africa (SSA) has a high proportion of premenopausal hormone receptor negative breast cancer. Previous studies reported a strikingly high prevalence of germline mutations in BRCA1 and BRCA2 among Nigerian patients with breast cancer. It is unknown if this exists in other SSA countries. Methods: Breast cancer cases, unselected for age at diagnosis and family history, were recruited from tertiary hospitals in Kampala, Uganda and Yaoundé, Cameroon. Controls were women without breast cancer recruited from the same hospitals and age-matched to cases. A multigene sequencing panel was used to test for germline mutations. Results: There were 196 cases and 185 controls with a mean age of 46.2 and 46.6 years for cases and controls, respectively. Among cases, 15.8% carried a pathogenic or likely pathogenic mutation in a breast cancer susceptibility gene: 5.6% in BRCA1, 5.6% in BRCA2, 1.5% in ATM, 1% in PALB2, 0.5% in BARD1, 0.5% in CDH1, and 0.5% in TP53. Among controls,...
Background: Breast cancer among indigenous Africans is characterized by higher prevalence of trip... more Background: Breast cancer among indigenous Africans is characterized by higher prevalence of triple-negative disease and poor prognosis. A previous study in Nigeria reported a strikingly high prevalence of deleterious germline mutations in BRCA1 and BRCA2 among Nigerian women with breast cancer. It is unknown if this is true in other sub-Saharan African countries. Aim: The objective of this study is to determine the frequency of germline mutations among an unselected sample of women in Africa. Methods: We conducted a case-control study of breast cancer in Uganda and Cameroon to investigate genetic and nongenetic risk factors for breast cancer. Breast cancer cases were enrolled in two tertiary hospitals in the two countries, unselected for age at diagnosis and family history. Controls who were free of breast cancer were enrolled in the same hospitals and matched to cases on age. A 24-gene sequencing panel was used to test germline mutations in cases and controls. Results: There were ...
Background: Open biopsy of the breast used to be the main traditional method of diagnosis of brea... more Background: Open biopsy of the breast used to be the main traditional method of diagnosis of breast lumps. Fine Needle Aspiration Cytology (FNAC) was later introduced which depends on suction and thus yields hemorrhagic material for cytological study.This study was undertaken to find out if there is a difference in diagnostic accuracy in using Fine Needle Aspiration Cytology and Fine Needle Sample (FNS) without aspiration in the diagnosis of palpable breast lumps. Methods: This was a cross-sectional study of women with palpable breast masses of 2cm and above in the widest diameter by ultrasound. Patients were subjected to FNS, FNAC and excision biopsy of the lump or mastectomy where appropriate. Cytodiagnosis of all the cases was compared to the histodiagnoses of the biopsies to establish the sensitivity, specificity and diagnostic accuracy. Results: Some 85 patients had FNS, FNAC and excision biopsy/ mastectomy done. The findings demonstrated that both FNS and FNAC have the same se...
In Uganda most cancers to the exception of bladder and penis are increasing in incidence. The inc... more In Uganda most cancers to the exception of bladder and penis are increasing in incidence. The incidence of cancer of stomach is 5.6/100,000 from 0.8/100,000 in the 1960s a seven fold increase.The purpose of this guideline document is to highlight the salient points in gastric cancer diagnosis and treatment in the Ugandan context. It doesn’t only outline what is practical and efficacious but also our aspirations of practice as resources committed to the whole area of Oncological care services improve in the country. The primary and secondary prevention strategies are outlined. The multistage process of gastric oncogenesis is discussed in relation to the scientific basis of diagnostic and screening procedures. The treatment modalities including surgery radiotherapy and chemotherapy are discussed. A prognostication scale is included. Traditionally gastric cancer presents late and with a poor prognosis. The greatest strategy we have for management is in primary and secondary prevention....
Acute cholecystitis is predominantly a disease of females who account for 62 percent of cases and... more Acute cholecystitis is predominantly a disease of females who account for 62 percent of cases and mainly affects those between 40 and 50 years1 and is closely associated with cholelithiasis. It occurs all over the world but Africa is a low risk area as compared to Europe and North America. The disease has been observed in children with ascariasis or those with acquired immune deficiency syndrome (AIDS). The commonest bacteria isolated in acute cholecystitis are E Coli. Clinical presentation includes a raised temperature. Leukocytosis may be absent even in those patients with gangrenous acute cholecystitis. However, Murphy's sign remains very specific. The mainstay of treatment remains surgical either open or laparoscopic cholecystectomy and in high-risk patients percutaneous or open cholecystostomy. Laparoscopic cholecystectomy has greatly increased operating time but reduced hospital stay. The over all mortality has remained 5-12% in the last 2 decades.
The objective was to investigate survival of breast cancer patients at Mulago Hospital. A retrosp... more The objective was to investigate survival of breast cancer patients at Mulago Hospital. A retrospective study of the medical records of 297 breast cancer patients referred to the combined breast clinic housed in the radiotherapy department between 1996 and 2000 was done. The female/male ratio was 24 : 1. The age range was 22-85 years, with a median of 45 years and peak age group of 30-39 years. Twenty-three percent had early disease (stages 0-IIb) and 26% had metastatic disease. Poorly differentiated was the most common pathological grade (58%) followed by moderately differentiated (33%) and well-differentiated (9%) tumours. The commonest pathological type encountered was 'not otherwise specified' (76%). Of all patients, 75% had surgery, 76% had radiotherapy, 60% had hormonotherapy and 29% had chemotherapy. Thirty-six (12%) patients received all the four treatment modalities. The 5-year survival probabilities (Kaplan-Meier) for early disease were 74 and 39% for advanced dise...
†<p>Adjusted for age at diagnosis or interview (categorical), ethnicity, education (categor... more †<p>Adjusted for age at diagnosis or interview (categorical), ethnicity, education (categorical), age at menarche (categorical), number of live births (categorical), age at first live birth (categorical), menopausal status, family history of breast cancer, benign breast disease, hormonal contraceptive use, BMI (continuous), and height (continuous);</p>‡<p>Adjusted for the above variables and study site.</p><p>Includes drinkers who drink a combination of alcoholic beverages.</p><p>Multivariable logistic regression analyses of alcohol consumption and breast cancer risk among women in Nigeria, Cameroon and Uganda, 1998–2013, using data after multiple imputation (N = 4727).</p
Background: The Nigerian Breast Cancer Study (NBCS) model is a new risk assessment tool developed... more Background: The Nigerian Breast Cancer Study (NBCS) model is a new risk assessment tool developed for predicting risk of invasive breast cancer in Nigeria. Its applicability outside of Nigeria remains uncertain as it has not been validated in other sub-Saharan Africa populations. Methods: We conducted a case–control study among women with breast cancer and controls ascertained in Cameroon and Uganda from 2011 to 2016. Structured questionnaire interviews were performed to collect risk factor characteristics. The NBCS model, the Gail model, the Gail model for Black population, and the Black Women's Health Study model were applied to the Cameroon and Uganda samples separately. Nigerian as well as local incidence rates were incorporated into the models. Receiver-Operating Characteristic analyses were performed to indicate discriminating capacity. Results: The study included 550 cases (mean age 46.8 ± 11.9) and 509 controls (mean age 46.3 ± 11.7). Compared with the other three models...
†<p>Among drinkers.</p><p>Includes drinkers who drink a combination of alcoholi... more †<p>Among drinkers.</p><p>Includes drinkers who drink a combination of alcoholic beverages, percentages may not add up to 100%.</p><p>Patterns of alcohol consumption among women in Nigeria, Cameroon and Uganda, 1998–2013</p
<p>Percentage of healthy controls who were current drinkers by age group in the three Afric... more <p>Percentage of healthy controls who were current drinkers by age group in the three African countries.</p
<p>*Adjusted for all other variables listed in this table as well as age at first live birt... more <p>*Adjusted for all other variables listed in this table as well as age at first live birth and study site.</p><p>Stratified analyses of alcohol consumption and breast cancer risk among women in Nigeria, Cameroon, and Uganda using data after multiple imputation, 1998–2013.</p
<p><b>Note</b>: Numbers in parentheses are proportions (%). SD: standard deviat... more <p><b>Note</b>: Numbers in parentheses are proportions (%). SD: standard deviation.</p>a<p>Proportions or means for the controls are adjusted values based on the age distribution of cases; <i>P</i>-values were also age-adjusted in logistic regressions.</p>b<p>Among parous women.</p><p>Demographics of women with invasive breast cancer (cases) and those without (controls) in Nigeria, Cameroon and Uganda, 1998–2013.</p
Background: Women of African ancestry across the diaspora have low risk of developing breast canc... more Background: Women of African ancestry across the diaspora have low risk of developing breast cancer compared to women of European ancestry. However, they suffer the highest mortality rates because of the disproportionate burden of young onset aggressive hormone receptor negative breast cancer. To implement strategies for early detection and prevention, it is critically important to develop better risk assessment tools. The Nigerian Breast Cancer Study (NBCS) model is a new risk assessment tool developed for the individual estimation of absolute risk of invasive breast cancer in Nigeria. Its applicability outside of Nigeria remains uncertain as it has not been validated in other Sub-Sahara African (SSA) populations. Methods: We conducted a case-control study among women with breast cancer and controls ascertained in Cameroon and Uganda from 2011 to 2016. Structured questionnaire interviews were performed to collect demographic and reproductive characteristics. The NBCS model, the Gai...
INTRODUCTION Reference values may vary significantly among populations and cultures for which die... more INTRODUCTION Reference values may vary significantly among populations and cultures for which dietary intakes may be different. Each laboratory is expected to investigate the transferability of the expected values to its own patient population and if necessary determine its own reference ranges. This study sought to establish Folic acid and Vitamin B(12) reference values for young Ugandan adults, which reference values could be used as baseline information for future research, especially related to their role in breast cancer prevention. METHODS A cross sectional study in which 200 undergraduate student volunteers were enrolled. The minimum sample size was 126 using the Open Epi version 2. Relevant demographics and physical examination parameters were taken as well as blood samples for laboratory tests. Prior ethical approval was granted. RESULTS The levels of folic acid were 4.17 - 20 ng/ml and remained constant over the age cohorts. The vitamin B(12) range was 117-1158 pg/ml. Both...
Background: Breast cancer is the third commonest cancer in women in Uganda. The majority of breas... more Background: Breast cancer is the third commonest cancer in women in Uganda. The majority of breast cancer patients in Uganda present with advanced disease. Many studies show that metastatic lesions frequently lodge in bones, lung and liver. Tumour hormone receptor status correlates with site of metastatic lesions and survival among breast cancer patients. Objective : To determine the sites of metastatic breast lesions and how they relate to the hormonal receptor status. Methods: In this cross sectional descriptive study, 71 women with histologically confirmed incident breast cancer with metastases were analysed, their hormonal receptor status was determined. All patients underwent a chest X-ray, an abdominopelvic ultrasound scan and a bone scan. The χ² and t tests were used to compare variables for statistical differences. Results: The mean age of participants was 45 years. Most metastases were to bone 56% (40/71), of these 45% (32/71 ) tumours were exclusive to bone and 94% of thes...
Background: Most studies on thyroid dysfunction have been on patients refereed for treatment, lit... more Background: Most studies on thyroid dysfunction have been on patients refereed for treatment, little is known about the prevalence in the general populations. The importance of knowing such prevalence data lies in that fact that subclinical thyroid dysfunction is an important risk on development of heart disease, osteoporosis, hypercholesterolemia and mental illness. This study set out to determine thyroid dysfunction prevalence in a health young adult population. Methods: A cross sectional study carried out at the College of Health Sciences, Makerere University enrolled 100 Undergraduate medical students by invitations through notices and announcements. Informed consent was sought after approval from research ethics committee. Results: Of the 100 students enrolled and the samples drawn; 83 tests for TSH and 82 tests for FT4 were successfully run. Three results were abnormal making a prevalence of 3.6% for thyroid dysfunction; a high TSH (5.71) with a normal fT4 (19.2), a normal TSH...
Cancer Epidemiology, Biomarkers & Prevention, 2019
Background: Sub-Saharan Africa (SSA) has a high proportion of premenopausal hormone receptor nega... more Background: Sub-Saharan Africa (SSA) has a high proportion of premenopausal hormone receptor negative breast cancer. Previous studies reported a strikingly high prevalence of germline mutations in BRCA1 and BRCA2 among Nigerian patients with breast cancer. It is unknown if this exists in other SSA countries. Methods: Breast cancer cases, unselected for age at diagnosis and family history, were recruited from tertiary hospitals in Kampala, Uganda and Yaoundé, Cameroon. Controls were women without breast cancer recruited from the same hospitals and age-matched to cases. A multigene sequencing panel was used to test for germline mutations. Results: There were 196 cases and 185 controls with a mean age of 46.2 and 46.6 years for cases and controls, respectively. Among cases, 15.8% carried a pathogenic or likely pathogenic mutation in a breast cancer susceptibility gene: 5.6% in BRCA1, 5.6% in BRCA2, 1.5% in ATM, 1% in PALB2, 0.5% in BARD1, 0.5% in CDH1, and 0.5% in TP53. Among controls,...
Background: Breast cancer among indigenous Africans is characterized by higher prevalence of trip... more Background: Breast cancer among indigenous Africans is characterized by higher prevalence of triple-negative disease and poor prognosis. A previous study in Nigeria reported a strikingly high prevalence of deleterious germline mutations in BRCA1 and BRCA2 among Nigerian women with breast cancer. It is unknown if this is true in other sub-Saharan African countries. Aim: The objective of this study is to determine the frequency of germline mutations among an unselected sample of women in Africa. Methods: We conducted a case-control study of breast cancer in Uganda and Cameroon to investigate genetic and nongenetic risk factors for breast cancer. Breast cancer cases were enrolled in two tertiary hospitals in the two countries, unselected for age at diagnosis and family history. Controls who were free of breast cancer were enrolled in the same hospitals and matched to cases on age. A 24-gene sequencing panel was used to test germline mutations in cases and controls. Results: There were ...
Background: Open biopsy of the breast used to be the main traditional method of diagnosis of brea... more Background: Open biopsy of the breast used to be the main traditional method of diagnosis of breast lumps. Fine Needle Aspiration Cytology (FNAC) was later introduced which depends on suction and thus yields hemorrhagic material for cytological study.This study was undertaken to find out if there is a difference in diagnostic accuracy in using Fine Needle Aspiration Cytology and Fine Needle Sample (FNS) without aspiration in the diagnosis of palpable breast lumps. Methods: This was a cross-sectional study of women with palpable breast masses of 2cm and above in the widest diameter by ultrasound. Patients were subjected to FNS, FNAC and excision biopsy of the lump or mastectomy where appropriate. Cytodiagnosis of all the cases was compared to the histodiagnoses of the biopsies to establish the sensitivity, specificity and diagnostic accuracy. Results: Some 85 patients had FNS, FNAC and excision biopsy/ mastectomy done. The findings demonstrated that both FNS and FNAC have the same se...
In Uganda most cancers to the exception of bladder and penis are increasing in incidence. The inc... more In Uganda most cancers to the exception of bladder and penis are increasing in incidence. The incidence of cancer of stomach is 5.6/100,000 from 0.8/100,000 in the 1960s a seven fold increase.The purpose of this guideline document is to highlight the salient points in gastric cancer diagnosis and treatment in the Ugandan context. It doesn’t only outline what is practical and efficacious but also our aspirations of practice as resources committed to the whole area of Oncological care services improve in the country. The primary and secondary prevention strategies are outlined. The multistage process of gastric oncogenesis is discussed in relation to the scientific basis of diagnostic and screening procedures. The treatment modalities including surgery radiotherapy and chemotherapy are discussed. A prognostication scale is included. Traditionally gastric cancer presents late and with a poor prognosis. The greatest strategy we have for management is in primary and secondary prevention....
Acute cholecystitis is predominantly a disease of females who account for 62 percent of cases and... more Acute cholecystitis is predominantly a disease of females who account for 62 percent of cases and mainly affects those between 40 and 50 years1 and is closely associated with cholelithiasis. It occurs all over the world but Africa is a low risk area as compared to Europe and North America. The disease has been observed in children with ascariasis or those with acquired immune deficiency syndrome (AIDS). The commonest bacteria isolated in acute cholecystitis are E Coli. Clinical presentation includes a raised temperature. Leukocytosis may be absent even in those patients with gangrenous acute cholecystitis. However, Murphy's sign remains very specific. The mainstay of treatment remains surgical either open or laparoscopic cholecystectomy and in high-risk patients percutaneous or open cholecystostomy. Laparoscopic cholecystectomy has greatly increased operating time but reduced hospital stay. The over all mortality has remained 5-12% in the last 2 decades.
The objective was to investigate survival of breast cancer patients at Mulago Hospital. A retrosp... more The objective was to investigate survival of breast cancer patients at Mulago Hospital. A retrospective study of the medical records of 297 breast cancer patients referred to the combined breast clinic housed in the radiotherapy department between 1996 and 2000 was done. The female/male ratio was 24 : 1. The age range was 22-85 years, with a median of 45 years and peak age group of 30-39 years. Twenty-three percent had early disease (stages 0-IIb) and 26% had metastatic disease. Poorly differentiated was the most common pathological grade (58%) followed by moderately differentiated (33%) and well-differentiated (9%) tumours. The commonest pathological type encountered was 'not otherwise specified' (76%). Of all patients, 75% had surgery, 76% had radiotherapy, 60% had hormonotherapy and 29% had chemotherapy. Thirty-six (12%) patients received all the four treatment modalities. The 5-year survival probabilities (Kaplan-Meier) for early disease were 74 and 39% for advanced dise...
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Papers by Antony Gakwaya