title: Stage at presentation of breast cancer in Luanda, Angola - a retrospective study.
abstract: BACKGROUND
  It is expected that, by 2020, 15 million new cases of cancer will occur every year in the world, one million of them in Africa. Knowledge of cancer trends in African countries is far from adequate, and improvements in cancer prevention efforts are urgently needed. The aim of this study was to characterize breast cancer clinically and pathologically at presentation in Luanda, Angola; we additionally provide quality information that will be useful for breast cancer care planning in the country.
  
  
  METHODS
  Data on breast cancer cases were retrieved from the Angolan Institute of Cancer Control, from 2006 to 2014. For women diagnosed in 2009 (5-years of follow-up), demographic, clinical and pathological information, at presentation, was collected, namely age at diagnosis, parity, methods used for pathological diagnoses, tumor pathological characteristics, stage of disease and treatment. Descriptive statistics were performed.
  
  
  RESULTS
  The median age of women diagnosed with breast cancer in 2009 was 47 years old (range 25-89). The most frequent clinical presentation was breast swelling with axillary lymph nodes metastasis (44.9 %), followed by a mass larger than 5 cm (14.2 %) and lump (12.9 %). Invasive ductal carcinoma was the main histologic type (81.8 %). Only 10.1 % of cancer cases had a well differentiated histological grade. Cancers were diagnosed mostly at advanced stages (66.7 % in stage III and 11.1 % in stage IV).
  
  
  CONCLUSIONS
  In this study, breast cancer was diagnosed at a very advanced stage. Although it reports data from a single cancer center in Luanda, Angola it reinforces the need for early diagnosis and increasing awareness. According to the main challenges related to breast cancer diagnosis and treatment herein presented, we propose a realistic framework that would allow for the implementation of a breast cancer care program, built under a strong network based on cooperation, teaching, audit, good practices and the organization of health services.
  
  
  CONCLUSIONS
  Angola needs urgently a program for early diagnosis of breast cancer.
authors.affiliation: Sagrada Esperança Clinic, Luanda, Angola. lygiavieiralopes@hotmail.com.
authors.forename: Lygia Vieira
authors.initials: LV
authors.lastname: Lopes
authors.affiliation: Angolan Institute of Cancer Control, Luanda, Angola. kialamig@hotmail.es.
authors.forename: Fernando
authors.initials: F
authors.lastname: Miguel
authors.affiliation: National Public Health Department, Ministry of Health, Luanda, Angola. helgareisfreitas@gmail.com.
authors.forename: Helga
authors.initials: H
authors.lastname: Freitas
authors.affiliation: Angolan Institute of Cancer Control, Luanda, Angola. antafred@gmail.com.
authors.forename: António
authors.initials: A
authors.lastname: Tavares
authors.affiliation: Angolan Institute of Cancer Control, Luanda, Angola. salvangola@yahoo.ef.
authors.forename: Salvador
authors.initials: S
authors.lastname: Pangui
authors.affiliation: Department of Epidemiology, Portuguese Oncology Institute of Porto, Porto, Portugal. Goncalo.MS.Lacerda@azores.gov.pt.
authors.forename: Clara
authors.initials: C
authors.lastname: Castro
authors.affiliation: Azores Cancer Registry, Azores Oncological Centre, Angra do Heroísmo, Portugal. longatto16@hotmail.com.
authors.forename: Gonçalo Forjaz
authors.initials: GF
authors.lastname: Lacerda
authors.affiliation: Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal. clara.castro@ipoporto.min-saude.pt.|Laboratory of Medical Investigation (LIM 14), Faculty of Medicine, São Paulo State University, São Paulo, Brazil. clara.castro@ipoporto.min-saude.pt.|Molecular Oncology Research Center "Centro de Pesquisa em Oncologia Molecular" (CPOM), Barretos, Brazil. clara.castro@ipoporto.min-saude.pt.
authors.forename: Adhemar
authors.initials: A
authors.lastname: Longatto-Filho
authors.affiliation: Cancer Registry of Norway, Oslo, Norway. Elisabete.Weiderpass.Vainio@ki.se.|Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway. Elisabete.Weiderpass.Vainio@ki.se.|Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. Elisabete.Weiderpass.Vainio@ki.se.|Department of Genetic Epidemiology, Folkhälsan Research Center, Samfundet Folkhälsan, Helsinki, Finland. Elisabete.Weiderpass.Vainio@ki.se.
authors.forename: Elisabete
authors.initials: E
authors.lastname: Weiderpass
authors.affiliation: Angolan Institute of Cancer Control, Luanda, Angola. llarasantos@gmail.com.|ONCOCIR - Education and Care in Oncology, Luanda, Angola. llarasantos@gmail.com.|Experimental Pathology and Therapeutics Research Center, Portuguese Oncology Institute of Porto, Porto, Portugal. llarasantos@gmail.com.
authors.forename: Lúcio Lara
authors.initials: LL
authors.lastname: Santos
mesh_terms: D000328:Adult; D000349:Africa; D000368:Aged; D000369:Aged, 80 and over; D000810:Angola; D001943:Breast Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008485:Medical Audit; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies