Histo-epidemiological aspects of gynecological and breast cancers at the University Teaching Hospital of Yaoundé

Introduction Cancer is a public health problem that affect women more than men. The aim of the study was to describe the epidemiological and histopathological features of gynecological malignancies in the city of Yaoundé, Cameroon. Methods This was a descriptive cross-sectional study of histologically proven gynecological cancers over a 10-year period (2008-2017) in the Gynecology and Pathological Anatomy Departments of the University Teaching Hospital of Yaoundé. Results A total of 682 cancers were identified among which, 342 gynecological cancers, for an overall frequency of 50.1% and an annual frequency of 34.2 cases on average. There was a trend suggesting an increase annual frequency over time. The cervix was the most frequent location with 182 cases (53.2%); followed by breast with 96 cases (28.1%); endometrium with 33 cases (9.7%) and ovaries 15 cases (4.4%). These patients were on average 51.9±13.7 years old, mostly housewives (56.8%), married (60.4%), multiparous (61.3%) and referred (62.6%). Histopathologically, cervical cancer was predominantly squamous cell carcinoma (86.8%), invasive (80.9%) and well differentiated (45.5%). For breast cancers, the majority were ductal carcinomas (78.1%), invasive (92%), and histological grade SBR II (50.6%). The most common histopathological types of endometrial and ovarian cancer were adenocarcinoma (72.2%) and serous cystadenocarcinoma (46.7%), respectively. Conclusion Gynecological cancers are common. Screening is expected to increase at 30 years for cervical cancer and start at age 40 with mammography for breast cancer.


Introduction
Cancer is a group of serious diseases, fatal in the absence of effective treatment, characterized by a rapid and uncontrolled proliferation of abnormal cells that can affect any part of the body. When it touches the breast, the ovary or an organ of the genital tract, it is called gynecological cancer. Breast cancer is the most common cancer in the world with 1.7 million new cases, including 522,000 deaths each year [1]. Cervical cancer ranks second among women's cancers worldwide with 528,000 new cases and 266,000 deaths in 2012.
Gynecological cancers account for 41.3% of all cancers in Africa [2].
They are responsible for 56.2% of cancer deaths among women in Cameroon [3]. Several studies have been conducted on gynecological cancers in Africa in general and in Cameroon in particular; however, few of them have been carried out at the University Teaching Hospital of Yaoundé, yet it is a reference hospital involved in the diagnosis and treatment of cancers. Therefore, we proposed to conduct this study, to help strengthen the prevention of these cancers. The case selection profile is presented in Figure 1. The data collection procedure is presented in Figure 2. The data were analyzed using the Epi info 7.1.3.3 software; the variables studied were frequency, age, marital status, occupation, religion, place of residence, cancer site, histological type, invasive character or not, the degree of differentiation and the year of diagnosis. : during the study period,   682 cancers were diagnosed among which 342 were gynecological and breast cancers, leading to an overall frequency of 50.1%. The annual incidence of gynecological cancers was 34.2 cases on average (342/10).

Distribution of gynecological cancers according to the
affected organ: Figure 3 shows distribution of gynecological cancers according to the affected organ. Cervical cancer was the most common with 53.2% (182 cases), followed by breast cancer with 28.1% (96 cases).

Distribution of gynecological cancers by year of diagnosis: distribution of gynecological cancers according to the
year of diagnosis is shown in Table 1. The frequency of diagnosed gynecological cancers tended to increase from one year to another.
The highest frequency was observed in 2016 with 23.7% (72) of cases, and the lowest frequency was observed in 2008 with 4.1% (14) cases.
Distribution of patients by age group and affected organ: the distribution of patients by age group and affected organ is shown in Table 2. Cancers were more common in those who were 40 years old and above. Table 3 shows that more than half of the patients were married (56.7%), housewives (60.4%) and Christian (64.9%) while less than half of the patients 51 (45.95%) resided in Yaoundé.

Distribution of patients by other socio-demographic characteristics:
Cervical cancer: the histological types, aggressiveness and degree of differentiation of cervical cancers were presented in Table 4 Cancer of the uterine body: the histological types of cancers of the uterine body were distributed as shown in Table 6.
Other cancers: eight cases of vaginal cancer were identified, of which 87.5% (7/8 cases) were squamous cell carcinoma and 12.5% (1/8) were embryonic rhabdomyosarcoma. All vulvar cancers (05 cases) were squamous cell carcinomas and all trunk cancers were adenocarcinomas.

Epidemiological characteristics of gynecological cancers
Average annual incidence of gynecological cancers in our series was 34.2 cases on average (342/10), which is lower than the 94. In contrast, a study using the cancer registry found that breast cancer is the leading cancer in women [4,9]. These discordant results raise the issue that, the cancer registry in Cameroon is not fully functional. However, breast cancer is the most prevalent of women's cancers in the world in both Pakistan [2,4,21]. These results are explained by the fact that the lining of the endometrium is covered by a simple cylindrical epithelium.
Ovarian cancer: epithelial cancers were the most common type of ovarian cancer with 86.7%, with serous cystadenocarcinoma being the most common. This predominance of epithelial cancers has been found in the literature in proportions varying between 68-93% [2,4,6,22,23]. The predominant histologic type of cancers of the vagina and vulva was squamous cell carcinoma in proportions of 88.9% (8 out of 9) and 100% (3 out of 3), respectively, which corroborates with data from the literature [2,6]. This result is explained by the fact that same type of epithelium, namely the pluristratified squamous epithelium, covers the mucous membranes of the vagina and vulva.

Conclusion
In this study, we aimed to describe the epidemiological and clinical characteristics of gynecological cancers at the University Teaching Hospital of Yaoundé. Our results indicate that gynecological cancers represent 50.1% of women's cancers and that the most common are cancers of the cervix and breast. Most of the gynecological cancer patients were housewives, multiparous and above 50 years of age.
The most common histopathological types were squamous cell carcinoma for cervical cancer and ductal carcinoma for breast cancer.