The mean age of patients presenting for breast-related complaints was 34.45 ± 14.03 years (range: 15 - 70 years), with 42% aged between 15 and 30 years. The majority of patients were married (58.33%) and had attained secondary-level education (30.83%). Homemakers (33.33%) and traders (22.50%) were the most frequently represented occupational categories (Table 1).

Table 1. Distribution of patients admitted for breast-related complaints in the Obstetrics and Gynecology Department of the CHUD-B/A (2016-2022), by sociodemographic characteristics.

Fruit consumption (60.83%) and sweetened beverage consumption (50.83%) were the most prevalent dietary behaviors, while tobacco use was reported by a minority of patients (10.83%) (Table 2).

Table 2. Distribution of patients by behavioral risk factors (CHUD-B/A, 2016-2022).

The vast majority of patients reported no family history of breast cancer (95.83%) and no history of hypertension (94.17%).

3.3.1. Hormonal and Reproductive Factors

Most patients experienced menarche between the ages of 13 and 18 years (82.5%), had regular menstrual cycles (61.67%), had not breastfed (76.74%), and had not used hormone replacement therapy (84.17%). The majority had their first pregnancy at age 30 years or older (77.91%), and most had never used contraception (66.67%) (Table 3).

Table 3. Distribution of patients by hormonal and reproductive characteristics (CHUD-B/A, 2016-2022).

3.3.2. Obstetric Characteristics

The majority of patients were multigravida (83.72%) and multiparous (77.91%). Primigravida and primiparous patients accounted for 16.28% and 22.09% of the sample, respectively.

3.3.3. Clinical Presentation

Breast pain was the leading chief complaint (65%), followed by a self-detected breast lump (23.33%) and referral for known or suspected breast cancer. Hypertension was present as a comorbidity in 15% of patients.

Breast abnormalities were detected in over half of all patients on clinical examination, with a predominance of left-sided involvement (55.83%). Peau d’orange appearance, a hallmark of dermal lymphatic invasion, was observed in 55.83% of cases. Superficial and deep mobility of the breast mass was preserved in 77.5% of patients, while fixation to surrounding structures was noted in 1.67% of cases (Table 4).

Table 4. Distribution of patients by physical examination findings (CHUD-B/A, 2016-2022).

Breast ultrasound was the most frequently requested investigation (62.5%), followed by histopathological examination (34.17%). Other modalities, including core biopsy, mammography, and fine-needle aspiration cytology, were used less frequently.

Of the 120 patients included, 39 (32.5%) received a diagnosis of breast cancer; the remaining 81 patients (67.5%) had benign or non-malignant breast conditions. Among the 39 confirmed breast cancer cases (23 histologically confirmed, 16 diagnosed on concordant clinical and imaging criteria), metastatic disease at presentation was the predominant pattern (56.41%), followed by inflammatory carcinoma (12.82%) and histologically unspecified malignant forms (12.82%). Other histological subtypes were rare, each accounting for less than 6% of cancer cases.

Treatment patterns reported here refer to the 39 confirmed breast cancer cases. Antibiotic therapy alone was administered to 56.41%, reflecting initial misclassification as inflammatory or infectious breast disease before the malignant diagnosis was established, 20.51% underwent surgical intervention (typically mastectomy without adjuvant therapy), and 23.08% received no oncology-directed treatment. No patient received chemotherapy. Antibiotic prescription, surgical intervention, and management of benign breast conditions in the remaining 81 patients with non-malignant diagnoses are not detailed here, as the focus of the analysis is breast cancer.

Outcomes are reported for the 39 confirmed breast cancer cases. Loss to follow-up was near-universal: 92.31% were lost to follow-up after the diagnosis was established, and 7.69% died during the observation period. No case of confirmed cure was recorded.

In the multivariable Poisson regression, age remained strongly associated with breast cancer diagnosis, with the likelihood of a malignant outcome rising sharply from the age of 30 years onwards (p < 0.001). Tobacco use was also independently associated with breast cancer (aPR = 2.21; 95% CI: 1.34 - 3.65; p = 0.002), with the adjusted estimate slightly attenuated relative to the crude figure as expected once age was accounted for (Table 5).

Table 5. Association between selected factors and breast cancer risk (CHUD-B/A, 2016-2022).

After adjustment for age, tobacco use, age at menarche, and breastfeeding history, advanced age at first pregnancy (≥30 years) remained associated with breast cancer diagnosis (aPR = 1.92; 95% CI: 1.21 - 3.04; p = 0.005). A history of breastfeeding was independently associated with a substantially lower probability of breast cancer (aPR = 0.18; 95% CI: 0.04 - 0.85; p = 0.004), with the magnitude of the association attenuated relative to the crude estimate but the direction and significance preserved. Age at menarche between 13 and 18 years was associated with a higher likelihood of breast cancer in the adjusted model (aPR = 2.18; 95% CI: 1.02 - 4.66; p = 0.04) (Table 6).

Table 6. Association between reproductive factors and breast cancer risk (CHUD-B/A, 2016-2022).

The mean age of patients presenting for breast complaints was 34.45 ± 14.03 years, with 42% under 30 years. This relatively young age profile warrants attention. Breast cancer has traditionally been regarded as a disease of postmenopausal women; yet this earlier age at presentation is increasingly documented in African contexts. Mihret et al. (2021) [8] reported a mean age of 37 years among Ethiopian women practicing breast self-examination, while Wendimu et al. (2024) [2], in a meta-analysis, noted high breast cancer prevalence among younger women in the sub-Saharan region. Plausible explanations include rapid lifestyle changes, urbanization, early oxidative stress exposure, and incompletely characterized genetic susceptibility factors. Xu et al. (2023) [12] demonstrated in a Chinese cohort that younger age at diagnosis may be associated with disruptions in metabolic pathways and post-transcriptional regulatory mechanisms.

More than half of patients were married (58.33%). This proportion, while reflective of social norms prevalent in West African societies, may influence care-seeking behavior in either direction depending on the quality of spousal support. Tang et al. (2024) [13] identified marital partnership as a protective factor against psychological distress in breast cancer patients, whereas Benallel et al. (2023) [14] reported that an unsupportive partner increased the risk of clinical depression.

Secondary-level education was the most common educational attainment (30.83%). Multiple studies have established that low educational level constitutes a barrier to timely screening and diagnosis. Shoukat et al. (2023) [15] found that 63.2% of Pakistani women surveyed were unaware of early breast cancer symptoms, with the highest rates of unawareness among women with no formal schooling.

The overrepresentation of homemakers (33.33%) and traders (22.5%) in this cohort reflects limited socioeconomic security, a structural determinant known to constrain access to health information and care, and to condition health-seeking attitudes [16].

Family history of breast cancer, particularly in the context of BRCA1 and BRCA2 mutations, is well-established as a major risk factor. In low-resource settings, however, this factor is systematically underestimated: patients may be unaware of causes of death among relatives or reluctant to disclose such information. The low rates of reported family history observed in the present series are therefore expected. Wendimu et al. (2024) [2] identified poor traceability of family cancer history as a critical weakness in breast cancer surveillance systems across sub-Saharan Africa.

From a biological standpoint, the near-absence of reported family history does not preclude a genetic contribution. Sporadic forms of breast cancer, driven by environmental exposures, hormonal influences, and metabolic perturbations, account for the majority of cases [12]. Moreover, heritable susceptibility may also be mediated through epigenetic mechanisms that remain undetectable in current clinical settings.

The low prevalence of hypertension in this cohort (5.83%) is consistent with the relatively young age of the sample. Although some evidence links hypertension to breast cancer through chronic inflammation and oxidative stress [16], this association has been more consistently documented in older patient populations.

Breast pain was the predominant presenting complaint (65%), followed by a palpable breast lump (23.33%) and referral for confirmed or suspected malignancy. Hypertension was present as a comorbidity in 15% of patients. This symptom profile is characteristic of settings where consultation is driven by alarming symptoms rather than proactive screening.

The preponderance of pain as a presenting symptom is common in low-resource contexts, though it is not a typical early feature of breast malignancy, which is often asymptomatic at initial stages. Pain at presentation more often indicates locally advanced or complicated disease. Wendimu et al. (2024) [2] documented mastalgia as a frequent reason for delayed presentation among African women, particularly those residing in rural areas.

The relatively low frequency of self-detected lumps (23.33%) suggests difficulties in lesion identification and inadequate awareness of breast self-examination techniques. This finding is consistent with Urga Workineh et al. (2021) [1], who reported that fewer than 40% of Ethiopian women practiced regular breast self-examination, despite reasonable perceived risk.

Regarding hypertension, present in 15% of patients, Çeli et al. (2023) [16] and Lopes et al. (2022) [10] have highlighted its association with chronic stress, poor dietary patterns, and oncological treatment toxicity, as well as its role as an indirect marker of cardiovascular vulnerability in women with breast cancer.

Clinical examination revealed breast abnormalities in more than half of patients, with left-sided predominance (55.83%). Peau d’orange appearance, a classic indicator of dermal lymphatic permeation, was present in 55.83% of cases. Although superficial and deep mobility was preserved in 77.5% of patients, a small proportion (1.67%) showed fixation to surrounding structures.

The high frequency of palpable abnormalities confirms detection at a relatively advanced stage of disease. Peau d’orange is characteristically associated with inflammatory or locally advanced breast cancer. Wendimu et al. (2024) [2] identified this clinical sign among the most frequent markers of delayed diagnosis in settings with limited access to imaging.

The left-sided predominance observed here, though notable, has been reported in earlier literature. Shoukat et al. (2023) [15] similarly described a higher frequency of left-sided tumors among Pakistani women. Proposed biological explanations include asymmetric systemic or hormonal pressures, though the evidence base remains inconclusive.

Preserved mobility in 77.5% of patients represents a relatively favorable prognostic indicator, potentially allowing conservative surgical options if timely diagnosis is achieved. Conversely, the presence of fixation, even at low frequency, is indicative of locoregional tissue invasion and portends a poor prognosis, as documented by Gedfew et al. (2024) [17].

Among patients admitted for breast complaints, metastatic carcinoma was the most frequent diagnosis (56.41%), followed by inflammatory carcinoma (12.82%) and unspecified forms (12.82%). This distribution reflects systematic diagnostic delay, a pattern consistently documented in sub-Saharan Africa, where the majority of women present at advanced stages. Wendimu et al. (2024) [2] confirmed in their meta-analysis that over 60% of patients on the continent reach hospital after the disease has already metastasized.

The virtual absence of early-stage cases in this series points to a dysfunctional or nonexistent screening infrastructure. Urga Workineh et al. (2021) [1] and Assefa et al. (2021) [4] have similarly underscored the impact of absent mammography programs, infrequent breast self-examination, and the cultural normalization of breast pain in delaying care.

On the therapeutic side, most patients received antibiotics alone (56.41%), only 20.51% underwent surgery, and 23.08% received no treatment. No patient received chemotherapy. This profile starkly illustrates the technical limitations of decentralized health facilities and the inadequacy of referral pathways. Gedfew et al. (2024) [17] attributed a substantial fraction of breast cancer mortality in Africa to the absence of structured oncological treatment, including radiotherapy and endocrine therapy, at secondary-level hospitals.

Clinical outcomes were dismal: 92.31% of patients were lost to follow-up following diagnosis, and 7.69% died during the observation period. No confirmed case of cure was recorded. Loss to follow-up of this magnitude may reflect stigmatization, treatment abandonment, unregistered deaths occurring outside the hospital, or inability to sustain care over time.

Statistical analysis identified several significant associations. Age ≥ 30 years was associated with markedly elevated breast cancer risk (p < 0.001), consistent with the global evidence base that identifies age as one of the primary determinants of breast cancer risk, mediated by cumulative hormonal exposure, somatic mutation accumulation, and declining DNA repair capacity. Wendimu et al. (2024) [2] reported a peak incidence between ages 35 and 50 years in African countries. The threshold of 30 years observed in this study is lower than that typically reported in Western populations, potentially reflecting distinct genetic profiles and earlier environmental exposures.

Tobacco use was independently associated with breast cancer diagnosis after adjustment for age and reproductive factors (aPR = 2.21; 95% CI 1.34 - 3.65; p = 0.002). Although the absolute prevalence of tobacco use in this cohort was low, its carcinogenic effect is well-documented. Xu et al. (2023) [12] demonstrated that tobacco-induced oxidative stress activates oncogenic pathways through aberrant post-transcriptional regulation. The slight attenuation of the adjusted relative to the crude estimate is consistent with partial confounding by age, but the association remained robust in the multivariable model.

Advanced age at first pregnancy (≥30 years) remained associated with breast cancer in the adjusted model (aPR = 1.92; 95% CI: 1.21 - 3.04; p = 0.005), a finding concordant with Tolessa et al. (2021) [3], who noted that delayed first pregnancy prolongs the interval during which breast tissue is exposed to unopposed estrogen stimulation, thereby increasing the probability of neoplastic transformation.

Breastfeeding emerged as an independent factor associated with a substantially lower probability of breast cancer diagnosis (aPR = 0.18; 95% CI: 0.04 - 0.85; p = 0.004). This protective association is well-recognized in the literature. Assefa et al. (2021) [4] and Wendimu et al. (2024) [2] have both shown that lactation reduces the frequency of menstrual cycles, thereby limiting cumulative estrogenic exposure, while also promoting beneficial cellular differentiation in breast tissue. The wide confidence interval reflects the limited number of breastfeeding-exposed women in the cohort and warrants cautious interpretation, but the direction and magnitude of the association remained stable after adjustment.

Age at menarche between 13 and 18 years was associated with a higher likelihood of breast cancer diagnosis in the adjusted model (aPR = 2.18; 95% CI: 1.02 - 4.66; p = 0.04), with the lower bound of the confidence interval close to unity. This finding is biologically plausible: earlier menarche extends the period of estrogen exposure across the reproductive lifespan, as described by Mihret et al. (2021) [8]. The borderline statistical significance and the relatively wide confidence interval call for cautious interpretation pending replication in larger samples.