BMJ  2005;331:779 (1 October), doi:10.1136/bmj.331.7519.779-a

Letter

A theme issue by, for, and about Africa

Collaborative work between Nigeria and UK on breast cancer has been successful

EDITOR—Breast cancer is a rapidly emerging disease in Africa.¹ It has similar implications for African women as HIV, but it receives little attention in terms of publicity, funding (both overseas and internally), and local research. Affected women are young and poor and present with late stage disease. Five year survival is 5-15% compared with over 60% in developed countries.^{2 3} The disease is controlled by mutilating surgery. Without prosthetic support, the patient rapidly loses self esteem and may die young.

We encountered many challenges with research governance in studying the pattern of occurrence and molecular genetic variations of breast cancer in Nigeria and the UK.⁴ Ethics approval in Nigeria is not well structured. Existing consent forms are generic and do not cover special collaborations such as genetic studies. Tracing patients to request consent for the use of archive material is difficult. Post and telecommunications do not always work. Record keeping and data retrieval have deficiencies. Lack of accurate, supporting databases such as cancer registries,⁵ population census, and demography make interpretation of research information difficult.

We collected data from multiple sources to bridge the gap in supporting databases.⁴ Couriers were used for transporting appropriately package samples as well as messages. To insist that the same ethical requirements of developed countries are to be fulfilled by African collaborators may be impractical. Often, consideration has to be made for the many peculiar situations that exist while still protecting the "best interests" of patients. The safeguard is to plan research that allows for all of these problems rather than to encounter them midway through.

i.gukas{at}uea.ac.uk
School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ

School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ

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Competing interests: IDG was formerly consultant general and breast surgeon at the Plateau State Specialist Hospital, Jos, Nigeria.

References

1. Walker AR, Adam FI, Walker BF. Breast cancer in black African Women: a changing situation. J R Soc Health 2004;124: 81-5.[Medline]
2. Ihezue CH, Ugwu BT, Nwana EJ. Breast cancer in Highlanders. Nigerian J Surg Sci 1994;4: 1-4.
3. Quinn M, Allen E. Changes in incidence of and mortality from breast cancer in England and Wales since introduction of screening. BMJ 1995;311: 1391-5.[Abstract/Free Full Text]
4. Gukas ID, Jennings BA, Mandong BM, Manasseh AN, Harvey I, Leinster SJ. A comparison of the pattern of occurrence of breast cancer in Nigerian and British women doi: 10.1016/j.breast.2005.02.003
5. Okobia MN. Cancer care in sub-Saharan Africa—urgent need for population-based cancer registries. Ethiop J Health Dev 2003;17: 89-98.

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