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Tag: anatomy

  • Anatomy of Nigerian corruption

    Feeble-hearted, self-deceiving attitude to corruption has invoked this offering. Corruption is perceived in so narrow parameters that pretend to limit its damaging impact on the corporate existence of all humanity. Some leaders think most dishonourably that they can come out of portals of corruption and commence a process of sanitising a people from corruption and its manifestations just by mouthing rules and regulations in the media. Some leaders ignore their own paths strewn with distortions of truth and patronisation of shades of falsehood. This cannot be so. People who ascend the ladder to power through corrupt portals must first shed the fruits of corruption, return to status quo ante and come afresh as new human beings before their work against corruption can take root. If this does not happen, followers rub off dirt and have to wallow in one group Karma or the other on account of perfidy of leaders.

    Humanity is one specie. A defect in one part afflicts other parts. Pollution of purity in one part exports that resultant impurity to other parts. The whole of humanity without exception draws from one stream of power from the origin of life. A distortion like someone desiring financial benefit and perverting justice in that pursuit is presumed to end happily with such benefits by fools in creation.  Fake human beings attach importance to such people because they command wealth with which so much apparently values are realised. Sometimes such people are revered and they throw their dirty weights about deluding themselves that they have smartly earned some importance. What they achieve is worsening their spiritual condition with new guilt that must be expiated before they find true happiness. For happiness resulting from spiritual lightness is the ultimate goal of human spirits. The mere volition for undeserved benefit sets in motion a series of threads of activities in lighter regions of creation that work eternally without error spawning the conditions which human beings who originate such volitions must inexorably experience.

    If for example volition is targeted at unearned income or fraud, forms are created in lighter regions of creation by beings that make it inescapable for similar thought forms to aggregate and evolve into monsters of thought forms that afflict our lives adversely. They meet similar thought forms, strengthen them and wreak havoc on all forms. The manifestation may just be that someone qualified for a contract is denied it and in place of that, a beneficiary chosen on the basis of patronage by nepotism or share of benefits or for whatever other inappropriate selfish reason, gets the job, a chain of negative consequences are powered into existence resulting in suffering for the majority. Human spirits who subscribe energies toward bringing hardship to people never find peace here or hereafter. Even with stupendous wealth they find no peace of mind and body. It is of no value therefore to seek undue advantage in any endeavour. Corruption issues from volition to bend circumstances into one’s favour.

    This is one aspect of corruption with which most people are familiar. It is also the mould into which most concepts of corruption fits. This mould however is the remote effects of the real corruption which originates from thought of benefit without work or reaping without sowing. It is a manifestation of greed, indolence of spirit and avarice which are separately distortions of natural law of give and take. It could originate from volition of so-called leaders born of lust for undue benefits while in public office. It becomes grave and irremediable when suffering is inflicted on a large population by a single act or volition for self-enrichment. The social cost of such an act could lead to unassailable social costs to people and denial of social benefits for a large number of people which may not find remedy in one incarnation only. Many human spirits on earth shall spend a long and horrific span of time paying for such distortions beyond our plane. Life does not end in only one incarnation. Overlook Christian faith that life is only once and after it – the judgment. Existence requires love and social responsibility for others to power a human spirit to higher planes of wholesome existence.

    The “secret” acts of leaders manifest in comforts that are visible that corrupt subordinates into similar acts of seeking gratification for services they provide and the corruption rupture takes on humungous existence that now afflict the purpose of governance. Purity of thought, word and volition and action is lost at the altar of vain lust. Naturalness is extinguished. Merit takes flight. Structures of governance collapse, and distortions develop in geometric progression incommoding larger and larger number of people as more and more of that type of corruption is conceived and willed and actually perpetrated. The level of corruption we suffer in Nigeria is the cumulative derivative of years of distortions inflicted on Nigeria from Festus Okotie-Eboh’s days in the first republic through the military regimes that ousted them till this day. A thick cloud has developed and we are gasping witnesses of the blatant robbery of our commonwealth that has become stark reality today. Deziani Allison Madueke and her co-travellers have become indices of social destruction and denial of progress for our violently ravished economy.

  • Anatomy of an uppercut

    For the sake of boxing neophytes, an uppercut is probably the deadliest punch in that fistic game. If you have never been dealt one before then Hardball dares say that you need to reassess your masculinity in this brawny world. Think of the school playing field bully, the roughnecks of the bus-stop brawls or the ‘hood toughie’ who thinks you are too cool for his liking and determines to undo your cool at the street corner one of those festive seasons.

    My man you just must have gotten stung by one upper cut at one point or the other. It is often better experienced. In fact, it gives a man the stiff upper lip which is the mark of every true man.

    Depending on who is dealing it, an uppercut has the capacity to daze, unsettle, jar and if professionally executed, an uppercut is bound to lift you slightly off your feet. And whether you return to your feet or crash on the canvass in a mass also depends on the power and intensity of the puncher.

    Is Hardball about to take to boxing? What is the meaning of this treatise on pugilism? Well, in a manner of speaking or better still in a manner of his speaking there may be a punch up soon between the World Bank and the Federal Government of Nigeria. And the World Bank (WB) may have drawn the first blood with an uppercut right under the chin. According to a report emanating from that bastion of capitalism, Nigeria is considered not serious with the much touted diversification of her economy.

    Africa’s Pulse, WB’s biannual analysis on economic trends in Africa, has predicted that growth in 2016 would fall deeper than projected. But in a more direct jab (uppercut if you like) the bank picked on our dear country noting that African countries like Nigeria which depend on commodities are not serious about diversification of their economies.

    Some of the countries performing badly on the continent currently, going by the bank, are: Nigeria, Chad, Angola, Madagascar, Botswana, Sierra Leone, Cape Verde, The Gambia and – well, South Africa.

    Hardball cannot agree less with WB. Being man on the ground and about town, the street indications are pretty bad. Apart from the dollar rate that is soaring away like a vile eagle, misery pervades the land like an early harmattan haze making the environment pale. Jobs have gone, salaries are late and far between.

    But just as the bank has noted, not much has been done to find a replacement for crude oil earnings. No aggressive drive towards replacing imported food items with local substitutes or even curbing ostentation and waste among public figures and politicians. No drastic reforms being proposed or being put to effect. It remains largely business as usual.

    It is not often that WB throws hard punches; this is why we consider this an upper cut.

     

  • Anatomy of corruption in Nigeria

    Anatomy of corruption in Nigeria

    Preamble

    The title of today’s article is not a coinage of this columnist. It is rather the title of a book jointly written by 14 likeminded world class Nigerian lawyers of the Senior Advocate of Nigeria (SAN) cadre and Professors of Law.

    This is therefore an unconventional review. The book which contains 468 pages and 11 chapters is a compendium of well-researched articles authoritatively written by the contributing gurus.

    It is about the monster called corruption, its genesis, its causes, its varieties, its devastating effect on the society and the possible solutions to it.

     

    Preface

    In the preface to the book written by its Editor, Mallam Yusuf Olaolu Ali, SAN, of Al-Ghalib Chambers, it is stated that corruption which is as old as formation of the society by man has been promoted to state craft and described as the single most debilitating cankerworm eating deeply into the fabric of the nation and destroying it almost endemically.

    Mallam Ali quoted former President Olusegun Obasanjo as saying at the inauguration of the Independent Corrupt Practices Commission in 2001 that:

    “With corruption, there can be no sustainable development, nor political stability. By breeding and feeding on inefficiency, corruption invariably strangles the system of social organisation. In fact, corruption is literally the antithesis of development and progress.”

    And quoting the Transparency International, he also writes in the same preface as follows:

    “Corruption corrodes the fabric of society. It undermines people’s trust in political and economic systems, institutions and leaders. It can cost people their freedom health, money-and sometimes, their lives.”

    Mallam Ali then reveals a disturbing instance of corruption perception index released in 2015 by the same Transparency International in which Nigeria was rated number 136 of 167 countries with a score of 25 per cent and concluded that the publication of such frightening reports contributed to the thought leading to the writing this book.

     

    Foreword

    The foreword to the book is written by the Chief Justice of Nigeria, Justice Mahmud Mohammed, GCON, who states inter alia as follows:

    “This book (Anatomy of corruption), no doubt provides the appropriate reference to the conceptualisation of corruption, casting a glance to the past of this menace, identifying the present state of affairs of the cankerworm and projecting the death of the cancer should be doing in order to finally nail the coffin of corruption in Nigeria, and give it the desired burial”.

    He writes further thus: “In our fight against corruption in all its ramifications, all hands must be on deck and we must collectively save our country from the jaws of the corrupt. All sectors of the society must be fully and totally committed to the anti-corruption crusade.

    “The Nigerian judiciary will continue to be in the forefront of the fight against corruption by ensuring that the cases brought to the courts are determined with dispatch; to this end, there is in place a fast-track mechanism to ensure that cases of corruption are determined with little or no delay.

    “There are challenges of infrastructure, resources and manpower but we are resolved, as an arm of government, to play our part and write our names in gold when the history of this struggle in Nigeria is chronicled.”

     

    Recommendation

    Observing that the contents of the book touch almost all Nigerian professions, including academia,  artisanship and business concerns, Justice Mohammed says: “I recommend this book to all Nigerians (home and abroad), especially jurists, legal practitioners, academics, media practitioners, students, politicians, business people and indeed, all lovers of our dear country, Nigeria.

    We must all stand to be counted in this battle to rid our nation of this destructive menace called corruption”. Genesis

     

    Comment

    No one can say, with precision, when corruption began on earth or where it emanated from. But we came to learn that as far back as the time of Egyptian civilisation, the Egyptians used special preservatives to spare their dead from complete corruption and that corruption of the upper class in the Roman Empire led to the collapse of that Empire.

    We also learned from history that the famous Greek philosopher, Socrates, was put to death because the ancient Athenians believed that he was spreading corruption among their youths.

    When the late vociferous lawyer and human rights activist, Gani Fawehinmi, made a queer but thought-provoking statement in a public lecture at Ansar-ud-Deen College, Isolo, in 1974, he hardly envisaged today’s situation of Nigeria.

    He said: “It is criminal to be law abiding in a lawless society”. By what currently obtains in the country, sheer impunity seems to have put that statement in the front burner with unintended authority. Thus, it can be concluded that corruption is the tap root of a poisonous tree with no depth measure.

     

    Foreign Perception

    Appraising the foreign perception of Nigeria in relation to corruption, one of the contributors to this book, Adebayo O. Adelodun, (SAN), succinctly captured the comment of a Singaporean journalist who covered the Commonwealth Heads of Government meeting in Nigeria in December 2003 as follows:

    “Blessed by nature but undone by man, Nigeria has been described as the Cinderella who never made it to the ball. Corruption is endemic in this West African nation. Corruption stifles economic growth. A country’ position on the corruption table is closely correlated to its poverty rating. Hence Nigeria is among the poorest countries in the world. It is the world’s sixth largest producer of crude oil, yet, most of its petrol is imported…Those in official positions squeeze the people. Even when the government decides to help out, the poor don’t benefit. The money set aside doesn’t get to the people as it is hijacked along the way.”

    Prescribing his own solution to the cancerous social virus called corruption, Adelodun writes:

    “In fact, it is high time for Nigeria to adopt the Chinese and Saudi Arabia models for punishment of official corruption. The penalty is death sentence. This may appear drastic but we all agree that the situation in Nigeria requires drastic suggestions and measures.

    “The Nigerian legislature is expected to borrow a leaf from those countries. We must reform our laws on corruption and input provisions to protect and reward whistle blowers and informants. We must insist on minimum standard on moral behaviour in public offices.”

    He also has advice for Nigerian citizens as follows:

    “The citizenry should be encouraged to see corruption as a stigma on their reputation. Focus should change to the fact that corruption makes us poorer as a people. The little resources (available) can go round if not for corrupt practice of greed and selfishness.

    “The citizens must be ready to play the role of whistle blowers and informants for the agencies that are saddled with the responsibility of combating corruption”.

     

    Head knock for Nigerian Judiciary

    In his own contribution to the book, Adebayo Olanipekun, S. A. N., gave a painful knock to the judiciary on the head for being an aiding factor in making corruption a monster that it is in Nigeria.

    He states that: “Our criminal justice system is skewed in a way that it does not deter corruption but rather has the opposite effect of encouraging it.

    Situations where a poor boy who stole a hen is sentenced to two years imprisonment and a high-ranking public officer who embezzled N23 billion is given an option of paying N250, 000 fine cannot be said to deter corruption”.

    He quoted a onetime Chief Justice of Nigeria, Justice Dahiru Musdapha, where the latter, at the SERAP’s 9th Roundtable conference in 2012 gave a keynote address as follows:

    “…When the rule of law is weak, corruption will remain a nagging problem. Corruption in the Justice sector is a keystone to corruption throughout the society. Without an honest criminal justice system, the wealthy, especially the corrupt, can escape the consequences of their crimes.

    Impunity reduces the perceived cost of corruption. The risk that corrupt activities will result in imprisonment and accompanying public humiliation is minimal. The gains of corruption are therefore not discounted and there is thus, little reason beyond personal integrity not to engage in corrupt acts”.

    Talking about the importance of the Judiciary in the fight against corruption, he quoted Nigeria’s first female Senior Advocate of Nigeria (SAN), Mrs. Folake Solanke, as saying: “Nigeria is sick and needs urgent treatment. The judicial system is the only method by which erring members of the society can be made accountable and be made to pay the penalty of any wrong doing. Yes, there is corruption in the land and only the court can purge the society. But alas! What about the judiciary itself”.

     

    Role of the media

    And commenting on the role of the media in fighting corruption in the society, Adenipekun says: “Nigerian Media are manned by Nigerian citizens. As watchdogs of the society, Journalists are expected to bridge the gap between the government and the society”. He quoted a London Times editorial of 1851 which articulated the role of the Media as follows:

    “…The Press (being a professional whistle blower) lives by disclosures…for us with whom publicity and truth are the air and light of existence, there can be no greater disgrace than to recoil from the frank and accurate disclosure of facts as they are. We are bound to tell the truth as we find it, without fear of consequences-to lend no convenient shelter to act of injustice and oppression, but to consign them at once to the judgment of the world”.

    Other contributors to the book are as follows:

    Adebayo Adenipekun (SAN); Professor Bolaji Owasanoye of Nigerian Institute of Legal Studies; Hon. Justice I. T. Muhammad (Justice of the Supreme Court of Nigeria); K. K. Eleja & Co Chambers; Professor Mojeed Olujimi Alabi of the University of Ilorin; Prof Yemi Akinseye-George (SAN), of Nasarawa State University, Nasarawa State; Prof Wahab Egbewole of the University of Ilorin; Awa U. Kalu (SAN) of the University of Lagos/Abia State University, Uturu; Justice S. D. Kawu, Chief Judge of Kwara State and Dr. Hammed A. Hannafi.

    Though quotations from their writings cannot be accommodated here, all of them are nevertheless veritably quotable in their respective fields as they will be found in their respective contributions to the book.

     

    Public Presentation

    The book: ‘Anatomy of Corruption’ will be publicly presented at Ladi Kwali Hall of Sheraton Hotel, Abuja, on Tuesday, May 17, 2016.

    The Chief Guest at the occasion will be the Vice-President, Prof Yemi Osinbajo, SAN, GCON

    The Chairman of the occasion will be the Chief Justice of Nigeria, Hon. Justice Mahmud Mohammed, GCON.

    The Guest Speaker will be Prof. Wole Soyinka, Nobel laureate while Chief Presenter  will be the Chairman of Skye Bank Plc, Otunba Tunde Ayeni.

    The book will be reviewed by Prof Ademola Popoola of the Faculty of Law, Obafemi Awolowo University, Ile Ife, and the Chief Host the President of Nigerian Bar Association, Augustine Alege, SAN.

     

  • Anatomy society to review curriculum for varsities

    Anatomy society to review curriculum for varsities

    The Anatomical Society of Nigeria (ASN) is set to review the BSc Anatomy curriculum in Nigerian universities.

    In a communiqué issued at the end of its 12th Scientific Conference and Annual General Meeting held at the University of Benin, Edo State, the ASN said its curriculum review committee, headed by Prof. T. B. Ekanem of the University of Calabar, recommended the inclusion of new courses for the department.

    The new inclusions in the curriculum are: Behavioural and Reproductive Biology, Mortuary Science and Funeral Directing, Introduction to Forensic Science, Medical Anthropology and Archeology, Stereology and Biological Morphometry, Basic Histopathology, Sports Science, Aesthetics and Cosmetology and Basic Prosthetics.

    The society also called for an outright review of its constitution, following the observed lapses in the current constitution and the ambiguity of the document on certain important issues, such as the tenure and membership of the Board of Trustees and Advisory Council.

    The meeting also set up a five-man committee, headed by Prof. M. B. T.  Umar of the University of Jos, to act on the mandate by the house.

    In his welcome address at the conference, which was attended by about 400 scientists across the country, the President of the society, Prof. T.W. Jacks, expressed joy with the progress being made by the society.

    In the guest lecture, titled “The Anatomist and Forensic Anthropology”, Dr. Wilson Akhiwu, who is the Force Pathologists and the Commissioner of Police, emphasized the need for anatomists in Nigeria to announce their presence and play their roles in the field of forensic sciences. He further stated that the major crop of forensic anthropologists and biologists should be formed by a background of anatomists that will contribute to the growing need for the forensic sciences in Nigeria.

    The keynote speaker, Prof. Ayodele B. O. Desalu, who spoke on the ‘Role of Anatomist in Nation Building’, described the roles of anatomists in nation building as invaluable. He listed the areas in which anatomists are playing valuable roles to include security, economy, education and health care.

    The communiqué also listed other decisions reached at the meeting to include: “Having observed the anachronistic nature of the Anatomical Act of 1933, an act that has been left buried in the sands of history, the AGM emphasized the need to review it in line with its current needs and contemporary issues surrounding the development of anatomy as a discipline; professionalising and diversifying the subject with the view to enthroning the subject as one of absolute boundlessness in the scheme biomedical, physical and earth sciences. It further directed that such revision should be initiated by the executive council and done through the appropriate channel-the National Assembly.

    “The AGM was informed of the ill-advised directive from the Medical and Dental Council of Nigeria (MDCN) to Vice-Chancellors to employ only appropriate medically qualified teachers to teach medical/dental students by 2019. However, the AGM was also informed that the Association of Vice-Chancellors of Nigerian Universities (AVCNU) has rejected the directive in its entirety because it runs contrary to global best practices which now encourage multidisciplinary approach to research for innovative discoveries across disciplines. As a result, the house called for continuous unity and peaceful coexistence for inter-professional capacity building between the two backgrounds of anatomy teachers in Nigeria.

     

  • Breast cancer: Clinical anatomy and breast self-examination

    Breast cancer: Clinical anatomy and breast self-examination

    Causes of  breast cancer in women

    Though, a constellation of factors operate to cause the disease, it is relevant to note that the normal growth of breast tissue depends on certain hormones such as Thyroxin, Prolactin, Estrogen (ducts) Progesterone (glands), Growth hormones, HCG (Human Chorionic Gonadotropin) and HPL (Human placental lactogen)  amongst others.

    There are clinical and demographic overlaps, but in general, a woman’s risk of developing Breast Cancer has been linked, to a number of factors which include in order of clinical surgical importance.

    1. Female gender: It occurs mostly in women 99.9% as opposed to men 0.1%
    2. Age: It is the 2nd most important risk factor. Breast Cancer is rare before 20, but can occur in any age group. It is common in women between 30 60 years olds. More than 50% of Breast Cancer occur in women 65 years and older. PABC (Pregnancy associated Breast Cancer) appears to occur  most commonly in younger age groups.
    3. Family History: Striking family history of Breast Cancer is characterized by the presence of multiple first degree relatives

    – Mothers

    – Grand mothers

    – Aunts

    – First cousins with pre menopausal Breast Cancer

    – Bilateral disease

    – Family history of Ovarian Cancer

    1. Presence of Precursor lesions on Prior biopsy:

    90%of breast lumps are not breast cancer, but all breast lumps are presumed to be cancer until otherwise proven

    1. Women with fertility problems: These are often diagnosed with high doses of ovarian stimulating hormones
    2. Those achieving first Pregnancy and child birth beyond age 30 years and above.
    3. Genetic factors:

    Breast Cancer 1 (BRCA) gene and in males Breast Cancer 2 (BRCA1), RAP 80 and newer genes have been implicated. Population studies have demonstrated two (2) base pair deletions at position 185 and a single base pair insertion at position 5382 of BRCA2. For BRCA1, single base pair deletions at 6174 have been documented. These constitute most of the mutant alleles in AshKenazi Jews.

    Experts believe that in some cases,mutation in the genes controlling proliferation and apoptosis (programmed cell death) are responsible for Cancer. Mutations in the BRCA at 17 q 21 and BRCA2 13 q 12 Oncogenes have given support to the argument that cancer is a genetic disease, Estrogen and to a lesser extent Progesterone acting via the agency of heredity to promote neoplasia  in concert with other trigger factors.

    The P53 tumor suppressor gene(a transcription factor) operates by loss of function when activated, and is inherited in a recessive pattern, where as the oncogenes which are associated with dominant pattern of inheritance operate by gain of function when activated(proliferation)  ;others are bcl-gene associated with apoptosis and the metastasis gene for which the nm23 is a candidate gene. They are believed to operate in concert with growth factors in controlling activities of thyrosine kinase at the presynthetic(G1/S) and premitotic(G2/M) phases of the cell cycle

    1. Breastfeeding: Those who chose not to breast feed or whose husbands refuse to separate sexual breasts from reproductive breasts, are on their own at risk. Breast Cancer  having been observed to be relatively uncommon in primate and sub primate mammals, research indicates that breast feeding for about 36 months, throughout a woman’s reproductive life, offers some degree of protection against breast cancer. E3 (estriol) as opposed to E2 (estradiol) is protective,from the period of first term pregnancy and parturition throughout life. Women with gonadal dysgenesis (born without normal organs of sex/reproduction)may also enjoy protection which perhaps further implicates the ovarian factor in the concert of major events leading to breast cancer in women, as explained further hereunder,

    * The ovary do not secrete estrogen in experimental hyper prolactinemia.

    * Prolactin appears to affect granulosa cell function in vitro(in the living), by inhibiting synthesis of progesterone. It also alters the normal Testosterone: Dihydrotestosterone ratio.  In this way, it decreases aromatizable substrate(amount of cholesterol /derivatives available in adipose and other tissues convertible to estrogen) and increases local concentration of anti estrogen.

    In non breast feeding women, there is a mean delay before the first ovulation of about 45 days.

    * The development of estrogen receptor at puberty is largely prolatin dependent(good and     bad sides of baby fat).

    * The nexus of paracrine interaction between the gonadotrophs and lactotrophs estrogen, ultimately impact on the breast.

    1. Blood group, Nutrition and breast cancer( Blood group A, AB,)

    Recent and ongoing research aimed at characterization of diseases has demonstrated increasing frequency of Breast Cancer among individuals in blood group A, and AB, though no blood group is totally immune

    1. Previous breast lumps
    2. Early menarche and late menopause : these leave the system awash with hormones

    Android obesity significantly and Gynoid obesity less so, lower the threshold for early menarche ,similarly, high levels of post menopausal Estrone (E) produced by aromatization, can lead to neoplastic changes

    1. HIV/AIDS and Breast Cancer

    Viral peptides have been found in tissue biopsies, from patients with early breast cancer. Studies have shown that retroviruses including HIV are capable of acting as cellular gene transcription factors. Even the presence of viral particles of HIV in the vicinity of Human T-lymphocytes have been known to produce transformed lymphocytes which apart from becoming the targets for Natural Killer CD 8 lymphocytes also become oncogenes. Some retroviruses (ART) encode MAP (membrane associated proteins). It is interesting to note that young T- lymphocytes are more prone to HIV induced transformation.

    On the other hand weakened and reduced T  lymphocyte population can hardly mount formidable viral attack. How ever, Breast Cancer is not listed by the CDC as one of the recognised  opportunistic infections (OIS) disease conditions

    1. Patients on HRT (Hormone Replacement therapy).

    The biochemical commonality between the female gonadal steroids and environmental carcinogens is the benzene ring. These agents which are being abused by women with fertility issues undergoing treatment from Herbalists can induce cancer any where in the body, either directly or through the intermediates  produced when they are metabolized,

    . Others

    Uncontrolled exposure to X-rays, use of breast firming creams, Alcohol recycled vegetable oil, Tobacco, flavouring and colouring agents in fast foods are all potential carcinogens depending on genetic constitution of the individual.

    Some symptoms and signs?

    Symptoms and signs of breast cancer may be concealed, masked or obvious . They  can also  be generalized or specific, depending on the stage of the tumor, location and extent of spread. Pain, yellow eyes, malaise, lethargy, thirst and weight loss are some of the non specific or generalized symptoms.

    Grave signs that should require serious action include

    1)            Painless breast lump

    2)            Breast oedema

    3)            Skin ulceration (not dimples) seen to be coming from a solid breast lump

    4)            Fixation of tumor to the chest wall muscles and even beyond

    5)            Presence of matted axillary lumph nodes or even a single axillary (Armpit) lymph node more than 2.5cm (larger than the breadth of an adult finger)

    6)            Arm oedema (pitting or non pitting) swelling of the Arm of the side where breast has a problem.

    7)            Sudden appearance of a painful hard lump in pregnancy is serious, more so if  unilateral (in one side).

    The most important single fact about the clinical features of breast cancer is that it is not like tooth ache or wound in the tongue; it can be silent at the onset and at any other time like partially extinguished fire only to come out stronger and deadlier.

  • Breast cancer: Clinical anatomy and breast self-examination

    Breast cancer: Clinical anatomy and breast self-examination

    The deaths in very recent past of prominent Nigerians, Professor K.D.K Koki, Dr. D. Fiberesima , Yinka Craig, Chief Gani Fawehimi and a host of others unreported, will have severed as a wake up call to experts and primary health care practitioners about the urgent need to look at cancer in Nigeria as a public health problem and no longer a diseases of the White race.

    No known curable drug for cancer has been discovered, and in resources limited countries like Nigeria, studies have shown that of all the several approaches towards healthcare, the most beneficial with regards to costs and benefits  is in the province of preventive health care.

    Surveys across the globe have shown that 7 to 10% of all cancer related deaths are attributable to factors  that  can be curtailed . These include

    –              Reproductive / sexual behaviors

    –              Diet and life style

    –              Environmental pollution

    –              Geographical features

    –              Genetic factors

    What follows hereunder contains materials suitable for the medical, academic, allied medical and other categories of people interested in or involved with the subject matter. The lay public can benefit  greatly by taking out what they can and then  seek clarifications where necessary.

    Amongst women, questions are being raised with regards to the changing patterns of cancer;  is cancer changing from the cervix to the breast? What trends are we seeing with respect to our environment and carcinogens. Do we now have a place for the old but rejected and disregarded BSE (Breast Self Examination)? How effective is Breast Self Examination in primary level care particularly amongst uneducated rural women compared to women in high socio-economic class in whom breast cancer is most common?

    In any case, the issues are worth considering;

    Cancer is Greek World for Crab, which arose, because of the need by Ancient Anatomist to define  a new growth, (neoplasia) that had gone beyond the confines of it’s tissues and developed the structures with which it can spread to distant sites,(usually un encapsulated). That scientific enquiry by Anatomist gave birth to the word cancer as it is known today.

    The smallest morphologically identifiable and functional unit of an organism is the cell. Cancer is said to have occurred when a group of cells arising from the same origin become selectively and abnormally favored in such a away that  the normal regulatory mechanism for  cellular growth, is lost, with the result that the cells  expand and invade neighboring tissues, neurovascular channels and then spread to distant sites.

    Breast cancer is now being referred to as the ultimate cancer in women, because the organ undergoes morphological (structural) changes throughout the life of a woman. According to SEER (Surveillance Epidemiology and End Results), the probability of a woman developing breast cancer increases throughout life  from birth to death.

    World wide 43,000 women out of reported cases die each year and on the average, 1000,000 women develop breast cancer each year. Studies in the US show an age adjusted rate of 27 per 100,000 deaths and Globally it has been estimated that 1 out of every 11 women will develop breast cancer in their life time.

    In Nigeria, breast cancer afflicts an estimated 12,000 women annually. About 5% of cases of pregnancy associated breast cancer have been seen and in most studies mortality is as high as 80  90% adding to the burden of care associated with perinatal and maternal morbidity.

     

    The Problem

    The form (morphology) function (physiology) and diseases (Pathology) of the human female breast are major concerns of  not only physicians, but families and  societies.

    The organ(breast) is located in an exposed part of the body, but sexual health is  taught sparingly in most Nigerian Schools, Cultural and religious barriers  forbid detailed conversations of the nature expected of that private part of the human body. In deed and in some parts of the Country and the world, only female medical practitioners are permitted to carry out detailed medical examination on women. More over, because signature symptoms and signs of breast cancer are subtle, emerge later or even absent from the onset, some affected women die without ever knowing what killed them. Breast cancer patients of the Nigerian African descent at the time of presentation, are on the average 10 to 15 years younger ,compared with women in the Western countries and it is in the younger age group that pregnancy associated breast cancer(PABC) though uncommon present with very challenging obstetric and gynecological situations.

    The whip lash of the economy cuts deepest into the underserved who live in abject poverty, have no access to radio and television and are too far away from primary health care facilities. How do we mainstream these vulnerable and under reported group? The answer is not far to fetch; we create awareness and encourage participatory health care delivery system, in the spirit of self realization because health education and health promotional activities yield better and sustainable results when you start from the known to the unknown.

    To ascertain health status of  the breast, detect and diagnose early abnormalities and treat or be treated. It is of paramount importance that, every woman(age not a serious barrier), first responders, paramedics, general practitioners, family Physicians and other specialists at various levels of the system understand the anatomy of both the glandular and connective tissue components of the breast, and of the inter relationship between these components..

    Research findings suggest that if there is increased awareness and improvement in the capacity of women to understand themselves and members of their families, to enable them cultivate risk avoidance  behavior and seek medical attention early enough, further substantial reduction in breast cancer and other cancer related death is achievable.  Awareness may not translate to knowledge all the time, but according to Ancient Chinese Public health practitioners,

    “When I hear about something I forget it”

    “When I see something,  I remember it,”

    “When  I do something,  I know it.”

    Indeed, physical examination of the breast by self, Sister, Aunt, Mom, is in fact a demonstration of its Anatomy, in a living subject. The same concepts apply as when a physician does breast examination in the consulting room.

     

    Clinical Anatomy

    The breast; nor Mamma is a modified skin appendage of appocrine sweat gland specialized for milk production. It is the major anatomic structure, by virtue of which modern humans as  Homosapiens are placed in the class Mammalia.

    Prepubertal male breast is nearly always the same as the female, and just like females males can develop cancer of the breast and die even faster from it’s complications. In the growing human, distinct anatomical differences develop soon after under the influence of gonadal (Ovarian) hormones. Indeed, the male breast can be made to enlarge and even produce breast milk, if the appropriate hormonal regulatory factors are supplied in controlled amounts.

     

    Embryology

    Development  of the breast begins by about the 4th week of intra uterine life, through the 8th  to the 12thweek . This falls within and a little  beyond the period of human embryogenesis .it is during  this period that  agents  which are capable of disrupting or aborting the  normal process or program of development are best avoided. By puberty, the human hypothalamohypophyseal gonadal axis becomes more active and releases it’s hold on Ovarian activities, leading to the growth and development of the female breast.

    At the appropriate time, pregnancy pumps estrogen and progesterone into the female circulation  reinforced by placental uterine , thyroid and adrenal hormones, all leading to enlargement of the glandular and connective tissue elements of the breast, changes which in most cases are only slightly but significantly reversible with cessation of lactation.