1
|
Mutebi M, Anderson BO, Duggan C, Adebamowo C, Agarwal G, Ali Z, Bird P, Bourque JM, DeBoer R, Gebrim LH, Masetti R, Masood S, Menon M, Nakigudde G, Ng'ang'a A, Niyonzima N, Rositch AF, Unger-Saldaña K, Villarreal-Garza C, Dvaladze A, El Saghir NS, Gralow JR, Eniu A. Breast cancer treatment: A phased approach to implementation. Cancer 2021; 126 Suppl 10:2365-2378. [PMID: 32348571 DOI: 10.1002/cncr.32910] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/31/2020] [Accepted: 03/31/2020] [Indexed: 12/14/2022]
Abstract
Optimal treatment outcomes for breast cancer are dependent on a timely diagnosis followed by an organized, multidisciplinary approach to care. However, in many low- and middle-income countries, effective care management pathways can be difficult to follow because of financial constraints, a lack of resources, an insufficiently trained workforce, and/or poor infrastructure. On the basis of prior work by the Breast Health Global Initiative, this article proposes a phased implementation strategy for developing sustainable approaches to enhancing patient care in limited-resource settings by creating roadmaps that are individualized and adapted to the baseline environment. This strategy proposes that, after a situational analysis, implementation phases begin with bolstering palliative care capacity, especially in settings where a late-stage diagnosis is common. This is followed by strengthening the patient pathway, with consideration given to a dynamic balance between centralization of services into centers of excellence to achieve better quality and decentralization of services to increase patient access. The use of resource checklists ensures that comprehensive therapy or palliative care can be delivered safely and effectively. Episodic or continuous monitoring with established process and quality metrics facilitates ongoing assessment, which should drive continual process improvements. A series of case studies provides a snapshot of country experiences with enhancing patient care, including the implementation of national cancer control plans in Kenya, palliative care in Romania, the introduction of a 1-stop clinic for diagnosis in Brazil, the surgical management of breast cancer in India, and the establishment of a women's cancer center in Ghana.
Collapse
Affiliation(s)
- Miriam Mutebi
- Breast Surgical Oncology, Aga Khan University Hospital, Nairobi, Kenya
| | - Benjamin O Anderson
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Section of Surgical Oncology, Department of Surgery, University of Washington, Seattle, Washington
| | - Catherine Duggan
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Clement Adebamowo
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland.,Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland.,Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland.,Center for Bioethics and Research, Ibadan, Nigeria
| | - Gaurav Agarwal
- Endocrine and Breast Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Zipporah Ali
- Kenya Hospices and Palliative Care Association, Nairobi, Kenya
| | | | - Jean-Marc Bourque
- Department of Radiation Oncology, University of Ottawa, Ottawa, Ontario, Canada.,Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Rebecca DeBoer
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Luiz Henrique Gebrim
- Department of Mastology, Federal University of São Paulo, São Paulo, Brazil.,Centro de Referência da Saúde da Mulher, São Paulo, Brazil
| | - Riccardo Masetti
- Department of Women and Child Health, Catholic University, Rome, Italy
| | - Shahla Masood
- University of Florida Health Jacksonville Breast Center, Jacksonville, Florida
| | - Manoj Menon
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Anne Ng'ang'a
- National Cancer Control Program, Ministry of Health, Nairobi, Kenya
| | - Nixon Niyonzima
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Uganda Cancer Institute, Kampala, Uganda
| | - Anne F Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Karla Unger-Saldaña
- Epidemiology Unit, Instituto Nacional de Cancerología - México, Mexico City, Mexico
| | - Cynthia Villarreal-Garza
- Tecnologico de Monterrey, Centro de Cancer de Mama, Hospital Zambrano Hellion, Monterrey, Mexico
| | - Allison Dvaladze
- Section of Surgical Oncology, Department of Surgery, University of Washington, Seattle, Washington
| | | | - Julie R Gralow
- Section of Surgical Oncology, Department of Surgery, University of Washington, Seattle, Washington
| | - Alexandru Eniu
- Hopital Riviera Chablais, Vaud-Valais, Rennaz, Switzerland
| |
Collapse
|
2
|
Kamita M, Mweni S, Nzioka A, Figueroa JD, Makokha F. Analysis of cancer diagnoses from 2015-2019 within Machakos County, Kenya, support establishment of Cancer Centre in 2019 likely changing referral patterns. Wellcome Open Res 2020. [DOI: 10.12688/wellcomeopenres.16340.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: In Kenya, cancer is an increasing public health challenge, with an estimated 48,000 new cancer cases and over 33,000 deaths recorded each year. Machakos County, Kenya, recently opened a cancer centre with an aim of bringing cancer services such as surgical oncology, chemotherapy, radiotherapy, and pathological services closer to the residents of Machakos County. The county is also one of four counties selected for the universal health coverage pilot programme making it uniquely poised to inform cancer control programs at the local, national, and international levels. Methods: This study aimed to build a cancer database to enable future population-based cancer studies by reviewing cancer diagnosis records for selected major public hospitals in Machakos County from 2015-2019. Medical records data were retrieved from Machakos Level 5 Hospital and Kangundo, Matuu, Kathiani and Mwala Level 4 Hospitals. Results: A total of 522 cancer cases were recorded across the study period with more than a third (N=172, 33%) diagnosed August-December of 2019 when the Machakos Cancer Centre opened. Among the cancers diagnosed, the majority were in women (59.2%), with cervix uteri (n=106, 34.3%) followed by breast (n=62, 20.1%) as the most common cancers. For males, oesophagus (n=52, 24.4%) followed by prostate (n=43, 20.2%) were the most common cancer types. The highest crude rates per 100,000 persons were for Kangundo 67.4 and Matungulu 53.2 subcounties. Conclusion: It is clear that access to cancer care treatment will change referral patterns for residents in Machakos County and with the establishment of this database we expect to enable future population-based surveillance of the cancer burden and research studies, to inform cancer control programs.
Collapse
|
3
|
Yesufe AA, Assefa M, Bekele A, Ergete W, Aynalem A, Wondemagegnehu T, Tausjø J, Assefa Tessema G, Kantelhardt EJ, Gansler T, Jemal A. Adequacy of Pathologic Reports of Invasive Breast Cancer From Mastectomy Specimens at Tikur Anbessa Specialized Hospital Oncology Center in Ethiopia. J Glob Oncol 2019; 4:1-12. [PMID: 30084708 PMCID: PMC6223529 DOI: 10.1200/jgo.17.00198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Purpose Although information from pathology reports is essential to the care of individuals with cancer and to population-level cancer control, no systematic evidence exists regarding the adequacy of breast pathology reporting in Ethiopia. This study audited pathology reports of mastectomy specimens from patients evaluated at the Tikur Anbessa Specialized Hospital Oncology Center in Addis Ababa, Ethiopia. Methods Mastectomy pathology reports from February 2014 through January 2016 were assessed for gross and microscopic information considered by the Breast Cancer Initiative 2.5 (BCI 2.5; formerly the Breast Health Global Initiative) guideline to be necessary for care of patients with breast cancer stratified according to basic, limited, and enhanced resource settings. Results Fewer than two thirds (61.6%) of the 417 reports we reviewed included all four of the BCI 2.5 basic pathology data elements we could evaluate with available data (tumor category, lymph node category, histologic type, and histologic grade). Only 1.0% of reports included all three pathology data elements recommended for limited resource settings (estrogen receptor status, margin status, and lymphovascular invasion). Several elements were significantly more likely to be noted in reports from nonpublic hospitals than from public hospitals. Although only three of 417 reports included checklists or templates, all three of these reports included all of the basic pathology information, and they all included at least two of the three limited pathology elements not already on the basic list. Conclusion More than one third (38.4%) of mastectomy pathology reports did not meet BCI 2.5 standards for basic resource settings. Quality measurement and improvement programs and capacity-building interventions by national pathology and oncology organizations, collaboration with medical and public health organizations in neighboring countries, adoption of synoptic reporting templates, use of electronic pathology reporting, and histotechnology and histopathology training collaborations with laboratories in high-resource regions are recommended.
Collapse
Affiliation(s)
- Abdu A Yesufe
- Abdu A. Yesufe, Mathewos Assefa, Abebe Bekele, Wondwossen Ergete, Abreha Aynalem, and Tigeneh Wondemagegnehu, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa; Gizachew Assefa Tessema, University of Gondar, Gondar, Ethiopia; Johan Tausjø, Norwegian Radium Hospital, Oslo University, Oslo, Norway; Eva Johanna Kantelhardt, Institute of Medical Epidemiology, Martin-Luther-University, Halle an der Saale, Germany; and Ted Gansler and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Mathewos Assefa
- Abdu A. Yesufe, Mathewos Assefa, Abebe Bekele, Wondwossen Ergete, Abreha Aynalem, and Tigeneh Wondemagegnehu, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa; Gizachew Assefa Tessema, University of Gondar, Gondar, Ethiopia; Johan Tausjø, Norwegian Radium Hospital, Oslo University, Oslo, Norway; Eva Johanna Kantelhardt, Institute of Medical Epidemiology, Martin-Luther-University, Halle an der Saale, Germany; and Ted Gansler and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Abebe Bekele
- Abdu A. Yesufe, Mathewos Assefa, Abebe Bekele, Wondwossen Ergete, Abreha Aynalem, and Tigeneh Wondemagegnehu, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa; Gizachew Assefa Tessema, University of Gondar, Gondar, Ethiopia; Johan Tausjø, Norwegian Radium Hospital, Oslo University, Oslo, Norway; Eva Johanna Kantelhardt, Institute of Medical Epidemiology, Martin-Luther-University, Halle an der Saale, Germany; and Ted Gansler and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Wondwossen Ergete
- Abdu A. Yesufe, Mathewos Assefa, Abebe Bekele, Wondwossen Ergete, Abreha Aynalem, and Tigeneh Wondemagegnehu, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa; Gizachew Assefa Tessema, University of Gondar, Gondar, Ethiopia; Johan Tausjø, Norwegian Radium Hospital, Oslo University, Oslo, Norway; Eva Johanna Kantelhardt, Institute of Medical Epidemiology, Martin-Luther-University, Halle an der Saale, Germany; and Ted Gansler and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Abreha Aynalem
- Abdu A. Yesufe, Mathewos Assefa, Abebe Bekele, Wondwossen Ergete, Abreha Aynalem, and Tigeneh Wondemagegnehu, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa; Gizachew Assefa Tessema, University of Gondar, Gondar, Ethiopia; Johan Tausjø, Norwegian Radium Hospital, Oslo University, Oslo, Norway; Eva Johanna Kantelhardt, Institute of Medical Epidemiology, Martin-Luther-University, Halle an der Saale, Germany; and Ted Gansler and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Tigeneh Wondemagegnehu
- Abdu A. Yesufe, Mathewos Assefa, Abebe Bekele, Wondwossen Ergete, Abreha Aynalem, and Tigeneh Wondemagegnehu, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa; Gizachew Assefa Tessema, University of Gondar, Gondar, Ethiopia; Johan Tausjø, Norwegian Radium Hospital, Oslo University, Oslo, Norway; Eva Johanna Kantelhardt, Institute of Medical Epidemiology, Martin-Luther-University, Halle an der Saale, Germany; and Ted Gansler and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Johan Tausjø
- Abdu A. Yesufe, Mathewos Assefa, Abebe Bekele, Wondwossen Ergete, Abreha Aynalem, and Tigeneh Wondemagegnehu, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa; Gizachew Assefa Tessema, University of Gondar, Gondar, Ethiopia; Johan Tausjø, Norwegian Radium Hospital, Oslo University, Oslo, Norway; Eva Johanna Kantelhardt, Institute of Medical Epidemiology, Martin-Luther-University, Halle an der Saale, Germany; and Ted Gansler and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Gizachew Assefa Tessema
- Abdu A. Yesufe, Mathewos Assefa, Abebe Bekele, Wondwossen Ergete, Abreha Aynalem, and Tigeneh Wondemagegnehu, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa; Gizachew Assefa Tessema, University of Gondar, Gondar, Ethiopia; Johan Tausjø, Norwegian Radium Hospital, Oslo University, Oslo, Norway; Eva Johanna Kantelhardt, Institute of Medical Epidemiology, Martin-Luther-University, Halle an der Saale, Germany; and Ted Gansler and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Eva Johanna Kantelhardt
- Abdu A. Yesufe, Mathewos Assefa, Abebe Bekele, Wondwossen Ergete, Abreha Aynalem, and Tigeneh Wondemagegnehu, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa; Gizachew Assefa Tessema, University of Gondar, Gondar, Ethiopia; Johan Tausjø, Norwegian Radium Hospital, Oslo University, Oslo, Norway; Eva Johanna Kantelhardt, Institute of Medical Epidemiology, Martin-Luther-University, Halle an der Saale, Germany; and Ted Gansler and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Ted Gansler
- Abdu A. Yesufe, Mathewos Assefa, Abebe Bekele, Wondwossen Ergete, Abreha Aynalem, and Tigeneh Wondemagegnehu, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa; Gizachew Assefa Tessema, University of Gondar, Gondar, Ethiopia; Johan Tausjø, Norwegian Radium Hospital, Oslo University, Oslo, Norway; Eva Johanna Kantelhardt, Institute of Medical Epidemiology, Martin-Luther-University, Halle an der Saale, Germany; and Ted Gansler and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Ahmedin Jemal
- Abdu A. Yesufe, Mathewos Assefa, Abebe Bekele, Wondwossen Ergete, Abreha Aynalem, and Tigeneh Wondemagegnehu, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa; Gizachew Assefa Tessema, University of Gondar, Gondar, Ethiopia; Johan Tausjø, Norwegian Radium Hospital, Oslo University, Oslo, Norway; Eva Johanna Kantelhardt, Institute of Medical Epidemiology, Martin-Luther-University, Halle an der Saale, Germany; and Ted Gansler and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| |
Collapse
|
4
|
Bravaccini S, Bucchi L, Puccetti M, Ravaioli S, Tumedei MM, Serra P, Masini C, Kahima J, Masalu N, Amadori D. Explaining the aggressiveness of breast cancer in sub-Saharan African patients. J Clin Pathol 2019; 72:723-724. [PMID: 31409610 DOI: 10.1136/jclinpath-2019-206071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/05/2019] [Accepted: 08/06/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Sara Bravaccini
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Lauro Bucchi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | | | - Sara Ravaioli
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Maria Maddalena Tumedei
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Patrizia Serra
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Carla Masini
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Jackson Kahima
- Bugando Medical Center, Mwanza, United Republic of Tanzania
| | - Nestory Masalu
- Bugando Medical Center, Mwanza, United Republic of Tanzania
| | - Dino Amadori
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| |
Collapse
|
5
|
Mammographic Breast Density and Breast Cancer Molecular Subtypes: The Kenyan-African Aspect. BIOMED RESEARCH INTERNATIONAL 2018; 2018:6026315. [PMID: 29607324 PMCID: PMC5828539 DOI: 10.1155/2018/6026315] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 12/05/2017] [Indexed: 12/04/2022]
Abstract
Introduction Data examining mammographic breast density (MBD) among patients in Sub-Saharan Africa are sparse. We evaluated how MBD relates to breast cancer characteristics in Kenyan women undergoing diagnostic mammography. Methods This cross-sectional study included women with pathologically confirmed breast cancers (n = 123). Pretreatment mammograms of the unaffected breast were assessed to estimate absolute dense area (cm2), nondense area (cm2), and percent density (PD). Relationships between density measurements and clinical characteristics were evaluated using analysis of covariance. Results Median PD and dense area were 24.9% and 85.3 cm2. Higher PD and dense area were observed in younger women (P < 0.01). Higher dense and nondense areas were observed in obese women (P-trend < 0.01). Estrogen receptor (ER) positive patients (73%) had higher PD and dense area than ER-negative patients (P ≤ 0.02). Triple negative breast cancer (TNBC) patients (17%) had lower PD and dense area (P ≤ 0.01) compared with non-TNBCs. No associations were observed between MBD and tumor size and grade. Conclusions Our findings show discordant relationships between MBD and molecular tumor subtypes to those previously observed in Western populations. The relatively low breast density observed at diagnosis may have important implications for cancer prevention initiatives in Kenya. Subsequent larger studies are needed to confirm these findings.
Collapse
|
6
|
Makau-Barasa LK, Greene SB, Othieno-Abinya NA, Wheeler S, Skinner A, Bennett AV. Improving Access to Cancer Testing and Treatment in Kenya. J Glob Oncol 2017; 4:1-8. [PMID: 30241200 PMCID: PMC6180746 DOI: 10.1200/jgo.2017.010124] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose In response to the increasing cancer burden in Kenya, this study identified
barriers to patients seeking access to cancer testing and treatment and to
clinicians in delivering these services. Policy recommendations based on
findings are presented. Methods This qualitative study used semistructured key informant interviews.
Purposive sampling was used to recruit 14 participants: seven oncology
clinicians and seven support and advocacy leaders for patients with cancer.
Qualitative analysis was used to identify themes. Results Seven barriers to cancer testing and treatment were identified: high cost of
testing and treatment, low level of knowledge about cancer among population
and clinicians, poor health-seeking behaviors among population, long
distances to access diagnostic and treatment services, lack of decentralized
diagnostic and treatment facilities, poor communication, and lack of better
cancer policy development and implementation. Conclusion Kenyans seeking cancer services face significant barriers that result in late
presentation, misdiagnosis, interrupted treatment, stigma, and fear. Four
policy recommendations to improve access for patients with cancer are (1)
improve health insurance for patients with cancer; (2) establish testing and
treatment facilities in all counties; (3) acquire diagnosis and treatment
equipment and train health personnel to screen, diagnose, and treat cancer;
and (4) increase public health awareness and education about cancer to
improve diagnoses and treatment. Effective cancer testing and treatment
options can be developed to address cancer in a resource-constrained
environment like Kenya. An in-depth look at effective interventions and
policies being implemented in countries facing similar challenges would
provide valuable lessons to Kenya’s health sector and
policymakers.
Collapse
Affiliation(s)
- Louise K Makau-Barasa
- Louise K. Makau-Barasa, Sandra B. Greene, Stephanie Wheeler, and Antonia V. Bennett, University of North Carolina at Chapel Hill, Chapel Hill; Asheley Skinner, Duke University, Durham, NC; and Nicholas A. Othieno-Abinya, University of Nairobi, Nairobi, Kenya
| | - Sandra B Greene
- Louise K. Makau-Barasa, Sandra B. Greene, Stephanie Wheeler, and Antonia V. Bennett, University of North Carolina at Chapel Hill, Chapel Hill; Asheley Skinner, Duke University, Durham, NC; and Nicholas A. Othieno-Abinya, University of Nairobi, Nairobi, Kenya
| | - Nicholas A Othieno-Abinya
- Louise K. Makau-Barasa, Sandra B. Greene, Stephanie Wheeler, and Antonia V. Bennett, University of North Carolina at Chapel Hill, Chapel Hill; Asheley Skinner, Duke University, Durham, NC; and Nicholas A. Othieno-Abinya, University of Nairobi, Nairobi, Kenya
| | - Stephanie Wheeler
- Louise K. Makau-Barasa, Sandra B. Greene, Stephanie Wheeler, and Antonia V. Bennett, University of North Carolina at Chapel Hill, Chapel Hill; Asheley Skinner, Duke University, Durham, NC; and Nicholas A. Othieno-Abinya, University of Nairobi, Nairobi, Kenya
| | - Asheley Skinner
- Louise K. Makau-Barasa, Sandra B. Greene, Stephanie Wheeler, and Antonia V. Bennett, University of North Carolina at Chapel Hill, Chapel Hill; Asheley Skinner, Duke University, Durham, NC; and Nicholas A. Othieno-Abinya, University of Nairobi, Nairobi, Kenya
| | - Antonia V Bennett
- Louise K. Makau-Barasa, Sandra B. Greene, Stephanie Wheeler, and Antonia V. Bennett, University of North Carolina at Chapel Hill, Chapel Hill; Asheley Skinner, Duke University, Durham, NC; and Nicholas A. Othieno-Abinya, University of Nairobi, Nairobi, Kenya
| |
Collapse
|
7
|
Trupe LA, Rositch A, Dickerson L, Lucas S, Harvey SC. Knowledge and Attitudes About Breast Cancer in Limpopo, South Africa. J Glob Oncol 2017; 3:509-514. [PMID: 29094090 PMCID: PMC5646900 DOI: 10.1200/jgo.2016.008102] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Purpose Breast cancer survival is unacceptably low in many low-resource settings, including rural South Africa, where access to screening and treatment services is limited. To describe the context for implementing an early detection program, we assessed knowledge and attitudes toward breast cancer risk, early detection, and treatment. Methods We conducted a cross-sectional survey among 243 women presenting to Hlokomela Clinic in Hoedspruit, South Africa, during April and May 2016. We used quantitative and qualitative analyses to determine levels of knowledge of risk factors, symptoms, and treatment of breast cancer, as well as experience with and attitudes toward detection and treatment methods. Results Thirty-one percent of women correctly identified at least six of 12 risk factors for breast cancer, and 53.1% identified breast lumps as an important symptom. Although > 97% of women stated that self–breast examination and early detection were highly important and that they would seek care for changes in their breasts, only 33.3% of women reported performing self–breast examination, and only 24.3% reported receiving a clinical breast examination. Age and education were not associated with knowledge, and level of knowledge did not predict care-seeking behaviors or attitudes. Conclusion Although women demonstrated moderate levels of knowledge of breast cancer symptoms and risk factors and the importance of early detection, few women reported seeking services. These data demonstrate sufficient levels of knowledge and positive attitudes toward care seeking and suggest both a need and readiness for increased access to cost-effective services to facilitate early diagnosis and improved outcomes.
Collapse
Affiliation(s)
- Lydia A Trupe
- , University of Cape Town School of Public Health and Family Medicine, Cape Town; , University of Witwatersrand School of Medicine and Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa; , Johns Hopkins Bloomberg School of Public Health; and , Johns Hopkins University School of Medicine; and , Johns Hopkins Hospital, Baltimore, MD
| | - Anne Rositch
- , University of Cape Town School of Public Health and Family Medicine, Cape Town; , University of Witwatersrand School of Medicine and Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa; , Johns Hopkins Bloomberg School of Public Health; and , Johns Hopkins University School of Medicine; and , Johns Hopkins Hospital, Baltimore, MD
| | - Lindsay Dickerson
- , University of Cape Town School of Public Health and Family Medicine, Cape Town; , University of Witwatersrand School of Medicine and Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa; , Johns Hopkins Bloomberg School of Public Health; and , Johns Hopkins University School of Medicine; and , Johns Hopkins Hospital, Baltimore, MD
| | - Su Lucas
- , University of Cape Town School of Public Health and Family Medicine, Cape Town; , University of Witwatersrand School of Medicine and Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa; , Johns Hopkins Bloomberg School of Public Health; and , Johns Hopkins University School of Medicine; and , Johns Hopkins Hospital, Baltimore, MD
| | - Susan C Harvey
- , University of Cape Town School of Public Health and Family Medicine, Cape Town; , University of Witwatersrand School of Medicine and Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa; , Johns Hopkins Bloomberg School of Public Health; and , Johns Hopkins University School of Medicine; and , Johns Hopkins Hospital, Baltimore, MD
| |
Collapse
|
8
|
Islami F, Lortet-Tieulent J, Okello C, Adoubi I, Mbalawa CG, Ward EM, Parkin DM, Jemal A. Tumor size and stage of breast cancer in Côte d'Ivoire and Republic of Congo - Results from population-based cancer registries. Breast 2015; 24:713-7. [PMID: 26371692 DOI: 10.1016/j.breast.2015.08.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 08/07/2015] [Accepted: 08/26/2015] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Breast cancer is now the leading female cancer in sub-Saharan Africa, but there is relatively little information on breast cancer characteristics from this region. We studied, on a population basis, the size and stage of female breast cancer at diagnosis in Côte d'Ivoire and Republic of Congo. METHODS Data on tumor size and stage of breast cancer at diagnosis were collected by population-based cancer registries in Abidjan (the capital of Côte d'Ivoire; 141 cases) and Brazzaville (the capital of Republic of Congo; 139 cases) from a random group of female breast cancer cases that were diagnosed in 2008-2009 using the same protocol. RESULTS The majority of breast cancers in both countries were advanced cancers. In Côte d'Ivoire, 68% of tumors were ≥5 cm in diameter and 74% of cancers were stage III or IV at diagnosis; the corresponding proportions in Republic of Congo were 63% and 81%. CONCLUSION These results underscore the importance of increased awareness about early detection of breast cancer, as well as expansion of the capacity to provide appropriate diagnosis, treatment, and palliative care in sub-Saharan Africa.
Collapse
Affiliation(s)
- Farhad Islami
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, United States
| | - Joannie Lortet-Tieulent
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, United States
| | - Catherine Okello
- African Cancer Registry Network, INCTR African Registry Programme, Oxford, United Kingdom
| | - Innocent Adoubi
- Service de Cancérologie, Centre Hospitalier Universitaire de Treichville, Abidjan, Cote d'Ivoire
| | - Charles Gombé Mbalawa
- Service de Carcinologie et Radiothérapie, Centre Hospitalier Universitaire de Brazzaville, Brazzaville, Congo
| | - Elizabeth M Ward
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, United States
| | - D Maxwell Parkin
- African Cancer Registry Network, INCTR African Registry Programme, Oxford, United Kingdom; Clinical Trials Service Unit & Epidemiological Studies Unit, Nuffield Department of Public Health, University of Oxford, Oxford, United Kingdom.
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, United States
| |
Collapse
|
9
|
Galukande M, Wabinga H, Mirembe F, Karamagi C, Asea A. Molecular breast cancer subtypes prevalence in an indigenous Sub Saharan African population. Pan Afr Med J 2014; 17:249. [PMID: 25309649 PMCID: PMC4189896 DOI: 10.11604/pamj.2014.17.249.330] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 02/26/2014] [Indexed: 12/19/2022] Open
Abstract
Introduction Sub-Saharan Africa is predicted to face an unprecedented growth of cancers including breast cancer. There are indications of a significant burden of aggressive and late stage breast disease among premenopausal women in sub-Saharan Africa; because hormonal status tests are not routinely done, many women are given anti-hormonal therapy empirically. There is paucity of data on breast cancer molecular subtypes and their characteristics among women in sub Saharan Africa. The objective is to determine the prevalence of breast cancer molecular phenotypes among Ugandan women. Methods This was a cross sectional descriptive study, conducted at a tertiary hospital in Africa. Eligible participants’ formalin fixed and paraffin embedded sections were evaluated. H & E stains and Immunochemistry (Estrogen Receptor (ER), Progesterone Receptor (PR), Human Epidermal growth factor Receptor (HER2)) were performed. Ethical approval was obtained. Results A total of 226 patient samples were evaluated. The mean age was 45 years (SD 14);the prevalence of Triple Negative Breast Cancer (TNBC) was 34% (77/226), Luminal A 38% (83/226), HER2 positive was 22% (49/226), and Luminal B was 5% (13/226). High-grade (III) tumors were 68%, stage III and IV constituted 75% of presentations. Histological type was mostly invasive ductal carcinoma. Most patients (55%) were from rural areas. Conclusion Ugandan women had an over representation of TNBC and high-grade breast tumors. Underlying reasons ought to be investigated. The empirical use of tamoxifen (anti-hormonal therapy) should be reexamined.
Collapse
Affiliation(s)
- Moses Galukande
- Department of Surgery, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Henry Wabinga
- Department of Pathology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Florence Mirembe
- Department of Obstetrics and Gynecology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Charles Karamagi
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Alexzander Asea
- The Texas A & M Health Science Center College of Medicine, USA
| |
Collapse
|