Pregnancy Associated Invasive Apocrine Carcinoma of the Breast: Case Report from Ethiopia

We present a case report on a case of invasive apocrine carcinoma of breast during pregnancy at a tertiary referral hospital in Ethiopia. The patient's case in this report signifies the challenging clinical situation that the patient, developing fetus and treating physicians have to go through and the need to improve maternal-fetal medicine and oncologic setup and treatment guidelines in Ethiopia. Our case also illustrates the huge disparity between the management of both breast cancer and its occurrence during pregnancy in low-income countries like Ethiopia and developed nations elsewhere. Our case report shows a rare histological finding. The patient has invasive apocrine carcinoma of the breast. To our knowledge, it is the first case to be reported in the country.

Female representation in oncology leadership in Africa: Analysis of trends in the African organization for cancer research and training in cancer (AORTIC)

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Background: Board membership in oncology organizations and invitation to speak at major oncology conferences is an established indicator of gender disparities in oncology leadership. Recent studies note an upward trend in female board membership and female speakers at oncology conferences in European and American contexts. However, little is known about trends of female representation in board membership and at oncology conferences in Africa. AORTIC is the premier African cancer organization and hosts a biennial conference, during which its council members are elected for a two-year term. The conference hosts over 1000 participants and is highly regarded internationally. As the largest gathering of African oncologists, the conference presents a unique opportunity for insight into workforce disparities and trends. This study presents an analysis of female council membership and speaker participation at the 2015, 2017, 2019 and 2021 AORTIC conferences. Methods: AORTIC conference programmes and AORTIC elections for council membership in 2015, 2017, 2019 and 2021 were analyzed for gender representation. Speakers were divided into categories including keynote speakers, facilitators, session speakers, panelists, and oral abstract presenters. For each AORTIC session, data was collected on speaker name, gender, and affiliated country. Participants who presented multiple times were counted multiple times, as their role often varied between sessions. Personal data and country affiliation was determined through online biographies of speakers and/or visual confirmation of professional photographs. A simple descriptive analysis of the data and trends is presented here. Results: Since 2015, the proportion of female speakers and council members at AORTIC has increased. In 2015, females accounted for 44% of speakers, in contrast to 55% in 2021. In 2021, females made up over 50% of all speaker categories except keynote. The proportion of female council members also increased, from 42% in 2015 to 69% in 2021. Trends in geographic representation of speakers were also analyzed for gender, revealing an increase in female speakers residing in Africa. (Table) Conclusions: The proportion of female speakers and council members at Africa’s largest cancer conference has increased significantly since 2015. Female speaker participation was higher than in North America and Europe in 2017 and surpassed 50 % in 2021. In addition, female council membership in AORTIC has surpassed 50%, up to 69% in 2021. These trends suggest a rise in female leadership in cancer research and training on the continent, indicating that strengthening local platforms in LMIC may be associated with improved gender assimilation. [Table: see text]

Challenges faced by female oncologists in sub-Saharan Africa

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Background: Recent articles by ASCO and ESMO have identified challenges facing female oncologists in western contexts. The challenges female oncologists face in sub-Saharan Africa (SSA) have yet to be explored. This study was launched by the AORTIC Education and Training Committee to determine the most common and substantial challenges faced by female oncologists in SSA and identify potential solutions. Methods: A diverse panel of 32 female oncologists from 20 countries in SSA was recruited through professional and personal networks. Following an initial meeting to review terminology, a modified three-round Delphi process took place. Participants iteratively reviewed a list of previously identified challenges facing women in oncology in SSA and identified new challenges. The survey was conducted via REDCap, a secure-web-based software platform. Participants reflected on personal experiences or those of colleagues, and were asked to indicate their agreement with each listed challenge, as well as propose solutions. Descriptive statistics identified the most common challenges. Following the third survey, a focus group was held to enrich study data. A thematic analysis is being conducted on the focus group transcript to identify key themes, and a subsequent modified Delphi process is being executed to build consensus around potential solutions to identified challenges. Results: Response rates for the 3 modified Delphi rounds were 66%, 66%, and 53%. The challenge with the greatest agreement was, “pressure to maintain a work-family life balance and meet social obligations”. These were felt to be unique to women in SSA due to an extended family network with several responsibilities beyond the nuclear family. The next two top-scored challenges were “lack of female support and networks”, and “micro-aggressions” (Table). Conclusions: Female oncologists in SSA experience many of the challenges that have been previously identified by similar studies in other regions, with different degrees of perceived importance. Some challenges have a different lived experience for female oncologists in SSA. The second part of this study will include thematic analysis of the recent focus group and explore potential solutions to mitigate these challenges, which will add insight and potential paths forward to optimizing a diverse workforce in SSA.[Table: see text]

Social determinants of health: poverty, national infrastructure and investment

This case presentation of a 19-year-old Ethiopian woman diagnosed with nasopharyngeal carcinoma reveals the barriers the patient has to medical treatment, including poverty and a lack of national infrastructure. The patient lives a life of poverty, and the outcome of her illness is a result of her being unable to overcome barriers to accessing health care due to inability to afford transport, lodging and treatment. In this case, the patient's vulnerability to disease due to her poverty is not overcome because of lack of infrastructure. The infrastructure fails to develop because of inadequate investment and other delays in building. The end result is that the patient is vulnerable to disease. Her disease process impacts her family and their contribution to Ethiopia's development.