scholarly journals Understanding Breast Cancer and Improving Outcomes in Malawi

2018 ◽  
Vol 4 (Supplement 3) ◽  
pp. 49s-49s
Author(s):  
Takondwa Zuze ◽  
Tamiwe Tomoka ◽  
Ruth Nyirenda ◽  
Richard Nyasosela ◽  
Ryan Seguin ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Cancer Treatment ◽  
Radical Mastectomy ◽  
Sub Saharan Africa ◽  
Hiv Positive ◽  
Modified Radical Mastectomy ◽  
Term Survival ◽  
Sub Saharan

Purpose Despite the increasing breast cancer burden in sub-Saharan Africa, outcomes are suboptimal as a result of limited screening, limited diagnostic infrastructure, advanced stage, and limited treatment availability. In Malawi, we established the first prospective cohort of patients with breast cancer to comprehensively and longitudinally describe breast cancer in this environment. Methods Since December 2016, we have been enrolling patients with pathologically confirmed breast cancer at Kamuzu Central Hospital in Lilongwe, Malawi. All patients receive standardized baseline and follow-up evaluations and treatment that is consistent with National Comprehensive Cancer Network harmonized guidelines for sub-Saharan Africa. Results From December 2016 to May 2018, 70 women with breast cancer were enrolled. The median age was 48 years (range, 21 to 78 years) and 16 patients (23%) were HIV positive. Of 63 patients who could be formally staged, 54 (86%) had stage III and IV disease, including 40 (63%) with T4 tumors, 50 (79%) with at least N1, and 19 (30%) with distant metastases. Of 65 tumors histologically graded, 30 (46%) were grade 3 and 22 (34%) were grade 2. Of 66 biopsies evaluated, 31 (47%) were estrogen or progesterone receptor positive. Fifty biopsies were additionally evaluated for human epidermal growth factor receptor 2, of which 12 (22%) were positive and 15 (30%) triple negative. Thirty-nine women (56%) received curative-intent treatment, including eight with modified radical mastectomy followed by adjuvant chemotherapy, and 31 with neoadjuvant chemotherapy followed by modified radical mastectomy for localized bulky disease that was initially felt to be unresectable. Adjuvant/neoadjuvant chemotherapy was typically administered as doxorubicin plus cyclophosphamide. Twenty-five patients (36%) received palliative-intent chemotherapy, typically with single-agent paclitaxel. Six patients (9%) received no cancer treatment, with two patients dying before chemotherapy and four refusing cancer treatment. Median follow-up time was 7.8 months and overall survival was 88% at 12 months (95% CI, 76% to 96%) with no significant differences between HIV-positive and HIV-negative women ( P = .198). Conclusion Women at a national teaching hospital in Lilongwe, Malawi, presented with young age and advanced, bulky, high-risk breast cancer, but short-term survival was good in the context of a structured treatment program. Continued improvements for this population are needed for all aspects of the care cascade, including early detection, diagnosis, treatment, and palliation, to improve outcomes further. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . No COIs from the authors.

scholarly journals Inequities in breast cancer treatment in sub-Saharan Africa: findings from a prospective multi-country observational study

2019 ◽  
Vol 21 (1) ◽  
Author(s):  
Milena Foerster ◽  
Benjamin O. Anderson ◽  
Fiona McKenzie ◽  
Moses Galukande ◽  
Angelica Anele ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Observational Study ◽  
Cancer Treatment ◽  
Breast Cancer Treatment ◽  
Sub Saharan Africa ◽  
Sub Saharan

scholarly journals Follow-up of Breast Cancer Patients in Ghana: Challenges to Community-based Surveillance

2015 ◽  
Vol 7 (1) ◽  
Author(s):  
Dennis O. Laryea ◽  
Baffour Awuah ◽  
Yaw A. Amoako ◽  
Samuel Mensah ◽  
Fred K. Awittor
Keyword(s):  
Breast Cancer ◽  
Cancer Control ◽  
Sub Saharan Africa ◽  
Quality Data ◽  
Cancer Registration ◽  
Breast Cancer Patients ◽  
Control Programmes ◽  
Control And Prevention ◽  
Sub Saharan

Cancer-related deaths have been projected to increase in sub-Saharan Africa. Cancer control programmes require good quality data in order to provide information for planning and implementing cancer control and prevention activities. Cancer registration and follow-up of cancer cases to estimate survival are useful tools in cancer control programmes. We followed up 136 cases of breast cancer diagnosed from the year 2006 to 2008. The majority of cases (62.5%) could not be reached either by phone or at the residential address indicated in the folders. We recommend a strengthened system of demographic information collection on cases for effective surveillance.

Breast cancer survival in rural sub-Saharan Africa

2020 ◽  
Author(s):  
Paddy Ssentongo ◽  
John Oh ◽  
Forster Amponsah ◽  
William Wong ◽  
Xavier Candela ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Survival Rate ◽  
Low Income ◽  
Significant Proportion ◽  
Sub Saharan Africa ◽  
Lymph Node Status ◽  
Overall Survival Rate ◽  
Sub Saharan

Abstract INTRODUCTION: Five-year overall survival rate of breast cancer in low-income countries (LICs) is significantly lower than in high-resource countries. In this study, we explored clinical and pathological factors influencing mortality in a rural community setting in sub-Saharan Africa. METHODS: We performed a retrospective medical review of patients undergoing surgery and chemotherapy for breast cancer at a regional hospital in Ghana from January 2014 through January 2017. Descriptive and survival analysis was done. RESULTS: One hundred and twenty-nine patients were included in the study. The median age at presentation was 51 years. 60.0% of patients presented with poorly differential histological grade III. The most common histological type was invasive ductal carcinoma (83%). Based on assessment of stage using only tumor size and lymph node status, 60% presented at stage 3. Only 25% were tested for hormone receptor proteins and HER2 status. Of these, 57% had triple-negative breast cancer (TNBC). The 3-year overall survival rate was only 52%. A significant proportion of the patients (46%) were lost to follow-up. CONCLUSIONS: The cumulative 3-year survival was 52 %. Despite success in the reduction of cancer mortality in southern and northern Africa, survival in the rural communities of sub-Saharan Africa remains poor. A significantly higher percentage of GIII and TNBC is found in breast cancers seen in Ghana. Late-stage presentation, when combined with limited capacity for accurate diagnosis, cancer subtype analysis, adequate therapy and follow-up, leads to poor outcomes. Future studies should emphasize identification of barriers to care and opportunities for cost-effective and sustainable improvements in the diagnosis and treatment of breast cancer in LICs.

scholarly journals Integrated IMRT vs segmented 3D-CRT of the chest wall and supraclavicular region for Breast Cancer after modified Radical Mastectomy: An 8-year follow-up

2021 ◽  
Vol 12 (5) ◽  
pp. 1548-1554
Author(s):  
Yutian Zhao ◽  
Jiahao Zhu ◽  
Xiaojun Zhang ◽  
Gang Wu ◽  
Yu Xu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Chest Wall ◽  
Radical Mastectomy ◽  
Modified Radical Mastectomy ◽  
3D Crt

scholarly journals Establishing Cohorts to Generate the Evidence Base to Reduce the Burden of Breast Cancer in Sub-Saharan Africa: Results From a Feasibility Study in Kenya

2019 ◽  
pp. 1-10
Author(s):  
Sujha Subramanian ◽  
Robai Gakunga ◽  
Madeleine D. Jones ◽  
Asaph Kinyanjui ◽  
Emily Ochieng' ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Cancer Risk ◽  
Cancer Risk ◽  
Cohort Studies ◽  
Socioeconomic Factors ◽  
Sub Saharan Africa ◽  
Short Term ◽  
Cancer Symptoms ◽  
Sub Saharan

PURPOSE By 2025, Kenya is estimated to experience a two-thirds increase in the incidence of breast cancer. Local research is necessary to generate evidence to inform policy, public health, and medical practice. There have been no longitudinal cohort studies in sub-Saharan Africa of women with and without breast cancer. Our aim is to assess the feasibility of conducting cohort studies in Kenya that consider clinical characteristics, socioeconomic factors, and self-care behaviors. METHODS We initiated a short-term follow-up cohort study of women with and without a diagnosis of breast cancer with baseline face-to-face data collection and one follow-up interview (at approximately 3 months by telephone). We developed tailored instruments to capture demographics, socioeconomic factors, breast cancer risk, ability to identify breast cancer symptoms, treatments received for breast cancer, and quality of life of survivors. RESULTS We recruited 800 women between the ages of 20 and 60 years and successfully collected baseline data. Completeness of the data was high for demographic variables, but there was a larger proportion of missing information for specific variables required for assessing breast cancer risk. Respondents were able to complete standardized instruments to assess breast cancer knowledge among those without breast cancer and identification of symptoms among survivors. We were able to successfully contact approximately 80% of the participants for follow-up. CONCLUSION This short-term follow-up study provides evidence that women can be successfully tracked and contacted for follow-up in the Kenyan setting and offers lessons to establish future longitudinal cohorts to identify approaches to improve breast cancer outcomes.

scholarly journals Few Losses to Follow-up in a Sub-Saharan African Cancer Cohort via Active Mobile Health Follow-up

2020 ◽  
Vol 189 (10) ◽  
pp. 1185-1196 ◽  
Author(s):  
Milena Foerster ◽  
Angelica Anele ◽  
Charles Adisa ◽  
Moses Galukande ◽  
Groesbeck Parham ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Median Time ◽  
Mobile Health ◽  
Cancer Survival ◽  
Controlled Trial ◽  
Cancer Control ◽  
Sub Saharan Africa ◽  
Next Of Kin ◽  
Sub Saharan

Abstract Accurate survival estimates are needed for guiding cancer control efforts in sub-Saharan Africa, but previous studies have been hampered by unknown biases due to excessive loss to follow-up (LTFU). In the African Breast Cancer—Disparities in Outcomes Study, a prospective breast cancer cohort study, we implemented active mobile health follow-up, telephoning each woman or her next-of-kin (NOK) trimonthly on her mobile phone to update information on her vital status. Dates of every contact with women/NOK were analyzed from diagnosis in 2014–2017 to the earliest of September 1, 2018, death, or 3 years postdiagnosis. The cumulative incidence of being LTFU was calculated considering deaths as competing events. In all, 1,490 women were followed for a median of 24.2 (interquartile range (IQR), 14.2–34.5) months, corresponding to 8,529 successful contacts (77% of total contacts) with the women/NOK. Median time between successful contacts was 3.0 (IQR, 3.0–3.7) months. In all, 71 women (5.3%) were LTFU at 3 years: 0.8% in Nigeria, 2.2% in Namibia, and 5.6% in Uganda. Because of temporary discontinuity of active follow-up, 20.3% of women were LTFU after 2 years in Zambia. The median time to study notification of a death was 9.1 (IQR, 3.9–14.0) weeks. Although the present study was not a randomized controlled trial, in this cancer cohort with active mobile health follow-up, LTFU was much lower than in previous studies and enabled estimation of up-to-date and reliable cancer survival.

scholarly journals Quality of Breast Cancer Treatment at a Rural Cancer Center in Rwanda

2018 ◽  
pp. 1-11 ◽  
Author(s):  
Daniel S. O’Neil ◽  
Nancy L. Keating ◽  
Jean Marie V. Dusengimana ◽  
Vedaste Hategekimana ◽  
Aline Umwizera ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Endocrine Therapy ◽  
Early Stage ◽  
Locally Advanced ◽  
Sub Saharan Africa ◽  
Cancer Center ◽  
Incidence And Mortality ◽  
Sub Saharan

Purpose As breast cancer incidence and mortality rise in sub-Saharan Africa, it is critical to identify strategies for delivery of high-quality breast cancer care in settings with limited resources and few oncology specialists. We investigated the quality of treatments received by a cohort of patients with breast cancer at Butaro Cancer Center of Excellence (BCCOE), Rwanda’s first public cancer center. Patients and Methods We reviewed medical records of all female patients diagnosed with invasive breast cancer at BCCOE between July 2012 and December 2013. We evaluated the provision of chemotherapy, endocrine therapy, surgery, and chemotherapy dose densities. We also applied modified international quality metrics and estimated overall survival using interval-censored analysis. Results Among 150 patients, 28 presented with early-stage, 64 with locally advanced, and 53 with metastatic disease. Among potentially curable patients (ie, those with early-stage or locally advanced disease), 74% received at least four cycles of chemotherapy and 63% received surgery. Among hormone receptor–positive patients, 83% received endocrine therapy within 1 year of diagnosis. Fifty-seven percent of potentially curable patients completed surgery and chemotherapy and initiated endocrine therapy if indicated within 1 year of biopsy. Radiotherapy was not available. At the end of follow-up, 62% of potentially curable patients were alive, 24% were dead, and 14% were lost to follow-up. Conclusion Appropriate delivery of chemotherapy and endocrine therapy for breast cancer is possible in rural sub-Saharan African even without oncologists based on site. Performing timely surgery and ensuring treatment completion were key challenges after the opening of BCCOE. Further investigation should examine persistent quality gaps and the relationship between treatment quality and survival.

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