ObjectiveTo evaluate medical resource utilisation and timeliness of access to specific aspects of a standard care pathway for breast cancer at tertiary centres in sub-Saharan Africa.DesignData were retrospectively abstracted from records of patients with breast cancer treated within a prespecified 2-year period between 2014 and 2017. The study protocol was approved by local institutional review boards.SettingSix tertiary care institutions in Ghana, Kenya and Nigeria were included.ParticipantsHealth records of 862 patients with breast cancer were analysed: 299 in Ghana; 314 in Kenya; and 249 in Nigeria.InterventionsAs directed by the treating physician.Outcome measuresParameters selected for evaluation included healthcare resource and use, medical procedure turnaround times and out-of-pocket (OOP) payment patterns.ResultsUse of mammography or breast ultrasonography was <45% in all three countries. Across the three countries, 78%–88% of patients completed tests for hormone receptors and human epidermal growth factor receptor 2 (HER2). Most patients underwent mastectomy (64%–67%) or breast-conserving surgery (15%–26%). Turnaround times for key procedures, such as pathology, surgery and systemic therapy, ranged from 1 to 5 months. In Ghana and Nigeria, most patients (87%–93%) paid for diagnostic tests entirely OOP versus 30%–32% in Kenya. Similarly, proportions of patients paying OOP only for treatments were high: 45%–79% in Ghana, 8%–20% in Kenya and 72%–89% in Nigeria. Among patients receiving HER2-targeted therapy, the average number of cycles was five for those paying OOP only versus 14 for those with some insurance coverage.ConclusionsPatients with breast cancer treated in tertiary facilities in sub-Saharan Africa lack access to timely diagnosis and modern systemic therapies. Most patients in Ghana and Nigeria bore the full cost of their healthcare and were more likely to be employed and have secondary or postsecondary education. Access to screening/diagnosis and appropriate care is likely to be substantively lower for the general population.

6562 Background: Breast cancer is the most frequently diagnosed malignancy and the most common cause of cancer-related death in women in Ghana, Kenya, and Nigeria. We evaluated healthcare resource use and financial burden for patients treated at tertiary cancer centers in these countries. Methods: Records of breast cancer patients treated at the following government/private tertiary centers were included – Ghana: Korle-Bu Teaching Hospital and Sweden Ghana Medical Centre; Kenya: Kenyatta National Hospital and Aga Khan University Hospital; Nigeria: National Hospital Abuja and Lakeshore Cancer Center. Patients presenting within a prespecified 2-year period were followed until death or loss to follow-up. Results: The study included 299 patient records from Ghana, 314 from Kenya, and 249 from Nigeria. The use of common screening modalities (eg, mammogram, breast ultrasound) was < 45% in all 3 countries. Use of core needle biopsy was 76% in Kenya and Nigeria, but only 50% in Ghana. Across the 3 countries, 91-98% of patients completed blood count/chemistry, whereas only 78-88% completed tests for hormone receptor and human epidermal growth factor receptor 2 (HER2). Most patients underwent surgery: mastectomy (64-67%) or breast-conserving Most patients in Ghana and Nigeria (87-93%) paid for their diagnostic tests entirely out of pocket (OOP) compared with 30-32% in Kenya. Similar to diagnostic testing, the proportion of patients paying OOP only for treatments was high: 72-89% in Nigeria, 45-79% in Ghana, and 8-20% in Kenya. Among those receiving HER2-targeted therapy, average number of cycles was 5 for patients paying OOP only vs 14 for patients with some level of insurance coverage. Conclusions: Patients treated in tertiary facilities in sub-Saharan African countries lack access to common imaging modalities and systemic therapies. Most patients in Ghana and Nigeria bore the full cost of their breast cancer care, suggestive of privileged financial status. Access to screening/diagnosis and appropriate care is likely to be substantively lower for the general population.

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Introduction breast cancer is the commonest malignant disease in Ghanaian women and accounts for 17% of cancer-related deaths in the country. It has been classified into molecular subtypes depending on the presence or absence of hormone receptors and the human epidermal growth factor receptor 2. Computed tomography is often the preferred modality for monitoring metastatic disease due to its ability to determine the extent of local and metastatic disease. Methods this was a retrospective study conducted at Sweden Ghana Medical Centre (SGMC). Hospital records and chest and abdominal computed tomography (CT) scan images of breast cancer patients who had been managed at SGMC between June 2016 and August 2019 were used to document age, gender, histological group, type of surgical intervention done, molecular subtypes of the disease and imaging findings. Microsoft Excel 2016 and SPSS version 20.0 were used to summarise the data obtained into tables, charts and to test for significant associations. Results the most common site of breast cancer metastasis was lymph nodes. The three commonest sites of distant metastases were the lung seen in 44 patients (55.3%), bone in 37 patients (44.6%) and liver in 33 patients (39.8%). Chi square test for association between the molecular subtypes of the breast cancer and proportion of patients that showed a particular type of metastases revealed that, the differences noted for lung, pleural and cardiac metastases were statistically significant, that for bone and liver were not. Conclusion breast cancer commonly metastasised to lymph nodes, lung, bone, liver, pleura and heart in descending order. The commonest CT patterns for metastases were multiple nodules for lung, effusion for pleura and heart and osteolytic lesions for bone.