An update on the management of breast cancer in Africa

Vanderpuye, Verna; Grover, Surbhi; Hammad, Nazik; Prabhakar, Pooja; Simonds, Hannah; Olopade, Funmilayo; Stefan, Daniela Cristina

doi:10.1186/s13027-017-0124-y

Cited by 134 publications

(151 citation statements)

References 106 publications

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“…[2,6] In Rwanda, Pace and colleagues recently discovered that the median delay to treatment was 15 months and delays of ≥6 months were significantly associated with more advanced-stage cancer. [6] Over the past two decades, several older studies documented an early-age onset of breast cancer in Africa, [7] which provides support for recent findings in Rwanda indicating the median age of 49 years at time of diagnosis. [6] In the US, the median age is 62 years and less than five percent are diagnosed younger than 40 years of age.…”

Section: Introductionmentioning

confidence: 56%

Breast cancer awareness: survey of participants at annual walk in Kigali

Bahumura¹,

Murekezi²,

Sego³

et al. 2018

Rwanda Journal of Medicine and Health Sciences

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Background: Breast cancer is the leading cause of cancer death in low-income countries and the second leading cause in high-income countries. Most women in sub-Saharan Africa are diagnosed later, with limited access to timely and effective treatment. Objectives: The main objective was to identify the awareness of breast cancer warning signs among participants attending the 2016 Breast Cancer Awareness Walk. Methods: A cross-sectional study of 93 participants was conducted after the Annual Breast Cancer Awareness Walk in Kigali on 23 October 2016. Participants, 15 years or older, completed the survey. Data were analyzed using descriptive statistics and Chi-square test. Results: The breast cancer warning sign "breast lump" was identified by over half of the women (54%) and many men (41%), though the majority (70%) did not know that the lump could be painless. The majority of participants were unaware of the many other breast cancer signs, and that the risk increases with age. Three potential barriers to delay seeking healthcare for a serious breast problem included lack of insurance or money to pay, difficulty to make appointment with doctor, and fear of removal of breast. Conclusion: Increased public awareness and early detection is imperative to help reduce the morbidity and mortality related to breast cancer in Rwandan women and men.

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Section: Introductionmentioning

confidence: 56%

Breast cancer awareness: survey of participants at annual walk in Kigali

Bahumura¹,

Murekezi²,

Sego³

et al. 2018

Rwanda Journal of Medicine and Health Sciences

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“…There is often extreme burden leading to delayed treatment. Moreover, frequent interruption of radiotherapy treatments due to the costs of traveling for therapy can be significant (30,31). Progressive introduction of shortened radiotherapy regimens like the one proposed in this study may effectively contribute to improved compliance and access to adjuvant breast cancer radiotherapy in areas with limited radiotherapy facilities.…”

Section: Discussionmentioning

confidence: 96%

Hypofractionated Whole Breast Radiotherapy with Simultaneous Integrated Boost Following Breast Conservative Surgery for Early Breast Cancer

Eldesoky

Elshahat

Eskander

et al. 2020

Benha Medical Journal

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Background: Hypofractionated whole breast radiotherapy (HF-WBRT) showed comparable efficacy and safety to conventional fractionated radiotherapy. Dose and fractionation of the tumor bed boost to be integrated during HF-WBRT schedules is still to be determined. Aim: to investigate the clinical feasibility of HF-WBRT with simultaneous integrated boost (SIB), in early breast cancer patients who underwent breast conserving surgery (BCS). Methods: This single arm prospective study included 40 female patients with pathologically proven stage I-II breast cancer following BCS with high risk factors. Patients received 3D conformal radiotherapy (3DCRT) with field in field (FIF) technique. The whole breast received a dose of 40 gray (Gy) over 15 fractions for 3 weeks with an additional SIB dose of 8 Gy over 15 fractions to be give daily during WBRT. Radiation toxicities were graded using the common terminology criteria for adverse events (NCI-CTCAE) scale version 4.03. Cosmetic outcome was assessed using Harvard cosmetic score.Kaplan Meier method was used to estimate the 3-year disease free (DFS) and overall survival (OS). Results: The median age at presentation was 48 years (range 33-68). No reported grade 3 or 4 toxicities. Grade 1 and 2 radiation dermatitis affected 80% of the patients, breast pain was observed in 62.5% of the patients while 25% had radiation pneumonitis.Most of the patients (95%) had excellent and good cosmetic outcomes. At 3 years the estimated DFS was 95% and OS was 97.5 %. Conclusion: WBRT-SIB using 3DCRT with FIF technique is clinically feasible for early stage breast cancer patients.

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“…The lack of reliable hormone receptor status assessment in LMICs hampers the optimal selection of endocrine interventions, and this results in a significant proportion of patients receiving chemotherapy instead of lower toxicity (and potentially more effective) endocrine therapy. Given that more than half of African breast cancers are hormone receptor positive and given the relative ease of administering oral therapies in comparison with other systemic treatments, the role of endocrine therapy and hormone receptor testing warrants careful examination in all resource settings 34 . Thus, one priority in the implementation of systemic therapy is represented by reliable tumor marker assessment to correctly determine the biology of the disease (primarily estrogen receptor and HER2) to allow appropriate selection of patients for endocrine therapy versus chemotherapy treatment as well as HER2 therapies when available.…”

Section: Multimodality Breast Cancer Treatment In Lmicsmentioning

confidence: 99%

Breast cancer treatment: A phased approach to implementation

Mutebi

Anderson

Duggan

et al. 2020

Cancer

106

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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. Cancer 2020;126:2365-2378.

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An update on the management of breast cancer in Africa

Cited by 134 publications

References 106 publications

Breast cancer awareness: survey of participants at annual walk in Kigali

Breast cancer awareness: survey of participants at annual walk in Kigali

Hypofractionated Whole Breast Radiotherapy with Simultaneous Integrated Boost Following Breast Conservative Surgery for Early Breast Cancer

Breast cancer treatment: A phased approach to implementation

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