Delayed diagnostic evaluation of symptomatic breast cancer in sub-Saharan Africa: A qualitative study of Tanzanian women

Sakafu, Lulu Lunogelo; Philipo, Godfrey Sama; Malichewe, Christina; Fundikira, Lulu; Lwakatare, Flora; Loon, Katherine Van; Mushi, Beatrice; DeBoer, Rebecca; Bialous, Stella Aguinaga; Lee, Amie Y.

doi:10.1371/journal.pone.0275639

Cited by 13 publications

(8 citation statements)

References 32 publications

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“…Three-quarters (72.9%) of clients with con rmed malignant lesions had staging and with over half (59.25%) with a late diagnosis and were enrolled in palliative care without the ability for curative treatment. just like another study on late breast cancer diagnosis done in Tanzania found [41]. This might be attributed to the late identi cation of clients due to low overall screening in the district (only 11% of women 15-49 years by March 2022), leading to late diagnosis followed by late enrollment into the tumor board.…”

Section: Discussionmentioning

confidence: 87%

Implementation of a Cervical Cancer Tumor Board to optimize patient care and follow-up at a rural hospital in Malawi

Mphande,

Chiphaka,

Kapira

et al. 2023

Preprint

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Cervical cancer is Malawi's most diagnosed and highest mortality cancer. Due to a lack of screening, it is often diagnosed at an advanced stage. It has poor survival outcomes because treatment is not always available, patients are not quickly engaged in care and follow-up can be challenging for patients, especially those living far from a secondary facility. We set up a multidisciplinary team-based cervical cancer tumor board (CCTB) to better capture and care for clients at risk for cervical cancer and those with a new diagnosis. In February 2019, we initiated a monthly cervical cancer CCTB to enroll, review and discuss management for clients with suspected cervical cancer lesions. Specifically, we developed a cervical cancer registry to log suspects at Neno District Hospital. Our CCTB team members included cervical cancer screening providers, obstetrics and gynecology clinicians, and palliative care, laboratory, and community health workers representative. Any client with findings that required confirmation of cervical cancer diagnosis through a biopsy following cervical cancer screening was enrolled. Once enrolled, patients were followed continuously for final pathology results, treatment planning, and outcomes including referrals for surgeries and death. Between 1 February 2019, and 30 April 2021, an estimated 4,822 Visual Inspections with Acetic Acid (VIAs) were performed in the district. We enrolled 72 clients from those initial screenings with suspected cervical cancer. We found a high linkage to care for clients of 97%. All women enrolled in the CCTB had their results for biopsies available (100%). Total loss to care was very minimal at 2% for premalignant lesions. Out of the clients enrolled in CCTB, 39.8% (n = 37) had cervical cancer and among them, 73.0% were successfully staged. Cervical cancer-focused CCTB is an effective way to follow clients with suspected and diagnosed cervical cancer to ensure appropriate treatment and subsequent follow-up. We demonstrated that CCTB could be successfully implemented in rural Malawi at the district hospital level.

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Section: Discussionmentioning

confidence: 87%

Implementation of a Cervical Cancer Tumor Board to optimize patient care and follow-up at a rural hospital in Malawi

Mphande,

Chiphaka,

Kapira

et al. 2023

Preprint

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“…In some parts of the world, symptomatic presentation of breast cancer is the only way breast cancer is diagnosed (e.g., sub‐Saharan Africa and India) 35–37 . In Ontario, Canada, use of a dedicated breast assessment unit is associated with shorter time to diagnosis for patients with symptomatic breast cancer 38 .…”

Section: Discussionmentioning

confidence: 99%

“…[28][29][30] In a study conducted in 1991-1992, In some parts of the world, symptomatic presentation of breast cancer is the only way breast cancer is diagnosed (e.g., sub-Saharan Africa and India). [35][36][37] In Ontario, Canada, use of a dedicated breast assessment unit is associated with shorter time to diagnosis for patients with symptomatic breast cancer. 38 In the United Kingdom, symptomatic breast cancer units are part of the National Health Service clinic system with patients generally presenting with later stage breast cancer and different demographics from screened patients.…”

Section: Comparison To Other Studiesmentioning

confidence: 99%

Persistence of patient‐detected breast cancer over time: 1990–2019

Malmgren

Atwood

Kaplan

2023

Cancer

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BackgroundThe continued presentation of patient‐detected breast cancer (BC) and associated characteristics over time is understudied.MethodsIn a large institutional cohort of first primary stage 0–IV patients with BC in 1990–2019 (n = 15,827), diagnostic method (patient‐detected [PtDBC] [n = 5844]; mammography‐detected [MamDBC] [nondiagnostic] [n = 9248]; and physician‐detected [PhysDBC] [n = 736]) and patient and tumor characteristics including age, race, TNM stage, and hormone‐receptor status were reviewed. Pearson χ2 tests for bivariate comparisons and logistic regression for patient detection–associated factors were used.ResultsIn a cohort from 1990 to 2019, the proportion aged 50–74 years (55%–63%; p < .001) and non‐White race (9%–37%; p < .001) increased over time. Percentage PtDBC decreased over time but case numbers increased (1990–1999: 44% [n = 1399]; 2010–2019: 34% [n = 2349]; p < .001). Excluding stage 0, PtDBC declined from 47% to 41% over time (p < .001). In 2010–2019, 21% of cases were stage 0, 91% of which were mammography detected (n = 1439). Seventy percent of patient‐detected cases were stage II–IV (stage II, 44%; stage III, 20%; stage IV, 6%; p < .001). In adjusted logistic regression, the odds of PtDBC decreased over time (2000–2009: odds ratio [OR], .65 [95% CI, .58–.72]; 2010–2019: OR, .54 [95% CI, .49–.60]), with age <40 years OR, 15.81, and Black and non‐White other at 50% increased risk.ConclusionsThe relative proportion of PtDBC decreased to a constant 34%–40% of total cases after 1990–1999. PtDBC case numbers increased in subsequent years (2000–2019), and were consistently higher stage. Interval cancers, mammography‐screening uptake, breast health awareness of age groups outside screening guidelines, and underserved socioeconomic groups may be related to the continued significant PtDBC incidence.Plain Language Summary After decades of mammography‐screening availability, symptomatic patient‐detected breast cancer declined over time from 44% to a persistent rate of 34% in our institutional cohort. The persistence of patient‐detected breast cancer over time presents a difficult situation for patients and care givers without clear diagnosis pathways for younger and older women outside recommended screening guidelines, who often present with higher stage and more lethal characteristics. More timely diagnosis and treatment including breast health awareness, prompt presentation of breast problems, outreach to younger age and minority groups, and provision of specialized training and care delivery for symptomatic patient‐detected breast cancer are needed.

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“…According to WHO, breast cancer is the most frequent cancer among women, impacting 2.1 million women each year, and causes the greatest number of cancer-related deaths among women [6]. Approximately half of all women diagnosed with breast cancer in Tanzania die of the disease [7] and approximately 80% of women diagnosed with breast cancer in Tanzania happen at advanced stages (III or IV), when treatment is less effective and outcomes are poor [4,5]. It is predicted that by 2030, new breast cancer cases will increase by 82% [4,5].…”

Section: Introductionmentioning

confidence: 99%

Profiling of Breast Cancer Prevalence and Its Diagnosis using Varied Imaging Techniques in Tanzania

Mzurikwao,

Sakafu,

Mayala

et al. 2024

Preprint

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Breast cancer is not only the most commonly occurring cancer among women, but also the most frequent cause of the cancer-related deaths in women in developing countries. Mortality rate is marginally higher in developing countries than in developed countries with about 60% of the death occurring in developing countries. In Tanzania for example, breast cancer is the second leading cancer in terms of incidence and mortality among women after cervical cancer. Approximately half of all women diagnosed with breast cancer in Tanzania die of the disease. This is due to poor and shortage of medical facilities for cancer screening and diagnosis, poor number of oncologists and pathologists, and the diagnosis costs in the country. Due to the mentioned factors, it is approximated that, 80% of breast cancer cases in in Tanzania are diagnosed at advanced stages (III or IV), when treatment is less effective, and outcomes are poor. By 2030, new breast cancer cases are approximated to increase by 82% in Tanzania. The diagnosis/screening of breast cancer starts with breast imaging with ultrasound and mammograms. Suspected cases are then subjected into pathology for confirmatory tests. Although breast imaging plays a major role in both breast cancer screening and diagnosis, the service is largely not available in many developing countries. Our study found absence of routinely breast cancer screening in Tanzania, resulting in late-stage detection of many cases. This is mainly due to lack of enough well-trained radiologists to read the images and the costs of the process. This study aimed at exploring the role and challenges of breast imaging in the screening and diagnosis of breast cancer in Tanzania, a developing country. Our results found that, there is a significant number of malignancies under the recommended age of breast cancer screening of fifty (50) years of age. Our study also found a very high Inter variability among radiologists, which suggest the necessity of at least two radiologists reading same case before conclusion of the diagnosis. This study also discovered in our sample size that 66% patients did not have their samples taken for confirmation by the pathologists. This might be due to the costs of the process or loss of follow ups as many patients came far from diagnosis Centre. Due to the challenges observed in breast imaging, this study recommends the use of Computer Aided Diagnosis (CAD) with Artificial Intelligence to assist the few numbers of radiologists available.

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Delayed diagnostic evaluation of symptomatic breast cancer in sub-Saharan Africa: A qualitative study of Tanzanian women

Cited by 13 publications

References 32 publications

Implementation of a Cervical Cancer Tumor Board to optimize patient care and follow-up at a rural hospital in Malawi

Implementation of a Cervical Cancer Tumor Board to optimize patient care and follow-up at a rural hospital in Malawi

Persistence of patient‐detected breast cancer over time: 1990–2019

Profiling of Breast Cancer Prevalence and Its Diagnosis using Varied Imaging Techniques in Tanzania

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