Educational Opportunities for Down-Staging Breast Cancer in Low-Income Countries: an Example from Tanzania

Yang, Kristen; Msami, Khadija; Calixte, Rose; Mwaiselage, Julius; Dorn, Joan M.; Soliman, Amr S.

doi:10.1007/s13187-019-01587-2

Cited by 13 publications

(12 citation statements)

References 24 publications

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“…Misdiagnosis is often attributed to poor knowledge and lack of health workers training about breast cancer; most health workers provided incorrect information to patients [ 24 , 29 , 31 , 34 , 41 ]. For instance, in one study, women reported that some of the health workers were unable to examine them appropriately [ 24 ].…”

Section: Resultsmentioning

confidence: 99%

Health system factors that influence diagnostic and treatment intervals in women with breast cancer in sub-Saharan Africa: a systematic review

et al. 2021

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Background Breast cancer patients in sub-Saharan Africa experience long time intervals between their first presentation to a health care facility and the start of cancer treatment. The role of the health system in the increasing treatment time intervals has not been widely investigated. This review aimed to identify existing information on health system factors that influence diagnostic and treatment intervals in women with breast cancer in sub-Saharan Africa to contribute to the reorientation of health policies in the region. Methods PubMed, ScienceDirect, African Journals Online, Mendeley, ResearchGate and Google Scholar were searched to identify relevant studies published between 2010 and July 2020. We performed a qualitative synthesis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Related health system factors were extracted and classified according to the World Health Organization’s six health system building blocks. The quality of qualitative and quantitative studies was assessed by using the Critical Appraisal Skills Program Quality-Assessment Tool and the National Institute of Health Quality Assessment Tool, respectively. In addition, we used the Confidence in the Evidence from Reviews of Qualitative Research tool to assess the evidence for each qualitative finding. Results From 14,184 identified studies, this systematic review included 28 articles. We identified a total of 36 barriers and 8 facilitators that may influence diagnostic and treatment intervals in women with breast cancer. The principal health system factors identified were mainly related to human resources and service delivery, particularly difficulty accessing health care, diagnostic errors, poor management, and treatment cost. Conclusion The present review shows that diagnostic and treatment intervals among women with breast cancer in sub-Saharan Africa are influenced by many related health system factors. Policy makers in sub-Saharan Africa need to tackle the financial accessibility to breast cancer treatment by adequate universal health coverage policies and reinforce the clinical competencies for health workers to ensure timely diagnosis and appropriate care for women with breast cancer in this region.

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Section: Resultsmentioning

confidence: 99%

Health system factors that influence diagnostic and treatment intervals in women with breast cancer in sub-Saharan Africa: a systematic review

et al. 2021

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“…This shows that patients in our region have an advanced disease at the time of diagnosis compared to Caucasian patients or patients from developed regions of the world. It should prompt action on health education and promotion of screening programmes in Northern Tanzania as this has been proven to be effective for earlier presentation of BC patients [ 50 ].…”

Section: Discussionmentioning

confidence: 99%

Clinicopathological characteristics of breast cancer patients from Northern Tanzania: common aspects of late stage presentation and triple negative breast cancer

Gnanamuttupulle¹,

Henke²,

Ntundu³

et al. 2021

ecancer

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Purpose: Breast cancer (BC) is the second most common cancer among Tanzanian women. Oestrogen (ER), progesterone and human epidermal growth factor receptor 2 play major roles in prognosis and treatment but data for Tanzania are sparse. This study aimed to determine these patterns and histological types, tumour grading and staging of BC patients in northern Tanzania for a better understanding of BC in the Sub-Saharan African (SSA) setting. Methods:A cross-sectional study recorded newly diagnosed BC cases at Kilimanjaro Christian Medical Centre between October 2018 and March 2019. Receptor status, histological types and grade, clinical stage and socio-demographic were recorded and descriptive and bivariate analyses performed.Results: 116 patients were enrolled. Median age was 53 years, 71.6% were ≥45 years. The commonest molecular subtype was triple negative breast cancer (TNBC) (n = 33; 28.4%). One hundred and two (87.9%) patients had invasive ductal carcinoma (IDC), poorly differentiated tumours (60; 51.7%) and clinical stage III disease (62; 53.0%). ER negative tumours were associated with poorly differentiated histological grade (relative risk (RR): 1.34 (0.87-2.07)), tumour size > 5 cm (RR: 1.67 (0.33-8.35)) and IDC (RR: 3.35 (0.56-20.23)). Clinical stages III & IV (odds ratio (OR): 1.64 (0.63-4.24)) were associated with hormone receptor (HR) negative tumours and metastasis (OR: 1.60 (0.68-3.74)) with TNBC. 18% of the patients reported about first-degree relatives with BC.Conclusions: Most patients presented in advanced stages and TNBC in their menopause. HR negative tumours were associated with poor histological differentiation and IDC. The high percentage of positive family history of BC and the differences in receptor patterns compared to other parts of the world should urge further genetic research on BC in SSA.

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“…Misdiagnosis is often attributed to poor knowledge and lack of health workers training about breast cancer; most health workers provided incorrect information to patients [30,32,35,41]. Some of them were unable to examine the patient appropriately [25].…”

Section: Poor Knowledge and Skillsmentioning

confidence: 99%

“…Logistical di culties included different waiting times for an appointment (medical or specialist consultation), investigations (imaging, biopsy), test results, referral or treatment (surgery, radiotherapy) [23][24][25][26][27][28][29][30][31]. A long waiting time for test results, more speci cally for the biopsy results, was a factor in uencing the time to treatment in 11 included studies [24,[26][27][28][29][30][32][33][34][35][36]. Seven included studies reported that referral was delayed for women who had visited other health facilities 1 to 4 times or more before visiting the diagnostic centre [23,24,30,[36][37][38][39].…”

Section: Health Service Deliverymentioning

confidence: 99%

Health System Factors That Influence Treatment Delay in Women With Breast Cancer in Sub-saharan Africa: A Systematic Review

Gbenonsi

Boucham

Belrhiti

et al. 2021

Preprint

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BackgroundBreast cancer patients in sub-Saharan Africa experience long delays between their first presentation to a health care facility and the start of cancer treatment. The role of the health system in the increasing delays in treatment has not been widely investigated. This review aimed to identify existing information on health system factors that influence treatment delays in women with breast cancer in sub-Saharan Africa to contribute to the reorientation of health policies in the region.MethodsPubMed, ScienceDirect, African Journals Online, Mendeley, ResearchGate and Google Scholar were searched to identify relevant studies published between 2010 and July 2020. We performed a qualitative synthesis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Related health system factors were extracted and classified according to the World Health Organization’s six health system building blocks. The quality of qualitative and quantitative studies was assessed by using the Critical Appraisal Skills Program quality-assessment tool and the National Institute of Health Quality Assessment Tool, respectively. In addition, we used the Confidence in the Evidence from Reviews of Qualitative Research tool to assess the evidence for each qualitative finding.ResultsFrom 14,184 identified studies, this systematic review included 28 articles. We identified a total of 36 barriers and 8 facilitators that may influence treatment delay in women with breast cancer. The principal health system factors identified were mainly related to human resources and service delivery, particularly difficulty accessing health care, diagnostic errors, poor management, and treatment cost.ConclusionThe present review shows that treatment delay among women with breast cancer in sub-Saharan Africa is influenced by many related health system factors. Policy makers in sub-Saharan Africa need to tackle the financial accessibility to breast cancer treatment by adequate universal health coverage policies and reinforce the clinical competencies for health workers to ensure timely diagnosis and appropriate care for women with breast cancer in this region.

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Educational Opportunities for Down-Staging Breast Cancer in Low-Income Countries: an Example from Tanzania

Cited by 13 publications

References 24 publications

Health system factors that influence diagnostic and treatment intervals in women with breast cancer in sub-Saharan Africa: a systematic review

Health system factors that influence diagnostic and treatment intervals in women with breast cancer in sub-Saharan Africa: a systematic review

Clinicopathological characteristics of breast cancer patients from Northern Tanzania: common aspects of late stage presentation and triple negative breast cancer

Health System Factors That Influence Treatment Delay in Women With Breast Cancer in Sub-saharan Africa: A Systematic Review

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