Pregnancy-associated breast cancer in rural Rwanda: the experience of the Butaro Cancer Center of Excellence

Abstract

BackgroundBreast cancer is the most common malignancy encountered during pregnancy. However, the burden of pregnancy-associated breast cancer (PABC) and subsequent care is understudied in sub-Saharan Africa (SSA). Here, we describe the characteristics, diagnostic delays and treatment of women with PABC seeking care at a rural cancer referral facility in Rwanda.MethodsData from female patients aged 18–50 years with pathologically confirmed breast cancer who presented for treatment between July 1, 2012 and February 28, 2014 were retrospectively reviewed. PABC was defined as breast cancer diagnosed in a woman who was pregnant or breastfeeding. Numbers and frequencies are reported for demographic and diagnostic delay variables and Wilcoxon rank sum and Fisher’s exact tests are used to compare characteristics of women with PABC to women with non-PABC at the alpha = 0.05 significance level. Treatment and outcomes are described for women with PABC only.ResultsOf the 117 women with breast cancer, 12 (10.3%) had PABC based on medical record review. The only significant demographic differences were that women with PABC were younger (p = 0.006) and more likely to be married (p = 0.035) compared to women with non-PABC. There were no significant differences in diagnostic delays or stage at diagnosis between women with PABC and women with non-PABC women. Eleven of the women with PABC received treatment, three had documented treatment delays or modifications due to their pregnancy or breastfeeding, and four stopped breastfeeding to initiate treatment. At the end of the study period, six patients were alive, three were deceased and three patients were lost to follow-up.ConclusionsPABC was relatively common in our cohort but may have been underreported. Although patients with PABC did not experience greater diagnostic delays, most had treatment modifications, emphasizing the potential value of PABC-specific treatment protocols in SSA. Larger prospective studies of PABC are needed to better understand particular challenges faced by these patients and inform policies and practices to optimize care for women with PABC in Rwanda and similar settings.Electronic supplementary materialThe online version of this article (10.1186/s12885-018-4535-y) contains supplementary material, which is available to authorized users.

Psychometric Properties of the Beck Depression Inventory (BDI-II) in Cancer Patients: Cancer Patients from Butaro Ambulatory Cancer Center, Rwanda

“…This national referral cancer center has various specialists and health-care providers to offer a spectrum of diagnostic oncology and treatments services, including chemotherapy, surgery, a pathology laboratory, counseling, and palliative care. 34,35 The center is designed to facilitate patient and staff flows, and comfortably accommodate patients and their attendants during extensive treatment regimens. This center also helps the government of Rwanda through the MoH to develop cancer centers in other referral hospitals in rural areas.…”

Duration of the patient interval in breast cancer and factors associated with longer delays in low‐and middle‐income countries: A systematic review with meta‐analysis

“…Detailed information about each article is included in Table S1. The majority of articles reported on studies conducted in countries in Africa (32%), 22–37 followed by South‐East Asia (30%), 38–51,71 the Middle East (20%), 52–61 Latin America (16%), 62–69 and Eastern Europe (2%) 45,70 . Two articles reported on patients from more than one country 24,45 …”

Experiences and challenges in the management of pregnancy-associated breast cancer at the Korle Bu Teaching Hospital: a review of four cases

“…Mastectomy is the recommendation of choice, but breast-conserving surgery (BCS) may be recommended if radiotherapy can be safely delayed till postpartum. Due to the advanced stage at presentation as in our case series, the majority of PABC in Africa usually require neoadjuvant chemotherapy and mastectomy with very few indications for BCS [ 10 , 21 ].…”

“…The management of breast cancer in a pregnant woman requires a dedicated multidisciplinary team (MDT) comprising oncologists, surgeons, obstetricians, neonatologist, psychologists, social workers, nurses and most importantly the patient and family to evaluate the risk and benefits of management options [ 6 ]. It is not unusual to have suggestions for therapeutic abortion for pregnant women diagnosed with breast cancer in Africa, as local data supporting good outcomes of foetus and patients are limited [ 10 ]. There is, however, global data discussing the impact of pregnancy on breast cancer outcomes, and the safe application of therapies that reduce poor foetal outcomes [ 11 , 12 ].…”