Taking on breast cancer in East Africa

Kantelhardt, Eva Johanna; Cubasch, Herbert; Hanson, Claudia

doi:10.1097/gco.0000000000000139

Cited by 23 publications

(31 citation statements)

References 43 publications

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“…This burden is projected to double between 2012 and 2030 due to population ageing and expansion 2. While breast cancer is, on average, a good-prognosis cancer in high-income countries, in SSA its prognosis is considerably lower 3. Excessive deaths due to breast cancer are reflected in a high breast cancer mortality:incidence ratio of 0.50 in SSA in 2012, twice that of Western Europe (0.24) 2…”

Section: Introductionmentioning

confidence: 99%

African Breast Cancer—Disparities in Outcomes (ABC-DO): protocol of a multicountry mobile health prospective study of breast cancer survival in sub-Saharan Africa

et al. 2016

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IntroductionSub-Saharan African (SSA) women with breast cancer (BC) have low survival rates from this potentially treatable disease. An understanding of context-specific societal, health-systems and woman-level barriers to BC early detection, diagnosis and treatment are needed.MethodsThe African Breast Cancer—Disparities in Outcomes (ABC-DO) is a prospective hospital-based study of overall survival, impact on quality of life (QOL) and delays along the journey to diagnosis and treatment of BC in SSA. ABC-DO is currently recruiting in Namibia, Nigeria, South Africa, Uganda and Zambia. Women aged 18 years or older who present at participating secondary and tertiary hospitals with a new clinical or histocytological diagnosis of primary BC are invited to participate. For consented women, tumour characteristics, specimen and treatment data are obtained. Over a 2-year enrolment period, we aim to recruit 2000 women who, in the first instance, will be followed for between 1 and 3 years. A face-to-face baseline interview obtains information on socioeconomic, cultural and demographic factors, QOL, health and BC attitudes/knowledge, and timing of all prediagnostic contacts with caregivers in orthodox health, traditional and spiritual systems. Responses are immediately captured on mobile devices that are fed into a tailored mobile health (mHealth) study management system. This system implements the study protocol, by prompting study researchers to phone women on her mobile phone every 3 months and, failing to reach her, prompts contact with her next-of-kin. At follow-up calls, women provide updated information on QOL, care received and disease impacts on family and working life; date of death is asked of her next-of-kin when relevant.Ethics and disseminationThe study was approved by ethics committees of all involved institutions. All participants provide written informed consent. The findings from the study will be published in peer-reviewed scientific journals, presented to funders and relevant local organisations and at scientific conferences.

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Section: Introductionmentioning

confidence: 99%

African Breast Cancer—Disparities in Outcomes (ABC-DO): protocol of a multicountry mobile health prospective study of breast cancer survival in sub-Saharan Africa

et al. 2016

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“…As noted in other articles, most recently in an article by Kantelhardt et al, 3 screening via mammography and the appropriate resources for proper follow-up of any results are not widely available in Africa. 3,5,6 Thus, patients may present at a late stage, when palliative chemotherapy is of more use than surgery. Surgery may be used for palliative management only when the resources needed to provide sufficient chemotherapy are lacking or unavailable.…”

Section: Early Detection and Screeningmentioning

confidence: 99%

“…Surgery may be used for palliative management only when the resources needed to provide sufficient chemotherapy are lacking or unavailable. 3 …”

Section: Early Detection and Screeningmentioning

confidence: 99%

“…Estimates of cancer statistics released in 2012 for 26 African countries indicated that breast cancer has become a leading cancer among women. 3 Of special concern, patients present late with advanced disease, treatment is often unavailable, delayed, or prohibitively expensive, and survival rates are low. 3 Early research suggests that breast cancer among African women is more aggressive, with a greater proportion of patients presenting at an earlier age and with high-grade and receptor-negative tumors.…”

Section: Introductionmentioning

confidence: 99%

“…3 Of special concern, patients present late with advanced disease, treatment is often unavailable, delayed, or prohibitively expensive, and survival rates are low. 3 Early research suggests that breast cancer among African women is more aggressive, with a greater proportion of patients presenting at an earlier age and with high-grade and receptor-negative tumors. 3,4 A literature search was conducted using search terms “breast cancer” and “Africa.” Whereas other studies have described regional variation of the occurrence of breast cancer in Africa, the focus of this review is to summarize the current management of breast cancer throughout the entire continent of Africa, specifically attempting to investigate surgical procedure rates and barriers to surgical care.…”

Section: Introductionmentioning

confidence: 99%

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Surgical Management of Breast Cancer in Africa: A Continent-Wide Review of Intervention Practices, Barriers to Care, and Adjuvant Therapy

Sutter

Slinker

Balumuka

et al. 2017

JGO

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Breast cancer has emerged as a leading cancer among women in Africa, necessitating improved understanding of its management across the continent. Although previous studies have described regional trends in therapy, this review aims to summarize continent-wide management and focus specifically on surgical interventions. Current literature shows that the rates of surgery, chemotherapy, and radiation therapy vary across different countries and institutions, indicating the need for greater use of standardized cancer treatment guidelines. Surgery, primarily modified radical mastectomy, is the most common form of therapy described. When chemotherapy is offered, the limited availability and cost of treatment lead to high rates of interruption and premature termination of cycles. Few patients have access to radiation or hormonal therapy because these treatments are not available in many countries. Significant delays in seeking treatment are common and contribute to patients presenting with advanced disease. Although limited infrastructure favors surgical management, interventions to improve early detection behavior, provide timely referrals to medical care, and initiate early treatment with access to clinically justified neo-adjuvant and adjuvant therapy are key to improving prognosis.

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Efficacy and safety of tailored and dose‐dense adjuvant chemotherapy and trastuzumab for resected HER2‐positive breast cancer: Results from the phase 3 PANTHER trial

Papakonstantinou

Matikas

Bengtsson³

et al. 2019

Cancer

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Background Dose‐dense (DD) adjuvant chemotherapy improves outcomes in early breast cancer (BC). However, there are no phase 3 randomized data to inform on its combination with trastuzumab for patients with human epidermal growth factor receptor 2 (HER2)–positive disease. Methods This was a protocol‐predefined secondary analysis of the randomized phase 3 Pan‐European Tailored Chemotherapy (PANTHER) trial. Women 65 years old or younger with node‐positive or high‐risk, node‐negative BC were randomized 1:1 to either tailored (according to hematologic nadirs) and DD epirubicin and cyclophosphamide followed by docetaxel or standard 5‐fluorouracil, epirubicin, and cyclophosphamide plus docetaxel every 3 weeks. Patients with HER2‐positive disease received 1 year of adjuvant trastuzumab. The primary endpoint was BC relapse–free survival. In addition, HER2‐positive patients and an equal number of HER2‐negative patients matched for age, treatment group, and institution who were enrolled at Swedish sites were asked to participate in a predefined study of cardiac safety and underwent echocardiography or multigated acquisition scanning and electrocardiography at the baseline and at 4 and 6 years of follow‐up. Results There were 342 HER2‐positive patients; 335 received at least 1 dose of trastuzumab, and 29 patients discontinued trastuzumab prematurely. Relapse‐free survival was not statistically significantly in favor of the tailored and DD group (hazard ratio, 0.68; 95% confidence interval, 0.37‐1.27; P = .231). Cardiac outcomes after 4 and 6 years of follow‐up did not differ significantly between HER2‐positive and HER2‐negative patients or between the 2 treatment groups. Conclusions The combination of DD chemotherapy and trastuzumab decreased the relative risk for relapse by 32% in comparison with standard treatment, a statistically nonsignificant difference. Its efficacy and safety merit further evaluation as part of both escalation and de‐escalation strategies.

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Taking on breast cancer in East Africa

Abstract: http://links.lww.com/COOG/A17

Cited by 23 publications

References 43 publications

African Breast Cancer—Disparities in Outcomes (ABC-DO): protocol of a multicountry mobile health prospective study of breast cancer survival in sub-Saharan Africa

African Breast Cancer—Disparities in Outcomes (ABC-DO): protocol of a multicountry mobile health prospective study of breast cancer survival in sub-Saharan Africa

Surgical Management of Breast Cancer in Africa: A Continent-Wide Review of Intervention Practices, Barriers to Care, and Adjuvant Therapy

Efficacy and safety of tailored and dose‐dense adjuvant chemotherapy and trastuzumab for resected HER2‐positive breast cancer: Results from the phase 3 PANTHER trial

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