Invasive breast Cancer treatment in Tanzania: landscape assessment to prepare for implementation of standardized treatment guidelines

Abstract

Background Incidence of breast cancer continues to rise in low- and middle-income countries, with data from the East African country of Tanzania predicting an 82% increase in breast cancer from 2017 to 2030. We aimed to characterize treatment pathways, receipt of therapies, and identify high-value interventions to increase concordance with international guidelines and avert unnecessary breast cancer deaths. Methods Primary data were extracted from medical charts of patients presenting to Bugando Medical Center, Tanzania, with breast concerns and suspected to have breast cancer. Clinicopathologic features were summarized with descriptive statistics. A Poisson model was utilized to estimate prevalence ratios for variables predicted to affect receipt of life-saving adjuvant therapies and completion of therapies. International and Tanzanian guidelines were compared to current care patterns in the domains of lymph node evaluation, metastases evaluation, histopathological diagnosis, and receptor testing to yield concordance scores and suggest future areas of focus. Results We identified 164 patients treated for suspected breast cancer from April 2015–January 2019. Women were predominantly post-menopausal (43%) and without documented insurance (70%). Those with a confirmed histopathology diagnosis (69%) were 3 times more likely to receive adjuvant therapy (PrR [95% CI]: 3.0 [1.7–5.4]) and those documented to have insurance were 1.8 times more likely to complete adjuvant therapy (1.8 [1.0–3.2]). Out of 164 patients, 4% (n = 7) received concordant care based on the four evaluated management domains. The first most common reason for non-concordance was lack of hormone receptor testing as 91% (n = 144) of cases did not undergo this testing. The next reason was lack of lymph node evaluation (44% without axillary staging) followed by absence of abdominopelvic imaging in those with symptoms (35%) and lack of histopathological confirmation (31%). Conclusions Patient-specific clinical data from Tanzania show limitations of current breast cancer management including axillary staging, receipt of formal diagnosis, lack of predictive biomarker testing, and low rates of adjuvant therapy completion. These findings highlight the need to adapt and adopt interventions to increase concordance with guidelines including improving capacity for pathology, developing complete staging pathways, and ensuring completion of prescribed adjuvant therapies.

Access to Radiation Therapy and Related Clinical Outcomes in Patients With Cervical and Breast Cancer Across Sub-Saharan Africa: A Systematic Review

“… 31 Financial burdens lead to delays, unplanned breaks, or nonstandard treatments. 32 - 37 They affect treatment options, particularly with new technologies such as intraoperative RT (IORT), which are ineligible for aid and, therefore, only available for wealthy South Africans. 38 Insurance may help offset impacts, increasing RT utilization.…”

“…Although some patients underwent surgery without a pathologic cancer diagnosis, they were less likely to accept recommended adjuvant therapies. 37 , 42 , 62 , 66 , 67 Specific to CC, a shortage of gynecologic oncologists places more pressure on RT services for early-stage patients who may be surgical candidates. 33 , 42 , 44 , 50 , 68 , 69 The use of multidisciplinary clinics may help improve staffing, referral systems, and delays as patients only need one visit to arrange care.…”

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

“…Based on the incidence of breast cancer in Tanzania the records indicate that the problem of breast cancer is steadily growing as breast-cancer is the second most common cancer and the second most common cause of cancer death among women in Tanzanian [15,17]. Tanzania is predicted to have an 82% increase in breast cancer from 2017 to 2030 [11].…”

“…The burden of breast cancer in the LMICs is escalated by different factors including ignorance of the susceptible, limited technology, shortages of cancer healthcare related personnel and the associated costs of the current ways for cancer diagnosis [8,9,10,11]. The listed factors account for the big number of deaths caused by breast cancer because of the late of detection of the disease.…”

Formulation, Optimization, and Evaluation of Moringa oleifera Leaf Polyphenol-Loaded Phytosome Delivery System against Breast Cancer Cell Lines

“…It is one of the most common types of women’s cancer in Sub-Saharan Africa with a projection of 416,000 deaths expected between 2020 and 2029 [ 4 ]. In Tanzania, case data demonstrated an upward growth trajectory from 2732 in 2012 to 3037 new cases in 2018 [ 2 ] which are anticipated to increase by 82% by 2030 [ 5 ]. Without interventions, the burden of breast cancer is bound to rise, exerting tremendous financial and emotional strains on individuals.…”