Breast cancer pathology services in sub-Saharan Africa: a survey within population-based cancer registries

Abstract

Background Pathologists face major challenges in breast cancer diagnostics in sub-Saharan Africa (SSA). The major problems identified as impairing the quality of pathology reports are shortcomings of equipment, organization and insufficiently qualified personnel. In addition, in the context of breast cancer, immunohistochemistry (IHC) needs to be available for the evaluation of biomarkers. In the study presented, we aim to describe the current state of breast cancer pathology in order to highlight the unmet needs. Methods We obtained information on breast cancer pathology services within population-based cancer registries in SSA. A survey of 20 participating pathology centres was carried out. These centres represent large, rather well-equipped pathologies. The data obtained were related to the known population and breast cancer incidence of the registry areas. Results The responding pathologists served populations of between 30,000 and 1.8 million and the centres surveyed dealt with 10–386 breast cancer cases per year. Time to fixation and formalin fixation time varied from overnight to more than 72 h. Only five centres processed core needle biopsies as a daily routine. Technical problems were common, with 14 centres reporting temporary power outages and 18 centres claiming to own faulty equipment with no access to technical support. Only half of the centres carried out IHC in their own laboratory. For three centres, IHC was only accessible outside of the country and one centre could not obtain any IHC results. A tumour board was established in 13 centres. Conclusions We conclude that breast cancer pathology services ensuring state-of-the-art therapy are only available in a small fraction of centres in SSA. To overcome these limitations, many of the centres require larger numbers of experienced pathologists and technical staff. Furthermore, equipment maintenance, standardization of processing guidelines and establishment of an IHC service are needed to comply with international standards of breast cancer pathology.

Patterns of care of breast cancer patients in Morocco – A study of variations in patient profile, tumour characteristics and standard of care over a decade

“…Non-availability of reliable immunohistochemistry (IHC) is a major hindrance to provide tailored breast cancer management in most LMICs. A recently published survey among the laboratories from 17 countries participating in the African Cancer Registry Network (AFCRN) observed that only half of these laboratories had IHC facilities [ 21 ]. The sub-optimal quality of IHC at such laboratories is evident from the unusually high (as much as 50%) frequency of triple-negative breast cancers reported in African studies [ 22 , 23 ].…”

Breast Cancer Diagnostics, Therapy, and Outcomes in Sub-Saharan Africa: A Population-Based Registry Study

“…In some of the registry areas included in this study, there was only 1 (Addis Ababa, Cotonou) or no (Bamako) laboratory with immunohistochemistry facilities for HRS testing. 23 The NCCN Harmonized Guidelines for SSA 9 present the standard-of-care situation with the availability of HRS and do not make recommendations for treatment when the HRS is unknown. Previous recommendations have suggested giving endocrine therapy to women with locally advanced BC even with unknown HRS.…”

Assessment of Breast Cancer Management in Sub-Saharan Africa

“… 42 Lack of pathologists, logistical support, and standardization of tests continue, however, to hinder quality cancer management and research output. 43 , 44 Core biopsy utilization and improved reporting turnaround in SSA indicate attempts at standardization. The mean turnaround time for pathology reporting in high-income countries, South Africa, and Botswana is 4, 16 (± 11), and up to 57 days, respectively.…”