Breast Cancer Pathology Turnaround Time in Botswana

Martei, Yehoda M.; Narasimhamurthy, Mohan; Prabhakar, Pooja; Hutson, Jeré; Setlhako, Dipho I; Chiyapo, Sebathu; Ramogola‐Masire, Doreen; Makozhombwe, Ignetious; Feldman, Michael D.; Kayembe, Mukendi; Grover, Surbhi

doi:10.1200/jgo.17.00090

Cited by 10 publications

(13 citation statements)

References 9 publications

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“…Although our study has not explicitly estimated the pathology result turnaround times, some portion of the diagnosis delays we observed could be attributed to prolonged pathology result turnaround times in the few available diagnostic facilities in the city. Similar to other sub-Saharan countries,47 patients with cancer in Addis Ababa waited on average for 15 days to get the pathology result 9…”

Section: Discussionmentioning

confidence: 97%

Time intervals experienced between first symptom recognition and pathologic diagnosis of breast cancer in Addis Ababa, Ethiopia: a cross-sectional study

et al. 2019

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ObjectivesThis study aimed to estimate the magnitude of patient and diagnostic delays and associated factors among women with breast cancer in Addis Ababa.DesignThis is a cross-sectional study.Settings and participantsAll women newly diagnosed with breast cancer in seven major healthcare facilities in Addis Ababa (n=441) were included in the study.Main outcomes and measuresPatient interval (time from recognition of first symptom to medical consultation) and diagnostic interval (time from first consultation to diagnosis). Patient intervals >90 days and diagnostic intervals >30 days were considered delays, and associated factors were determined using multivariable Poisson regressions with robust variance.ResultsThirty-six percent (95% CI [31.1%, 40.3%]) of the patients had patient intervals of >90 days, and 69% (95% CI [64.6%, 73.3%]) of the patients had diagnostic intervals of >30 days. Diagnostic interval exceeded 1 year for 18% of patients. Ninety-five percent of the patients detected the first symptoms of breast cancer by themselves, with breast lump (78.0%) as the most common first symptom. Only 8.0% were concerned about cancer initially, with most attributing their symptoms to other factors. In the multivariable analysis, using traditional medicine before consultation was significantly associated with increased prevalence of patient delay (adjusted prevalence ratio (PR) = 2.13, 95% CI [1.68, 2.71]). First consultation at health centres (adjusted PR = 1.19, 95% CI [1.02, 1.39]) and visiting ≥4 facilities (adjusted PR = 1.24, 95% CI [1.10, 1.40]) were associated with higher prevalence of diagnostic delay. However, progression of symptoms before consultation (adjusted PR = 0.73, 95% CI [0.60, 0.90]) was associated with decreased prevalence of diagnostic delay.ConclusionsPatients with breast cancer in Addis Ababa have prolonged patient and diagnostic intervals. These underscore the need for public health programme to increase knowledge about breast cancer symptoms and the importance of early presentation and early diagnosis among the general public and healthcare providers.

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Section: Discussionmentioning

confidence: 97%

Time intervals experienced between first symptom recognition and pathologic diagnosis of breast cancer in Addis Ababa, Ethiopia: a cross-sectional study

et al. 2019

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“…Possible reasons for this delay may be that the locations of tertiary care centres are widely dispersed with no clear referral infrastructure between them or that patients have financial constraints and require time to arrange for funds for the procedures or interventions. Notably, much shorter turnaround times for the initial diagnostic procedures for breast cancer management have been reported from Botswana, 15 which is one of the most developed African countries. Most patients in Ghana and Nigeria bore the full cost of their breast cancer care.…”

Section: Discussionmentioning

confidence: 99%

Real-world challenges for patients with breast cancer in sub-Saharan Africa: a retrospective observational study of access to care in Ghana, Kenya and Nigeria

et al. 2021

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ObjectiveTo evaluate medical resource utilisation and timeliness of access to specific aspects of a standard care pathway for breast cancer at tertiary centres in sub-Saharan Africa.DesignData were retrospectively abstracted from records of patients with breast cancer treated within a prespecified 2-year period between 2014 and 2017. The study protocol was approved by local institutional review boards.SettingSix tertiary care institutions in Ghana, Kenya and Nigeria were included.ParticipantsHealth records of 862 patients with breast cancer were analysed: 299 in Ghana; 314 in Kenya; and 249 in Nigeria.InterventionsAs directed by the treating physician.Outcome measuresParameters selected for evaluation included healthcare resource and use, medical procedure turnaround times and out-of-pocket (OOP) payment patterns.ResultsUse of mammography or breast ultrasonography was <45% in all three countries. Across the three countries, 78%–88% of patients completed tests for hormone receptors and human epidermal growth factor receptor 2 (HER2). Most patients underwent mastectomy (64%–67%) or breast-conserving surgery (15%–26%). Turnaround times for key procedures, such as pathology, surgery and systemic therapy, ranged from 1 to 5 months. In Ghana and Nigeria, most patients (87%–93%) paid for diagnostic tests entirely OOP versus 30%–32% in Kenya. Similarly, proportions of patients paying OOP only for treatments were high: 45%–79% in Ghana, 8%–20% in Kenya and 72%–89% in Nigeria. Among patients receiving HER2-targeted therapy, the average number of cycles was five for those paying OOP only versus 14 for those with some insurance coverage.ConclusionsPatients with breast cancer treated in tertiary facilities in sub-Saharan Africa lack access to timely diagnosis and modern systemic therapies. Most patients in Ghana and Nigeria bore the full cost of their healthcare and were more likely to be employed and have secondary or postsecondary education. Access to screening/diagnosis and appropriate care is likely to be substantively lower for the general population.

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“…In comparison, TATs for breast biopsies in Botswana were reported at 8 days and 57 days for surgical specimens, which the authors hypothesized to be due to pre-analytical delays with a reported goal TAT of < 7 days for all specimens in the future. 18 In HICs, reported mean TATs for surgical pathology specimens and mastectomies are 2.7 and 3.8 days, respectively. 19 , 20 There is no international recommendation on TATs for histopathology reports and certainly no national consensus.…”

Section: Discussionmentioning

confidence: 99%

Quality of Histopathological Reporting in Breast Cancer: Results From Four South African Breast Units

Toma

O’Neil

Joffe

et al. 2021

JCO Global Oncology

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PURPOSE High-quality histopathology reporting forms the basis for treatment decisions. The quality indicator for pathology reports from the European Society of Breast Cancer Specialists was applied to a cohort from four South African breast units. METHODS The study included 1,850 patients with invasive breast cancer and evaluated 1,850 core biopsies and 1,158 surgical specimen reports with cross-center comparisons. A core biopsy report required histologic type; tumor grade; and estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (HER2) status, with a confirmatory test for equivocal HER2 results. Ki-67 was regarded as optional. Pathologic stage, tumor size, lymphovascular invasion, and distance to nearest invasive margin were mandatory for surgical specimens. Specimen turnaround time (TAT) was added as a locally relevant indicator. RESULTS Seventy-five percent of core biopsy and 74.3% of surgical specimen reports were complete but showed large variability across study sites. The most common reason for an incomplete core biopsy report was missing tumor grade (17.9%). Half of the equivocal HER2 results lacked confirmatory testing (50.6%). Ki-67 was reported in 89.3%. For surgical specimens, the closest surgical margin was reported in 78.1% and lymphovascular invasion in 84.8% of patients. Mean TAT was 11.9 days (standard deviation [SD], 10.8 days) for core biopsies and 16.1 days (SD, 11.3) for surgical specimens. CONCLUSION Histopathology reporting is at a high level but can be improved, especially for tumor grade, HER2, and Ki-67, as is reporting of margins and lymphovascular invasion. A South African pathology consensus will reduce variability among laboratories. Routine use of standardized data sheets with synoptic reports and ongoing audits will improve completeness of reports over time.

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Breast Cancer Pathology Turnaround Time in Botswana

Cited by 10 publications

References 9 publications

Time intervals experienced between first symptom recognition and pathologic diagnosis of breast cancer in Addis Ababa, Ethiopia: a cross-sectional study

Time intervals experienced between first symptom recognition and pathologic diagnosis of breast cancer in Addis Ababa, Ethiopia: a cross-sectional study

Real-world challenges for patients with breast cancer in sub-Saharan Africa: a retrospective observational study of access to care in Ghana, Kenya and Nigeria

Quality of Histopathological Reporting in Breast Cancer: Results From Four South African Breast Units

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