Epidemiology, Pathology, Management and Open Challenges of Breast Cancer in Central Sudan: A Prototypical Limited Resource African Setting

Abstract

Litle is known about breast cancer in Sudan. According to the recent data published by the Khartoum Cancer Registry, breast cancer was the most common cancer among Sudanese women. Generally, breast cancer in native African women is characterized by young age at onset, occurrence in multiparous premenopausal patients, advanced stage at diagnosis, large tumor size, high-grade and triple-negative phenotype, with correspondingly poor prognosis. In Sudan, it was reported that about 70% of the women diagnosed with breast cancer were younger than 50 years old. We present here data from local and international publications as well as primary information from the National Cancer Institute in Wad Medani (one of the only two cancer hospitals of the country, both located in Central Sudan in Khartoum and Wad Medani). We provide an up-to-date situation analysis of breast cancer in Central Sudan as an example for an African reality and the various open challenges of breast cancer in a limited resource seting. A beter understanding of breast cancer in black African women is of global relevance, as there is an alarming increase in breast cancer among young black women worldwide, and these patients have the lowest survival rates.

Axillary Lymph Node Dissection for Breast Cancer: Efficacy and Complication in Developing Countries

“…Previous studies from Sudan reported that the majority of patients with breast cancer were diagnosed at advanced stages. 4 , 5 , 23 Ahmed 24 highlighted the possible reasons for late presentation of Sudanese patients with breast cancer and concluded that lack of education, a dependency on traditional medicine, and financial aspects of undergoing testing and treatment are the most important factors that play a role in prolonging the patient’s decision to seek medical treatment. In our setting, most patients with breast cancer are not candidates for SLNB because of advanced stage at presentation.…”

“…Although axillary lymph node dissection (ALND) has largely been replaced by sentinel lymph node biopsy (SLNB) for patients with cN0 breast cancer, 7 this advanced technique is presently not available in Sudan. 5 Therefore, ALND is recommended as part of the primary surgical management of patients with invasive breast cancer in our setting according to Sudan national guidelines for breast cancer management. 8…”

Unplanned attendances of cancer patients to an outpatient unit in a low-income country: A prospective study from Sudan

“…Sudanese women with breast cancer are on average younger compared with their counterparts from high-income countries. 9,18 More than two-thirds (73.5%) of our study population were from remote rural places and most of them were unemployed. Therefore, for them the financial implications of travelling to access healthcare at the NCI could be a huge burden.…”

“…6 Moreover, the majority of cancer patients have locally advanced or metastatic disease at presentation. 7,8,9,10,11,12 These challenges along with lack of access to palliative care services may result in higher numbers of unplanned attendances to outpatient units for palliation of uncontrolled symptoms, management of treatment-related side effects and end of life care. Therefore, outpatient units are often overcrowded and waiting periods for care can be long and uncomfortable.…”

Characteristics of Breast Cancer at First Presentation in Sudanese Patients Attending the National Cancer Institute–University of Gezira (NCI–UG)

“…Undue delay is sometimes ascribed to physicians who misdiagnose the 5 symptoms. The majority of Sudanese women with BC present with locally advanced disease (stage III) or worse metastatic disease (stage IV) that is difficult [6][7][8] to treat resulting in death. It has been reported that approximately two-thirds of Sudanese women noticed symptoms of their cancer for at least 12 months prior to diagnosis which is typical in many 5,7 countries in Sub-Saharan Africa.…”