Breast cancerdiagnosis in aresource poorenvironment through a collaborativemultidisciplinaryapproach: the Kenyan experience

Sayed, Shahin; Moloo, Zahir; Bird, Peter; Wasike, Ronald; Njoroge, Wambui; Karanu, Joseph; Nzioka, Ancent; Sherman, Omar; Prasad, Satya; Mariwa, Costa; Otieno, James; Chumba, David; Koech, Dorothy; Mbinga, Daniel; Mohammed, Musa; Njoroge, Richard; Chauhan, Rajendra; Vinayak, Sudhir; Kyobutungi, Catherine; Saleh, Mansoor N.

doi:10.1136/jclinpath-2012-201404

Cited by 11 publications

(10 citation statements)

References 18 publications

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“…Although SBE and CBE may be the only feasible options in low-resource settings, when combined with education about the early signs and symptoms of breast cancer, these may be important tools to facilitate early detection. 11 However, it is clear that, for a screening program to improve outcomes, an accessible treatment program must also be in place. There are several ways this could be achieved, again ranging from promising nonsurgical options such as ablative techniques to traditional treatments with surgery, chemotherapy, and/or radiation therapy.…”

Section: Discussionmentioning

confidence: 99%

Knowledge and Attitudes About Breast Cancer in Limpopo, South Africa

Trupe

Rositch

Dickerson

et al. 2017

JGO

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PurposeBreast cancer survival is unacceptably low in many low-resource settings, including rural South Africa, where access to screening and treatment services is limited. To describe the context for implementing an early detection program, we assessed knowledge and attitudes toward breast cancer risk, early detection, and treatment.MethodsWe conducted a cross-sectional survey among 243 women presenting to Hlokomela Clinic in Hoedspruit, South Africa, during April and May 2016. We used quantitative and qualitative analyses to determine levels of knowledge of risk factors, symptoms, and treatment of breast cancer, as well as experience with and attitudes toward detection and treatment methods.ResultsThirty-one percent of women correctly identified at least six of 12 risk factors for breast cancer, and 53.1% identified breast lumps as an important symptom. Although > 97% of women stated that self–breast examination and early detection were highly important and that they would seek care for changes in their breasts, only 33.3% of women reported performing self–breast examination, and only 24.3% reported receiving a clinical breast examination. Age and education were not associated with knowledge, and level of knowledge did not predict care-seeking behaviors or attitudes.ConclusionAlthough women demonstrated moderate levels of knowledge of breast cancer symptoms and risk factors and the importance of early detection, few women reported seeking services. These data demonstrate sufficient levels of knowledge and positive attitudes toward care seeking and suggest both a need and readiness for increased access to cost-effective services to facilitate early diagnosis and improved outcomes.

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Section: Discussionmentioning

confidence: 99%

Knowledge and Attitudes About Breast Cancer in Limpopo, South Africa

Trupe

Rositch

Dickerson

et al. 2017

JGO

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“…A critical challenge in the management of LABCs in LMICs is that a large fraction or even majority of these cancers are extremely advanced at presentation with large, ulcerated tumors. In these cases, extensive surgical resection is required to achieve complete removal of gross locoregional disease, even after neoadjuvant chemotherapy 18 . Although the traditional radical mastectomy (removal of the pectoralis muscles as well as the breast and axillary nodes) is rarely performed in high‐income countries today, muscle resection frequently continues to be required in sub‐Saharan Africa and other LMICs when tumors extensively invade the chest wall.…”

Section: Multimodality Breast Cancer Treatment In Lmicsmentioning

confidence: 99%

Breast cancer treatment: A phased approach to implementation

Mutebi

Anderson

Duggan

et al. 2020

Cancer

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102

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Optimal treatment outcomes for breast cancer are dependent on a timely diagnosis followed by an organized, multidisciplinary approach to care. However, in many low-and middle-income countries, effective care management pathways can be difficult to follow because of financial constraints, a lack of resources, an insufficiently trained workforce, and/or poor infrastructure. On the basis of prior work by the Breast Health Global Initiative, this article proposes a phased implementation strategy for developing sustainable approaches to enhancing patient care in limited-resource settings by creating roadmaps that are individualized and adapted to the baseline environment. This strategy proposes that, after a situational analysis, implementation phases begin with bolstering palliative care capacity, especially in settings where a late-stage diagnosis is common. This is followed by strengthening the patient pathway, with consideration given to a dynamic balance between centralization of services into centers of excellence to achieve better quality and decentralization of services to increase patient access. The use of resource checklists ensures that comprehensive therapy or palliative care can be delivered safely and effectively. Episodic or continuous monitoring with established process and quality metrics facilitates ongoing assessment, which should drive continual process improvements. A series of case studies provides a snapshot of country experiences with enhancing patient care, including the implementation of national cancer control plans in Kenya, palliative care in Romania, the introduction of a 1-stop clinic for diagnosis in Brazil, the surgical management of breast cancer in India, and the establishment of a women's cancer center in Ghana. Cancer 2020;126:2365-2378.

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“…However, the results of some African studies are compatible with the hypothesis that a third factor might be responsible-at least in part-of the molecular characteristics of BC in sub-Saharan Africa, that is, the biases deriving from preanalytical problems with tissue collection and processing, in particular from problems of underfixation or overfixation of surgical specimens. [5][6][7][8] These studies, in which standardised methods for collection, processing and reporting of specimens have been prospectively used, have reported that the frequency of Kenyan, Ethiopian and South African patients with ER-negative BC and triple-negative BC may be comparable with that found among patients from the Western countries. The authors have defined the standardisation of the preanalytic process and the implementation of quality assurance schemes as urgent needs.…”

Section: Correspondencementioning

confidence: 99%

“…6 7 They have also drawn attention to the fact that most African studies reporting a disproportionately high prevalence of patients with ER-negative BC had a retrospective design. 6 To add further evidence to the existing African literature on the relationship between the level of standardisation of the preanalytic process and the distribution by BC subtype, two of us (SB and MP) have reviewed the samples of the original immunohistochemical preparations from the Italian-Tanzanian study. 4 They have found that about one-third of specimens from Tanzania were not evaluable and showed staining artefacts reflecting limitations in fixation and paraffin-embedding procedures.…”

Section: Correspondencementioning

confidence: 99%

“…These actions may complement local initiatives like, for example, the multidisciplinary workshop held in Nairobi in 2012 as part of a multicentre study on the prevalence of triple-negative BC, 6 where the preanalytical factors impacting on the immunohistochemical process and the possible solutions were identified, and training in core biopsy was provided.…”

Section: Correspondencementioning

confidence: 99%

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