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

Twahir, Majid; Oyesegun, Razaq; Yarney, Joel; Gachii, Andrew; Edusa, Clement; Nwogu, Chukwumere; Mangutha, Gitangu; Anderson, Philip D.; Emmanuel, Benjamin; Müller, Borna; Ngoh, Charles

doi:10.1136/bmjopen-2020-041900

Cited by 15 publications

(17 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The stage at diagnosis was reported in 7/13 studies 25–27,30,33–36 ; histopathology data were found in all the studies except two, 25,35 and hormonal status in 5 out of 13 studies 26,27,30,33,34 . Data about the CT use were in all the studies except one 29 .…”

Section: Resultsmentioning

confidence: 97%

“…Bilateral therapeutic mammoplasty in most of the patients (222/251) was reported by Grubnick et al (2013); BCS was traced in two studies of South Africa 28 . BCS (or BCT) was reported in studies performed in Guinea, 25 South Africa, 28–32 Zambia, 33 and in an international multicenter study conducted in Ghana, Kenya, and Nigeria 34 …”

Section: Resultsmentioning

confidence: 99%

“…Two studies indicated the use of CT generically 25,37 . The use of HT was reported in two 27,34 and the use of RT in six studies 25–27,30,34,36 …”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Female breast cancer in sub‐Saharan Africa: A PRISMA‐S‐compliant systematic review of surgery

Amouzou

Ketevi

Sambiani

et al. 2021

Journal of Surgical Oncology

View full text Add to dashboard Cite

Background In sub‐Saharan countries (SSAs), the advanced stage at diagnosis and the limited surgical interventions of female breast cancer (FBC) lead to poor outcomes. This study assessed current modalities of FBC surgeries. Methods Six literature databases (Medline, Embase, African Journal Online, Google Scholar, Web of Science, Cochrane Library) were searched, plus a manual search, in 2011–2021. We included primary data studies with any setting and presurgeries or postsurgeries treatments, we excluded non‐English language studies, editorials, and grey literature. Results The search yielded 21 observational studies (16 retrospective, 3 prospective, and 2 case reports). Of the total 6900 patients, 4121 (60%) patients underwent FBC surgical excision only, and 751/2779 (27%) conservative surgery (BCS) or therapy (BCT). All studies reported similar use of mastectomy (>60%), the FBC surgical excision/reconstruction studies displayed more neoadjuvant chemotherapy (536/2779, 19% vs. 215/4121, 5%), and radiotherapy or adjuvant radiotherapy (1461/2779, 52% vs. 411/3921, 4%). Patients' age, histological classification, staging, and follow‐up data were often missing. Conclusions The FBC complexity requires structured management by general and plastic surgeons, radiotherapy specialists, and obstetrician‐gynecologists through shared guidelines, protocols, and specific programs of public health. In SSAs, FBC surgical strategies should point at decreasing radical mastectomy and increasing BCS/BCT.

show abstract

Section: Resultsmentioning

confidence: 97%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Female breast cancer in sub‐Saharan Africa: A PRISMA‐S‐compliant systematic review of surgery

Amouzou

Ketevi

Sambiani

et al. 2021

Journal of Surgical Oncology

View full text Add to dashboard Cite

show abstract

“…East African countries, for instance, Kenya, offer lessons in reducing financial toxicity of cancer treatment. 59 High out-of-pocket payments for care are an impediment to treatment compliance and cancer control in SSA, demanding urgent attention. 59 The spiraling costs of cancer care, dwindling health care budgets, and competition for monetary resources all contribute to the financial burden of cancer treatment in SSA.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Breast Cancer Management in Sub-Saharan Africa

Vanderpuye

Dadzie

Huo

et al. 2021

JCO Global Oncology

View full text Add to dashboard Cite

PURPOSE To document progress and bottlenecks in breast cancer management in sub-Saharan Africa, subsequent to a 2013 pilot survey conducted through the African Organization for Research and Treatment in Cancer (AORTIC) network. METHODS An anonymous survey of breast cancer management was conducted in 2018 among AORTIC members. Results concerning respondent specialty, access to tumor boards, treatment accessibility, diagnostic services, and factors influencing treatment outcomes were compared with the 2013 findings. RESULTS Thirty-seven respondents from 30 facilities in 21 sub-Saharan Africa countries responded. The majority (92%) were clinical oncologists. Radiotherapy facilities were available in 70% of facilities. Seventy-eight percent of these had linear accelerators, and 42% had cobalt60 machines. Eighty percent of facilities had multidisciplinary tumor boards. Immunohistochemistry was routinely performed in 74% of facilities, computed tomography scan in 90%, bone scan in 16%, and positron emission tomography scans in 5%. Anthracyclines, taxanes, tamoxifen, letrozole, anastrozole, and zoledronic acid were available in the majority; trastuzumab, fertility, and genetic counseling were available in 66%, 58%, and 16%, respectively. There were a 50% increase in oncologist respondents over 2013 and a > 50% increase in radiotherapy facilities, particularly linear accelerators. Availability of trastuzumab, aromatase inhibitors, and taxanes increased. Immunohistochemistry capacity remained the same, whereas facilities harvesting at least 10 axillary lymph nodes increased. Bone scan facilities decreased. Responses suggested improved diagnostic services, systemic therapies, and radiotherapy. Sociocultural and economic barriers, system delays, and advanced stage at presentation remain. CONCLUSION Clinicians in sub-Saharan Africa have basic tools to improve breast cancer outcomes, recording positive strides in domains such as radiotherapy and systemic therapy. Socioeconomic and cultural barriers and system delays persist. Workforce expansion must be prioritized to improve quality of care to improve outcomes.

show abstract

“… 8 For example, recent data from Ghana, Nigeria and Kenya indicate that only 21–29% of eligible patients receive AI treatment. 23 …”

Section: Pharmacogenetics Of Breast Cancer In Sub-saharan Africamentioning

confidence: 99%

Pharmacogenetics of Breast Cancer Treatments: A Sub-Saharan Africa Perspective

Nthontho¹,

Ndlovu²,

Sharma³

et al. 2022

PGPM

View full text Add to dashboard Cite

Breast cancer is the most frequent cause of cancer death in low- and middle-income countries, in particular among sub-Saharan African women, where response to available anticancer treatment therapy is often limited by the recurrent breast tumours and metastasis, ultimately resulting in decreased overall survival rate. This can also be attributed to African genomes that contain more variation than those from other parts of the world. The purpose of this review is to summarize published evidence on pharmacogenetic and pharmacokinetic aspects related to specific available treatments and the known genetic variabilities associated with metabolism and/or transport of breast cancer drugs, and treatment outcomes when possible. The emphasis is on the African genetic variation and focuses on the genes with the highest strength of evidence, with a close look on CYP2A6, CYP2B6, CYP2C8, CYP2C9, CYP2C19, CYP2D6, CYP3A4/5, CYP19A1, UGT1A4, UGT2B7, UGT2B15, SLC22A16, SLC38A7, FcγR, DPYD, ABCB1 , and SULT1A1 , which are the genes known to play major roles in the metabolism and/or elimination of the respective anti-breast cancer drugs given to the patients. The genetic variability of their metabolism could be associated with different metabolic phenotypes that may cause reduced patients’ adherence because of toxicity or sub-therapeutic doses. Finally, this knowledge enhances possible personalized treatment approaches, with the possibility of improving survival outcomes in patients with breast cancer.

show abstract

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

Cited by 15 publications

References 17 publications

Female breast cancer in sub‐Saharan Africa: A PRISMA‐S‐compliant systematic review of surgery

Female breast cancer in sub‐Saharan Africa: A PRISMA‐S‐compliant systematic review of surgery

Assessment of Breast Cancer Management in Sub-Saharan Africa

Pharmacogenetics of Breast Cancer Treatments: A Sub-Saharan Africa Perspective

Contact Info

Product

Resources

About