scholarly journals Follow-up of Breast Cancer Patients in Ghana: Challenges to Community-based Surveillance

2015 ◽  
Vol 7 (1) ◽  
Author(s):  
Dennis O. Laryea ◽  
Baffour Awuah ◽  
Yaw A. Amoako ◽  
Samuel Mensah ◽  
Fred K. Awittor
Keyword(s):  
Breast Cancer ◽  
Cancer Control ◽  
Sub Saharan Africa ◽  
Quality Data ◽  
Cancer Registration ◽  
Breast Cancer Patients ◽  
Control Programmes ◽  
Control And Prevention ◽  
Sub Saharan

Cancer-related deaths have been projected to increase in sub-Saharan Africa. Cancer control programmes require good quality data in order to provide information for planning and implementing cancer control and prevention activities. Cancer registration and follow-up of cancer cases to estimate survival are useful tools in cancer control programmes. We followed up 136 cases of breast cancer diagnosed from the year 2006 to 2008. The majority of cases (62.5%) could not be reached either by phone or at the residential address indicated in the folders. We recommend a strengthened system of demographic information collection on cases for effective surveillance.

scholarly journals Few Losses to Follow-up in a Sub-Saharan African Cancer Cohort via Active Mobile Health Follow-up

2020 ◽  
Vol 189 (10) ◽  
pp. 1185-1196 ◽  
Author(s):  
Milena Foerster ◽  
Angelica Anele ◽  
Charles Adisa ◽  
Moses Galukande ◽  
Groesbeck Parham ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Median Time ◽  
Mobile Health ◽  
Cancer Survival ◽  
Controlled Trial ◽  
Cancer Control ◽  
Sub Saharan Africa ◽  
Next Of Kin ◽  
Sub Saharan

Abstract Accurate survival estimates are needed for guiding cancer control efforts in sub-Saharan Africa, but previous studies have been hampered by unknown biases due to excessive loss to follow-up (LTFU). In the African Breast Cancer—Disparities in Outcomes Study, a prospective breast cancer cohort study, we implemented active mobile health follow-up, telephoning each woman or her next-of-kin (NOK) trimonthly on her mobile phone to update information on her vital status. Dates of every contact with women/NOK were analyzed from diagnosis in 2014–2017 to the earliest of September 1, 2018, death, or 3 years postdiagnosis. The cumulative incidence of being LTFU was calculated considering deaths as competing events. In all, 1,490 women were followed for a median of 24.2 (interquartile range (IQR), 14.2–34.5) months, corresponding to 8,529 successful contacts (77% of total contacts) with the women/NOK. Median time between successful contacts was 3.0 (IQR, 3.0–3.7) months. In all, 71 women (5.3%) were LTFU at 3 years: 0.8% in Nigeria, 2.2% in Namibia, and 5.6% in Uganda. Because of temporary discontinuity of active follow-up, 20.3% of women were LTFU after 2 years in Zambia. The median time to study notification of a death was 9.1 (IQR, 3.9–14.0) weeks. Although the present study was not a randomized controlled trial, in this cancer cohort with active mobile health follow-up, LTFU was much lower than in previous studies and enabled estimation of up-to-date and reliable cancer survival.

scholarly journals Circulating tumor DNA is readily detectable among Ghanaian breast cancer patients supporting non-invasive cancer genomic studies in Africa

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Samuel Terkper Ahuno ◽  
Anna-Lisa Doebley ◽  
Thomas U. Ahearn ◽  
Joel Yarney ◽  
Nicholas Titiloye ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Tumor Grade ◽  
Circulating Tumor Dna ◽  
Sub Saharan Africa ◽  
Health Study ◽  
Breast Cancer Patients ◽  
Cancer Driver ◽  
Sequencing Studies ◽  
Sub Saharan ◽  
Tumor Dna

AbstractCirculating tumor DNA (ctDNA) sequencing studies could provide novel insights into the molecular pathology of cancer in sub-Saharan Africa. In 15 patient plasma samples collected at the time of diagnosis as part of the Ghana Breast Health Study and unselected for tumor grade and subtype, ctDNA was detected in a majority of patients based on whole- genome sequencing at high (30×) and low (0.1×) depths. Breast cancer driver copy number alterations were observed in the majority of patients.

scholarly journals Prevalence and Spectrum of Breast Cancer Inherited Mutations in Uganda and Cameroon Women

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 43s-43s
Author(s):  
B. Adedokun ◽  
Y. Zheng ◽  
P. Ndom ◽  
A. Gakwaya ◽  
T. Makumbi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Family History ◽  
Positive Family History ◽  
Pathogenic Mutation ◽  
Germline Mutations ◽  
Sub Saharan Africa ◽  
Age At Diagnosis ◽  
Breast Cancer Patients ◽  
Brca1 And Brca2 ◽  
Sub Saharan

Background: Breast cancer among indigenous Africans is characterized by higher prevalence of triple-negative disease and poor prognosis. A previous study in Nigeria reported a strikingly high prevalence of deleterious germline mutations in BRCA1 and BRCA2 among Nigerian women with breast cancer. It is unknown if this is true in other sub-Saharan African countries. Aim: The objective of this study is to determine the frequency of germline mutations among an unselected sample of women in Africa. Methods: We conducted a case-control study of breast cancer in Uganda and Cameroon to investigate genetic and nongenetic risk factors for breast cancer. Breast cancer cases were enrolled in two tertiary hospitals in the two countries, unselected for age at diagnosis and family history. Controls who were free of breast cancer were enrolled in the same hospitals and matched to cases on age. A 24-gene sequencing panel was used to test germline mutations in cases and controls. Results: There were 176 cases and 177 controls with a mean age at diagnosis of 46.2 years for cases and mean age at interview of 46.7 years for controls. Among cases, 18.2% carried a pathogenic mutation in a breast cancer gene: 6.3% in BRCA1, 6.3% in BRCA2, 1.7% in ATM, 1.1% in PALB2, 0.6% in BARD1, 0.6% in CDH1, 0.6% in TP53, and 1.2% in any of 17 other genes. Among controls, 2.3% carried a pathogenic mutation in one of the 24 susceptibility genes. Cases were 9.6-fold more likely to carry a mutation compared with controls (odds ratio=9.61, 95% confidence interval: 3.28-38.1; P < 0.001). The mean age of breast cancer cases with pathogenic BRCA1 mutations was 38.3 years compared with 46.7 years among other cases without such mutations ( P = 0.03). There was a trend that cases with a positive family history had higher chance of carrying a mutation (33.3%) than cases without (17.1%), but few cases reported a positive family history. Conclusion: Our findings confirm the earlier report of a high proportion of deleterious mutations in BRCA1 and BRCA2 among breast cancer patients in sub-Saharan Africa. As most of these women present with advanced breast cancer, there is an urgent need to improve access to genomic testing and life saving cancer medicines including chemotherapy and clinical trials of novel agents like PARP inhibitors. Given the high burden of inherited breast cancer, genetic risk assessment should be integrated into cancer control plans in sub-Saharan Africa.

scholarly journals Why Do Women with Breast Cancer Get Diagnosed and Treated Late in Sub-Saharan Africa Perspectives from Women and Patients in Bamako, Mali

Breast Care ◽  
2018 ◽  
Vol 13 (1) ◽  
pp. 39-43 ◽  
Author(s):  
Kirstin Grosse Frie ◽  
Hatouma Samoura ◽  
Samba Diop ◽  
Bakarou Kamate ◽  
Cheick Bougadari Traore ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Cancer Patients ◽  
Low Income ◽  
Help Seeking ◽  
Sub Saharan Africa ◽  
Low Income Countries ◽  
Breast Cancer Patients ◽  
Cancer Knowledge ◽  
Sub Saharan

Background: Breast cancer, the most common cancer among women worldwide, has a high mortality rate in low-income countries. In sub-Saharan Africa, most breast cancer patients are diagnosed with advanced disease. Some studies have quantified the time delay to diagnosis in sub-Saharan Africa, but very few have used qualitative methods to understand barriers leading to delay. This study analyses barriers throughout a breast cancer patient's pathway from symptom recognition to treatment in Mali. Method: Three focus group discussions were conducted. The model of pathways to treatment was used to structure the results into 4 time intervals: appraisal, help-seeking, diagnosis, and treatment, with a focus on barriers during each interval. Results: The main barriers during the appraisal interval were a low level of breast cancer knowledge among women, their families, and medical professionals, and during the help-seeking interval, mistrust in the community health care centers and economic hardship. Barriers during the diagnosis interval were low quality of health care services and lack of social support, and during the pretreatment interval high costs and lack of specialized services. Conclusion: Multilevel interventions are needed to ensure access, availability, and affordability of a minimum standard of care for breast cancer patients in sub-Saharan Africa.

Breast cancer survival in rural sub-Saharan Africa

2020 ◽  
Author(s):  
Paddy Ssentongo ◽  
John Oh ◽  
Forster Amponsah ◽  
William Wong ◽  
Xavier Candela ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Survival Rate ◽  
Low Income ◽  
Significant Proportion ◽  
Sub Saharan Africa ◽  
Lymph Node Status ◽  
Overall Survival Rate ◽  
Sub Saharan

Abstract INTRODUCTION: Five-year overall survival rate of breast cancer in low-income countries (LICs) is significantly lower than in high-resource countries. In this study, we explored clinical and pathological factors influencing mortality in a rural community setting in sub-Saharan Africa. METHODS: We performed a retrospective medical review of patients undergoing surgery and chemotherapy for breast cancer at a regional hospital in Ghana from January 2014 through January 2017. Descriptive and survival analysis was done. RESULTS: One hundred and twenty-nine patients were included in the study. The median age at presentation was 51 years. 60.0% of patients presented with poorly differential histological grade III. The most common histological type was invasive ductal carcinoma (83%). Based on assessment of stage using only tumor size and lymph node status, 60% presented at stage 3. Only 25% were tested for hormone receptor proteins and HER2 status. Of these, 57% had triple-negative breast cancer (TNBC). The 3-year overall survival rate was only 52%. A significant proportion of the patients (46%) were lost to follow-up. CONCLUSIONS: The cumulative 3-year survival was 52 %. Despite success in the reduction of cancer mortality in southern and northern Africa, survival in the rural communities of sub-Saharan Africa remains poor. A significantly higher percentage of GIII and TNBC is found in breast cancers seen in Ghana. Late-stage presentation, when combined with limited capacity for accurate diagnosis, cancer subtype analysis, adequate therapy and follow-up, leads to poor outcomes. Future studies should emphasize identification of barriers to care and opportunities for cost-effective and sustainable improvements in the diagnosis and treatment of breast cancer in LICs.

scholarly journals Establishing Cohorts to Generate the Evidence Base to Reduce the Burden of Breast Cancer in Sub-Saharan Africa: Results From a Feasibility Study in Kenya

2019 ◽  
pp. 1-10
Author(s):  
Sujha Subramanian ◽  
Robai Gakunga ◽  
Madeleine D. Jones ◽  
Asaph Kinyanjui ◽  
Emily Ochieng' ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Cancer Risk ◽  
Cancer Risk ◽  
Cohort Studies ◽  
Socioeconomic Factors ◽  
Sub Saharan Africa ◽  
Short Term ◽  
Cancer Symptoms ◽  
Sub Saharan

PURPOSE By 2025, Kenya is estimated to experience a two-thirds increase in the incidence of breast cancer. Local research is necessary to generate evidence to inform policy, public health, and medical practice. There have been no longitudinal cohort studies in sub-Saharan Africa of women with and without breast cancer. Our aim is to assess the feasibility of conducting cohort studies in Kenya that consider clinical characteristics, socioeconomic factors, and self-care behaviors. METHODS We initiated a short-term follow-up cohort study of women with and without a diagnosis of breast cancer with baseline face-to-face data collection and one follow-up interview (at approximately 3 months by telephone). We developed tailored instruments to capture demographics, socioeconomic factors, breast cancer risk, ability to identify breast cancer symptoms, treatments received for breast cancer, and quality of life of survivors. RESULTS We recruited 800 women between the ages of 20 and 60 years and successfully collected baseline data. Completeness of the data was high for demographic variables, but there was a larger proportion of missing information for specific variables required for assessing breast cancer risk. Respondents were able to complete standardized instruments to assess breast cancer knowledge among those without breast cancer and identification of symptoms among survivors. We were able to successfully contact approximately 80% of the participants for follow-up. CONCLUSION This short-term follow-up study provides evidence that women can be successfully tracked and contacted for follow-up in the Kenyan setting and offers lessons to establish future longitudinal cohorts to identify approaches to improve breast cancer outcomes.

scholarly journals Breast Cancer in Ghana: Demonstrating the Need for Population-Based Cancer Registries in Low- and Middle-Income Countries

2017 ◽  
Vol 3 (6) ◽  
pp. 765-772 ◽  
Author(s):  
Abigail S. Thomas ◽  
Kelley M. Kidwell ◽  
Joseph K. Oppong ◽  
Ernest K. Adjei ◽  
Ernest Osei-Bonsu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
African American Women ◽  
Cancer Control ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Sub Saharan Africa ◽  
Grade 3 ◽  
Ghanaian Women ◽  
Risk Of Cancer

Purpose Breast cancer, the most common cancer worldwide, is the leading cause of cancer mortality in Ghanaian women. Previous studies find Ghanaian women are diagnosed at a younger age and at more advanced stages (III and IV), and have tumors with characteristics similar to African American women. We sought to remedy gaps in knowledge about breast cancer survival in Ghana and its relation to demographic and biologic factors of the tumors at diagnosis to assist in cancer control and registration planning. Methods Individuals with a breast cancer diagnosis who sought care at Komfo Anokye Teaching Hospital from 2009 to 2014 were identified via medical records. Follow-up telephone interviews were held to assess survival. Kaplan-Meier plots and Cox proportional hazards models assessed survival associated with clinical and demographic characteristics. Results A total of 223 patients completed follow-up and were analyzed. The median survival was 3.8 years. Approximately 50% of patients were diagnosed with grade 3 tumors, which significantly increased the risk of recurrence or death (hazard ratio [HR] for grade 2 versus 1, 2.98; 95% CI, 1.26 to 7.02; HR grade 3 v 1, 2.56; 95% CI, 1.08 to 6.07; P = .04). No other variables were significantly associated with survival. Conclusion Higher tumor grade was significantly associated with shorter survival, indicating impact of aggressive biology at diagnosis on higher risk of cancer spread and recurrence. Contrary to prevailing notions, telephone numbers were not reliable for follow-up. Collecting additional contact information will likely contribute to improvements in patient care and tracking. A region-wide population-based active registry is important to implement cancer control programs and improve survival in sub-Saharan Africa.

scholarly journals Understanding Breast Cancer and Improving Outcomes in Malawi

2018 ◽  
Vol 4 (Supplement 3) ◽  
pp. 49s-49s
Author(s):  
Takondwa Zuze ◽  
Tamiwe Tomoka ◽  
Ruth Nyirenda ◽  
Richard Nyasosela ◽  
Ryan Seguin ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Cancer Treatment ◽  
Radical Mastectomy ◽  
Sub Saharan Africa ◽  
Hiv Positive ◽  
Modified Radical Mastectomy ◽  
Term Survival ◽  
Sub Saharan

Purpose Despite the increasing breast cancer burden in sub-Saharan Africa, outcomes are suboptimal as a result of limited screening, limited diagnostic infrastructure, advanced stage, and limited treatment availability. In Malawi, we established the first prospective cohort of patients with breast cancer to comprehensively and longitudinally describe breast cancer in this environment. Methods Since December 2016, we have been enrolling patients with pathologically confirmed breast cancer at Kamuzu Central Hospital in Lilongwe, Malawi. All patients receive standardized baseline and follow-up evaluations and treatment that is consistent with National Comprehensive Cancer Network harmonized guidelines for sub-Saharan Africa. Results From December 2016 to May 2018, 70 women with breast cancer were enrolled. The median age was 48 years (range, 21 to 78 years) and 16 patients (23%) were HIV positive. Of 63 patients who could be formally staged, 54 (86%) had stage III and IV disease, including 40 (63%) with T4 tumors, 50 (79%) with at least N1, and 19 (30%) with distant metastases. Of 65 tumors histologically graded, 30 (46%) were grade 3 and 22 (34%) were grade 2. Of 66 biopsies evaluated, 31 (47%) were estrogen or progesterone receptor positive. Fifty biopsies were additionally evaluated for human epidermal growth factor receptor 2, of which 12 (22%) were positive and 15 (30%) triple negative. Thirty-nine women (56%) received curative-intent treatment, including eight with modified radical mastectomy followed by adjuvant chemotherapy, and 31 with neoadjuvant chemotherapy followed by modified radical mastectomy for localized bulky disease that was initially felt to be unresectable. Adjuvant/neoadjuvant chemotherapy was typically administered as doxorubicin plus cyclophosphamide. Twenty-five patients (36%) received palliative-intent chemotherapy, typically with single-agent paclitaxel. Six patients (9%) received no cancer treatment, with two patients dying before chemotherapy and four refusing cancer treatment. Median follow-up time was 7.8 months and overall survival was 88% at 12 months (95% CI, 76% to 96%) with no significant differences between HIV-positive and HIV-negative women ( P = .198). Conclusion Women at a national teaching hospital in Lilongwe, Malawi, presented with young age and advanced, bulky, high-risk breast cancer, but short-term survival was good in the context of a structured treatment program. Continued improvements for this population are needed for all aspects of the care cascade, including early detection, diagnosis, treatment, and palliation, to improve outcomes further. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . No COIs from the authors.

scholarly journals Review of mastectomy in the department of gynecology at the Treichville teaching hospital, Abidjan-Cote d’Ivoire

2018 ◽  
Vol 7 (4) ◽  
pp. 1313
Author(s):  
Yao Ignace N’guessan ◽  
Dia Jean-Marc Lamine ◽  
Toure Moctar ◽  
Saki Téa Corneille ◽  
Tela Simo Gilbert ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Axillary Dissection ◽  
Ductal Carcinoma ◽  
Sub Saharan Africa ◽  
University Hospital ◽  
Breast Cancer Surgery ◽  
Breast Cancer Patients ◽  
Simple Mastectomy ◽  
Sub Saharan ◽  
The University

Background: Mastectomy plays a key role in the management of breast cancer in our regions of sub-Saharan Africa. Because the advanced forms represent the essential stages of the diagnosis and some therapeutic means remain unavailable. Objective of this study was to report the experience of the practice of mastectomy in the treatment of breast cancer in our service.Methods: This is a retrospective and prospective, descriptive study conducted from January 1, 2013 to May 31, 2017 (age 05) at the University Hospital of Treichville involving 56 breast cancer patients who had undergone a mastectomy.Results: The frequency of the mastectomy was 28.5% and the average age of our patients was 48 years old. The majority of patients had an average socio-economic level (66%). 85.6% of our cancers discovered at advanced stages (T3 and T4). Adenocarcinoma accounted for 96% and infiltrating ductal carcinoma 82% of adenocarcinoma.Patey mastectomy associated with axillary dissection was performed in 96.4% and simple mastectomy in 3.5%. The results of axillary dissection reported lymph node invasion in 38 patients; With an average number of lymph nodes taken from 6.1 and an average number of ganglia affected is 3. Neoadjuvant chemotherapy was administered in 96.4% and adjuvant chemotherapy in 91%. Radiotherapy was performed in 34%. Complications were dominated by lymphoceles in 34% of cases. The 5-year survival of patients operating in the service is 37.8%.Conclusions: Mastectomy is at the forefront of breast cancer surgery in our service. She is supervised by chemotherapy. Radiotherapy remains inaccessible for most patients. Early detection would lead to conservative treatment and a reduction in the postoperative complication rate.

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