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Grosse Frie K, Samoura H, Diop S, Kamate B, Traore CB, Malle B, Coulibaly B, Kantelhardt EJ. 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 (Basel) 2018; 13:39-43. [PMID: 29950966 PMCID: PMC6016059 DOI: 10.1159/000481087] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
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.
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Affiliation(s)
- Kirstin Grosse Frie
- Institute for Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Hatouma Samoura
- Institute of Public Health, University of Bamako, Bamako, Mali
| | - Samba Diop
- Institute of Public Health, University of Bamako, Bamako, Mali
| | - Bakarou Kamate
- Institute of Pathology, University Hospital Point G, Bamako, Mali
| | | | - Brahima Malle
- Institute of Pathology, University Hospital Point G, Bamako, Mali
| | | | - Eva Johanna Kantelhardt
- Institute for Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
- Department of Gynecology, University Hospital Halle (Saale), Halle (Saale), Germany
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2
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Elmi M, Hussein H, Nofech-Mozes S, Curpen B, Leahey A, Look Hong N. Budget impact analysis of a breast rapid diagnostic unit. Curr Oncol 2017; 24:e214-e219. [PMID: 28680289 DOI: 10.3747/co.24.3381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The Odette Cancer Centre's recent implementation of a rapid diagnostic unit (rdu) for breast lesions has significantly decreased wait times to diagnosis. However, the economic impact of the unit remains unknown. This project defined the development and implementation costs and the operational costs of a breast rdu in a tertiary care facility. METHODS From an institutional perspective, a budget impact analysis identified the direct costs associated with the breast rdu. A base-case model was also used to calculate the cost per patient to achieve a diagnosis. Sensitivity analyses computed costs based on variations in key components. Costs are adjusted to 2015 valuations using health care-specific consumer price indices and are reported in Canadian dollars. RESULTS Initiation cost for the rdu was $366,243. The annual operational cost for support staff was $111,803. The average per-patient clinical cost for achieving a diagnosis was $770. Sensitivity analyses revealed that, if running at maximal institutional capacity, the total annual clinical cost for achieving a diagnosis could range between $136,080 and $702,675. CONCLUSIONS Establishment and maintenance of a breast rdu requires significant investment to achieve reductions in time to diagnosis. Expenditures ought to be interpreted in the context of institutional patient volumes and trade-offs in patient-centred outcomes, including lessened patient anxiety and possibly shorter times to definitive treatment. Our study can be used as a resource-planning tool for future rdus in health care systems wishing to improve diagnostic efficiency.
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Affiliation(s)
- M Elmi
- Division of General Surgery, Sunnybrook Health Sciences Centre-Odette Cancer Centre.,Department of Surgery, University of Toronto
| | - H Hussein
- Division of Breast Imaging, Sunnybrook Health Sciences Centre; and.,Department of Medical Imaging, University of Toronto, Toronto, ON; and.,Department of Medical Imaging, Cairo University, Cairo, Egypt
| | - S Nofech-Mozes
- Division of General Surgery, Sunnybrook Health Sciences Centre-Odette Cancer Centre
| | - B Curpen
- Division of Breast Imaging, Sunnybrook Health Sciences Centre; and.,Department of Medical Imaging, University of Toronto, Toronto, ON; and
| | - A Leahey
- Division of General Surgery, Sunnybrook Health Sciences Centre-Odette Cancer Centre
| | - N Look Hong
- Division of General Surgery, Sunnybrook Health Sciences Centre-Odette Cancer Centre.,Department of Surgery, University of Toronto
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3
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Becker S. A historic and scientific review of breast cancer: The next global healthcare challenge. Int J Gynaecol Obstet 2015; 131 Suppl 1:S36-9. [DOI: 10.1016/j.ijgo.2015.03.015] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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El Saghir NS, Farhat RA, Charara RN, Khoury KE. Enhancing cancer care in areas of limited resources: our next steps. Future Oncol 2015; 10:1953-65. [PMID: 25386812 DOI: 10.2217/fon.14.124] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
In-depth knowledge of local conditions is necessary in order to enhance care in low- and middle-income countries. In this review we discuss: improving cancer diagnosis, optimizing patient management, increasing health awareness, prevention, early detection, eradication of causative infectious diseases and agents, tobacco control, healthy diets and lifestyles, availability of diagnostic methods, easy access to care, affordable costs, improving infrastructures, quality care measures, implementing and adapting guidelines, multidisciplinary management, supportive and survivorship care, research and optimization of medical school curriculum and training in oncology. Establishment of national cancer control plans by policy makers, physician societies, medical schools, and patient advocates is recommended. We will review evidence and controversies, and outline the next steps needed to prevent cancer and enhance care of cancer patients in LMICs.
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Affiliation(s)
- Nagi S El Saghir
- Breast Center of Excellence, Naef K. Basile Cancer Institute, Division of Hematology Oncology, Department of Internal Medicine, American University of Beirut Medical Center, PO Box 11-0236, Riad El Solh 1107 2020, Beirut, Lebanon
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5
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Zhou Y, Gou LT, Guo ZH, Liu HR, Wang JM, Zhou SX, Yang JL, Li XA. Fully human HER2/cluster of differentiation 3 bispecific antibody triggers potent and specific cytotoxicity of T lymphocytes against breast cancer. Mol Med Rep 2015; 12:147-54. [PMID: 25760691 PMCID: PMC4438947 DOI: 10.3892/mmr.2015.3441] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 02/10/2015] [Indexed: 02/05/2023] Open
Abstract
The use of a bispecific antibody (BsAb) is a promising and highly specific approach to cancer therapy. In the present study, a fully human recombinant single chain variable fragment BsAb against human epidermal growth factor receptor (HER)2 and cluster of differentiation (CD)3 was constructed with the aim of developing an effective treatment for breast cancer. HER2/CD3 BsAb was expressed in Chinese hamster ovary cells and purified via nickel column chromatography. Flow cytometry revealed that the HER2/CD3 BsAb was able to specifically bind to HER2 and CD3-positive cells. HER2/CD3 BsAb was able to stimulate T-cell activation and induce the lysis of cultured SKBR-3 and BT474 cells in the presence of unstimulated T lymphocytes. HER2/CD3 BsAb efficiently inhibited the growth of breast cancer tissue by activating and inducing the proliferation of tumor tissue infiltrating lymphocytes. Therefore, HER2/CD3 BsAb is a potent tool which may be a suitable candidate for the treatment of breast cancer.
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Affiliation(s)
- Yan Zhou
- Gastroenterology Tumor and Microenvironment Laboratory, Department of Gastroenterology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan 610041, P.R. China
| | - Lan-Tu Gou
- State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Zhi-Hui Guo
- Gastroenterology Tumor and Microenvironment Laboratory, Department of Gastroenterology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan 610041, P.R. China
| | - Hai-Rong Liu
- Gastroenterology Tumor and Microenvironment Laboratory, Department of Gastroenterology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan 610041, P.R. China
| | - Jiang-Man Wang
- State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Shu-Xian Zhou
- Gastroenterology Tumor and Microenvironment Laboratory, Department of Gastroenterology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan 610041, P.R. China
| | - Jin-Liang Yang
- State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Xiao-An Li
- Gastroenterology Tumor and Microenvironment Laboratory, Department of Gastroenterology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan 610041, P.R. China
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El Saghir NS, Charara RN. International screening and early detection of breast cancer: resource-sensitive, age- and risk-specific guidelines. BREAST CANCER MANAGEMENT 2014. [DOI: 10.2217/bmt.14.28] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY In this article we review the evidence and current controversies surrounding screening and early detection of breast cancer, from the initially positive age-specific randomized trials of the 1970s and 1980s, to the 2009 USPSTF recommendations, 2013 interpretation of SEER data, 2014 Canadian Study updates, and BHGI resource-sensitive guidelines, as well as the few reports available from emerging countries. We will also discuss the burden of breast cancer in low- and middle- income countries with rising incidence rates and advanced stages at presentation, the need for increasing awareness and downstaging of disease. We will discuss the data putting it in perspective for general guidelines for the international scene, and suggest adoption of evidence-based resource-sensitive and risk-specific guidelines, with less reliance on broad age-specific guidelines.
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Affiliation(s)
- Nagi S El Saghir
- Breast Center of Excellence, Naef K. Basile Cancer Institute, Division of Hematology Oncology, Department of Internal Medicine, American University of Beirut Medical Center, PO Box 11–0236, Riad El Solh 1107 2020, Beirut, Lebanon
| | - Raghid N Charara
- Department of Internal Medicine, Breast Cancer Center of Excellence, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
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El Saghir NS, Assi HA, Jaber SM, Khoury KE, Nachef Z, Mikdashi HF, El-Asmar NS, Eid TA. Outcome of Breast Cancer Patients Treated outside of Clinical Trials. J Cancer 2014; 5:491-8. [PMID: 24959302 PMCID: PMC4066361 DOI: 10.7150/jca.9216] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 05/01/2014] [Indexed: 11/05/2022] Open
Abstract
Background: Information on outcome of breast cancer patients treated in the community is scarce. Data on outcome of patients treated in real-life clinical practice may provide useful information for performance improvement. Methods: Study population is from a single institution practice at the American University of Beirut Medical Center. Demographics, clinical characteristics and survival data on patients diagnosed 1997-2010 in two IRB-approved studies were entered and analyzed on SPSS program. Survival was estimated using Kaplan Meier Method. Findings: Total was 519 patients. 23.9% had stage I, 39.7% stage II, 30.4% Stage III and 6% stage IV. ER positive in 74.4% of patients. 30.6% of patients <35 had TNBC compared to 12.3% for the whole group. 45.9% of non-metastatic patients had breast-conserving therapy (BCT). BCT rates increased to 64% during the second half of the study, coinciding with increasing awareness and changing cultural mores. 5-year and 10-year overall survivals for stage I were 98.9% and 80.5%, 89.2% and 70.7% for stage II, 67.6% and 35.5% for stage III, and 39.1% and 26.1% for stage IV respectively. Interpretation: Patients treated outside clinical trials in a multidisciplinary fashion according to guidelines have comparable, and at times better, survival compared to data from trials or population statistics. Locally generated outcome data could be valuable for evaluating results of treatment at individual practices for the purpose of quality assessment and improvement. Our data also provides report of increased rate of breast conserving surgery from Middle East.
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Affiliation(s)
- Nagi S El Saghir
- 1. Breast Center of Excellence, Naef K. Basile Cancer Institute and Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hussein A Assi
- 1. Breast Center of Excellence, Naef K. Basile Cancer Institute and Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sara M Jaber
- 1. Breast Center of Excellence, Naef K. Basile Cancer Institute and Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Katia E Khoury
- 1. Breast Center of Excellence, Naef K. Basile Cancer Institute and Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Zahi Nachef
- 1. Breast Center of Excellence, Naef K. Basile Cancer Institute and Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hana F Mikdashi
- 1. Breast Center of Excellence, Naef K. Basile Cancer Institute and Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nadine S El-Asmar
- 1. Breast Center of Excellence, Naef K. Basile Cancer Institute and Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Toufic A Eid
- 2. Naef K. Basile Cancer Institute and Department of Radiation Oncology, American University of Beirut Medical Center, Beirut, Lebanon
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Sighoko D, Kamaté B, Traore C, Mallé B, Coulibaly B, Karidiatou A, Diallo C, Bah E, McCormack V, Muwonge R, Bourgeois D, Gormally E, Curado MP, Bayo S, Hainaut P. Breast cancer in pre-menopausal women in West Africa: Analysis of temporal trends and evaluation of risk factors associated with reproductive life. Breast 2013; 22:828-35. [DOI: 10.1016/j.breast.2013.02.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 08/15/2012] [Accepted: 02/15/2013] [Indexed: 12/25/2022] Open
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9
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Mena M, Wiafe-Addai B, Sauvaget C, Ali IA, Wiafe SA, Dabis F, Anderson BO, Malvy D, Sasco AJ. Evaluation of the impact of a breast cancer awareness program in rural Ghana: a cross-sectional survey. Int J Cancer 2013; 134:913-24. [PMID: 23913595 DOI: 10.1002/ijc.28412] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 07/17/2013] [Indexed: 11/08/2022]
Abstract
Community awareness is crucial to early detection of breast cancer in low- and middle-income countries. In Ghana 60% of the cases are detected at late stages. Breast Care International (BCI) is a Ghanaian non-governmental organization dedicated to raising breast cancer awareness. A cross-sectional survey was designed to assess the impact of BCI program on knowledge, attitudes and practices (KAP) toward breast cancer among women from rural communities of Ghana. A total of 232 women were interviewed in June 2011 in the Ashanti region; of these 131 participants were from a community that received the BCI program in August 2010 (intervention group) and 101 from another community that received the program post-survey (referent group). Data analysis was performed using Epi-Info version 3.5.3. Knowledge about breast cancer among participants who received the program was better than among those who did not. Only 53.5% of participants from the referent group knew that breast cancer usually appears as painless breast lump when compared to 82.3% from the intervention group. Participants who attended the program were significantly more likely to obtain higher knowledge scores (odds ratio (OR) = 2.10, 95% confidence interval (CI) = 1.14-3.86) and to state practicing breast self-examination (OR = 12.29, 95% CI = 5.31-28.48). The BCI program improved KAP toward breast cancer. Further research is warranted to provide stronger evidence that the program improves breast cancer early detection.
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Affiliation(s)
- Marisa Mena
- Epidemiology for Cancer Prevention, Team of HIV, Cancer and Global Health, Inserm U897 and Centre René Labusquière, Bordeaux Segalen University, Bordeaux, France; IDIBELL, Institut Català d'Oncologia-Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
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