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Guha S, Talukdar D, Mandal GK, Mukherjee R, Ghosh S, Naskar R, Saha P, Murmu N, Das G. Crude extract of Ruellia tuberosa L. flower induces intracellular ROS, promotes DNA damage and apoptosis in triple negative breast cancer cells. JOURNAL OF ETHNOPHARMACOLOGY 2024; 332:118389. [PMID: 38821138 DOI: 10.1016/j.jep.2024.118389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/14/2024] [Accepted: 05/23/2024] [Indexed: 06/02/2024]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Ruellia tuberosa L. (Acanthaceae) is a weed plant traditionally used in folklore medicine as a diuretic, anti-hypertensive, anti-pyretic, anti-cancerous, anti-diabetic, analgesic, and gastroprotective agent. It has been previously reported that R. tuberosa L. is enriched with various flavonoids, exhibiting significant cytotoxic potential in various cancer models but a detailed study concerning its molecular mechanism is yet to be explored. AIM OF THE STUDY Exploring and validating R. tuberosa L. flower methanolic extract (RTME) as an anti-cancerous agent as per traditional usage with special emphasis on multi-drug resistant human triple-negative breast cancer (TNBC) and investigating the possible signaling networks and regulatory pathways involved in it. MATERIALS AND METHODS In this study, RTME was prepared using methanol, and phytochemical analysis was performed through GC-MS. Then, the extract was tested for its anti-cancer potential through in-vitro cytotoxicity assay, clonogenic assay, wound healing assay, ROS generation assay, cell cycle arrest, apoptotic nuclear morphology study, cellular apoptosis study, mitochondrial membrane potential (MMP) alteration study, protein, and gene expressions alteration study. In addition, toxicological status was evaluated in female Balb/C mice, and to check the receptor-ligand interactions, in-silico molecular docking was also conducted. RESULTS Several phytochemicals were found within RTME through GC-MS, which have been already reported to act as ROS inductive, DNA damaging, cell cycle arresting, and apoptotic agents against cancer cells. Moreover, RTME was found to exhibit significant in-vitro cytotoxicity along with a reduction in colony formation, and inhibition of cell migratory potential. It also induced intracellular ROS, promoted G0/G1 cell cycle arrest, caused mitochondrial membrane potential (MMP) alteration, and promoted cell death. The Western blot and qRT-PCR data revealed that RTME promoted the intrinsic pathway of apoptosis. Furthermore, blood parameters and organ histology on female Balb/C mice disclosed the non-toxic nature of RTME. Finally, an in-silico molecular docking study displayed that the three identified lead phytochemicals in RTME show strong receptor-ligand interactions with the anti-apoptotic Bcl-2 and give a clue to the possible molecular mechanism of the RTME extract. CONCLUSIONS RTME is a potential source of several phytochemicals that have promising therapeutic potential against TNBC cells, and thus could further be utilized for anti-cancer drug development.
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Affiliation(s)
- Subhabrata Guha
- Department of Signal Transduction and Biogenic Amines, Chittaranjan National Cancer Institute, 37 S.P. Mukherjee Road, Kolkata, 700026, West Bengal, India; Department of Cancer Chemoprevention, Chittaranjan National Cancer Institute, 37 S.P. Mukherjee Road, Kolkata, 700026, West Bengal, India.
| | - Debojit Talukdar
- Department of Signal Transduction and Biogenic Amines, Chittaranjan National Cancer Institute, 37 S.P. Mukherjee Road, Kolkata, 700026, West Bengal, India.
| | - Gautam Kumar Mandal
- IQ City Medical College Hospital, IQ City Road, Durgapur, 713206, West Bengal, India.
| | - Rimi Mukherjee
- Department of Signal Transduction and Biogenic Amines, Chittaranjan National Cancer Institute, 37 S.P. Mukherjee Road, Kolkata, 700026, West Bengal, India.
| | - Srestha Ghosh
- Department of Signal Transduction and Biogenic Amines, Chittaranjan National Cancer Institute, 37 S.P. Mukherjee Road, Kolkata, 700026, West Bengal, India.
| | - Rahul Naskar
- Department of Chemistry, Jadavpur University, Kolkata, 700032, West Bengal, India.
| | - Prosenjit Saha
- Department of Cancer Chemoprevention, Chittaranjan National Cancer Institute, 37 S.P. Mukherjee Road, Kolkata, 700026, West Bengal, India.
| | - Nabendu Murmu
- Department of Signal Transduction and Biogenic Amines, Chittaranjan National Cancer Institute, 37 S.P. Mukherjee Road, Kolkata, 700026, West Bengal, India.
| | - Gaurav Das
- Department of Signal Transduction and Biogenic Amines, Chittaranjan National Cancer Institute, 37 S.P. Mukherjee Road, Kolkata, 700026, West Bengal, India.
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Feunaing RT, Tamfu AN, Gbaweng AJY, Djoko CLT, Ntchapda F, Henoumont C, Laurent S, Talla E, Anouar EH, Zingue S, Dinica RM. 3,3'4-trimethoxy-4'-rutinosylellagic acid and its acetylated derivative: Antioxidant activity and antiproliferative effects on breast cancer cells and molecular docking study. Biomed Pharmacother 2024; 179:117370. [PMID: 39208664 DOI: 10.1016/j.biopha.2024.117370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 08/13/2024] [Accepted: 08/26/2024] [Indexed: 09/04/2024] Open
Abstract
Cancers account for many deaths worldwide and natural compounds and their derivatives are interesting chemotherapeutic agents for cancer drug development. In this study, a natural compound 3,3'4-trimethoxy-4'-rutinosylellagic acid (TR2) and its acetylated derivative 3,3'4-trimethoxy-4'-hexaacetylrutinosylellagic acid (TR22) were evaluated for their antioxidant and anticancer effects against estrogen sensitive (MCF-7) and estrogen non-sensitive (MDA-MB 231) breast adenocarcinoma. In the β-Carotene-linoleic acid assay, DPPH• radical scavenging and CUPRAC assay, the compound TR2 had better activity than the standard α-Tocopherol, while in the ABTS•+ assay, it was more active than both standards α- α-Tocopherol and BHA. Both compounds had good antioxidant effects with TR2 being more active than TR22. Both compounds inhibited growth of breast carcinoma cells when compared to the untreated controls after 72 h. Compound TR22 significantly (p < 0.001) inhibited proliferation of both MCF-7 and MDA-MB 231 breast carcinoma cell lines suggesting that acetylation reaction improves inhibition of breast cancer cells growth. On the contrary, TR2 exhibited better inhibitory effect of clone formation than TR22 suggesting that acetylation reduces the activity in this assay. Both compounds inhibited migration of the cancer cells when compared to the untreated control cells and compound TR2 exhibited greater cellular anti-migration effect than TR22 at the same concentration and after the same period of incubation. Molecular docking studies supplemented the results and revealed that TR2 and TR22 had appreciable interactions with tyrosine kinase with negative binding energies suggesting that they are potent receptor tyrosine kinase inhibitors which can impede on cancer progression.
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Affiliation(s)
- Romeo Toko Feunaing
- Department of Chemistry, Faculty of Sciences, University of Ngaoundere, P.O. Box 454, Ngaoundere, Cameroon
| | - Alfred Ngenge Tamfu
- Department of Chemical Engineering, School of Chemical Engineering and Mineral Industries, University of Ngaoundere, P.O. Box 454, Ngaoundere, Cameroon; Department of Chemistry, Physics and Environment, Faculty of Sciences and Environment, 'Dunarea de Jos University', 47 Domneasca Str., Galati 800008, Romania.
| | - Abel Joel Yaya Gbaweng
- Department of Chemistry, Faculty of Sciences, University of Ngaoundere, P.O. Box 454, Ngaoundere, Cameroon
| | | | - Fidele Ntchapda
- Department of Biological Sciences, Faculty of Science, University of Ngaoundere, P.O. Box 454, Ngaoundere, Cameroon
| | - Celine Henoumont
- Laboratory of NMR and Molecular Imaging, Department of General, Organic Chemistry and Biomedical, University of Mons, Mons B-7000, Belgium
| | - Sophie Laurent
- Laboratory of NMR and Molecular Imaging, Department of General, Organic Chemistry and Biomedical, University of Mons, Mons B-7000, Belgium
| | - Emmanuel Talla
- Department of Chemistry, Faculty of Sciences, University of Ngaoundere, P.O. Box 454, Ngaoundere, Cameroon; Department of Chemical Engineering, School of Chemical Engineering and Mineral Industries, University of Ngaoundere, P.O. Box 454, Ngaoundere, Cameroon
| | - El Hassane Anouar
- Department of Chemistry, College of Sciences and Humanities in Al-Kharj, Prince Sattam bin Ab-dulaziz University, P.O. Box 830 Al-Kharj, Saudi Arabia
| | - Stephane Zingue
- Department of Pharmacotoxicology and Pharmacokinetics, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, P.O. Box 1364, Yaounde, Cameroon
| | - Rodica Mihaela Dinica
- Department of Chemistry, Physics and Environment, Faculty of Sciences and Environment, 'Dunarea de Jos University', 47 Domneasca Str., Galati 800008, Romania.
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Adesunkanmi AO, Wuraola FO, Fagbayimu OM, Calcuttawala MA, Wahab T, Adisa AO. Oncoplastic Breast-Conserving Surgery in African Women: A Systematic Review. JCO Glob Oncol 2024; 10:e2300460. [PMID: 39052945 DOI: 10.1200/go.23.00460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 04/22/2024] [Accepted: 06/03/2024] [Indexed: 07/27/2024] Open
Abstract
PURPOSE Breast cancer is the most frequently diagnosed cancer in women worldwide. Surgery is a major treatment modality for breast cancer, and over the years, breast-conserving surgeries with breast radiation have shown similar outcomes with mastectomy. Not much is known about the frequency and outcome of breast-conserving surgery in Africa. This systematic review provides a comprehensive summary of the evidence evaluating cosmetic and oncologic outcomes after oncoplastic breast-conserving surgery (OBCS) for breast cancer in African women. METHODS This review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Databases were systematically searched for studies on African women undergoing OBCS. The oncologic and cosmetic outcomes, as well as the localization and reconstruction techniques, were evaluated. Descriptive statistics were used to summarize the frequency and proportions of the extracted variables. RESULTS The literature search yielded 266 articles but only 26 of these were included in the review. Majority of the studies were from Egypt and South Africa. These studies collectively evaluated 1,896 patients with a mean age of 48.2 years and a mean follow-up period of 36.9 months. The most common histopathology was T2 (71.4%) invasive ductal carcinoma. Hook wire localization was the most common technique used for nonpalpable lesions in 85.3% of patients. Of the studies reporting oncoplastic technique, the latissimus dorsi volume replacement technique was the most reported (15%). Most patients were satisfied with their cosmetic outcome. Seroma was the most common postoperative complication (44.6%). Among studies that reported oncologic outcome data, the crude overall survival and disease-free survival were 93.1% and 89.4%, respectively. CONCLUSION This systematic review revealed that the outcome of OBCS in African women compares with that in developed countries.
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Affiliation(s)
| | - Funmilola Olanike Wuraola
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
- Department of Surgery, Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | | | - Tajudeen Wahab
- Elm Breast Care Centre, King George Hospital, London, United Kingdom
| | - Adewale Oluseye Adisa
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
- Department of Surgery, Obafemi Awolowo University, Ile-Ife, Nigeria
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Gbenonsi GY, Martini J, Mahieu C. An analytical framework for breast cancer public policies in Sub-Saharan Africa: results from a comprehensive literature review and an adapted policy Delphi. BMC Public Health 2024; 24:1535. [PMID: 38849808 PMCID: PMC11157826 DOI: 10.1186/s12889-024-18937-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 05/23/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Breast cancer is the leading cause of death from cancer in women and is a major public health problem worldwide. Despite the lower incidence rates of breast cancer in resource-limited settings, especially sub-Saharan Africa, there is a higher mortality rate compared to high-resource countries where the disease has a higher incidence. This makes breast cancer the second deadliest cancer in African women. These poor results reflect the weakness in public health policies. The aim of this paper is to contribute to the effective control of breast cancer by designing a framework for a comprehensive and systemic analysis of these policies in Sub-Saharan Africa. METHODS This research is based on a literature review that adopted a systematic approach followed by a modified policy Delphi involving breast cancer experts in Sub-Saharan Africa. We included narrative reviews and systematic reviews/meta-analyses published between 2015 and 2022 as well as official documents in the analysis. We integrated the World Health Organization's health system building blocks with Walt and Gilson's policy analysis triangle to analyse the information collected and develop our analytical framework. RESULTS A total of 22 reviews and documents were included in the study. Sixteen breast cancer experts from Sub-Saharan Africa participated in the first Delphi round, and nine participated in the second round. The different components identified for a comprehensive and systemic analysis of effective breast cancer policies can be classified into policy content divided according to the health system building blocks and related policy processes; individual, organized national and international policy stakeholders; and policy contexts. CONCLUSION This study enabled the design of a framework suitable for the comprehensive and systemic analysis of breast cancer control policies in Sub-Saharan Africa. This framework can be used as a checklist for stakeholders to guide the planning, implementation and evaluation of policies and specific breast cancer control programmes at the national and facility levels.
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Affiliation(s)
- Gloria Yawavi Gbenonsi
- School of Public Health- Research centre for Social Approaches to Health, Université libre de Bruxelles, Brussels, Belgium.
| | - Jessica Martini
- School of Public Health- Research centre for Social Approaches to Health, Université libre de Bruxelles, Brussels, Belgium
- European Social Observatory (OSE), Brussels, Belgium
| | - Céline Mahieu
- School of Public Health- Research centre for Social Approaches to Health, Université libre de Bruxelles, Brussels, Belgium
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Oppong R, Yeboah D, Owusu-Ansah M, Salifu SP. Radiation Therapy for Breast Cancer in Africa. Adv Radiat Oncol 2024; 9:101488. [PMID: 38681886 PMCID: PMC11043849 DOI: 10.1016/j.adro.2024.101488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 02/15/2024] [Indexed: 05/01/2024] Open
Abstract
Purpose Although radiation therapy is an effective treatment for breast cancer, it has a low rate of use in African countries. A systematic review was undertaken to investigate studies that used radiation therapy as a treatment modality for patients with breast cancer in Africa, focusing on survival outcomes, adverse effects, radiation therapy techniques, fractionation schedules, and effectiveness of radiation therapy. Methods and Materials We conducted a comprehensive literature search for studies that treated breast cancer with radiation therapy, using different electronic databases (PubMed, Scopus, and EBSCOhost) up to February 2023. The output was exported to a reference management system for analyses. Results The literature search primarily identified 3804 records from Scopus (2427), PubMed (982), and EBSCOhost (395). Based on the inclusion and exclusion criteria, 19 articles were finally included in this systematic review. Most of the studies published were conducted in North Africa (63%), followed by West Africa (21%) and Southeast Africa (16%). Most centers employed external beam radiation therapy to deliver radiation therapy to patients with breast cancer with the standard fractionation size of 50 Gy in 25 fractions. The long-term outcomes with regards to adverse effect suggests that radiation therapy was fairly tolerated among patients with breast cancer. Conclusions The reports provide substantial evidence that there are limited number of published studies on the use of radiation therapy for breast cancer treatment in Africa, as well as lower overall survival rate compared with developed countries. To improve breast cancer survivorship, it is necessary for government and other health care planners to provide more radiation therapy resources and implement training programs for personnels.
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Affiliation(s)
- Rita Oppong
- Department of Biochemistry and Biotechnology, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - David Yeboah
- Department of Biochemistry and Biotechnology, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | | | - Samson Pandam Salifu
- Department of Biochemistry and Biotechnology, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
- Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kumasi, Ghana
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Fetene D, Taylor L, Ferrell B, Deribe B, Abdella J, Aynalem A. Factors affecting need and utilization of palliative care services among Ethiopian women in an oncology department: A hospital-based cross-sectional study. Palliat Care Soc Pract 2024; 18:26323524241253625. [PMID: 38800039 PMCID: PMC11127578 DOI: 10.1177/26323524241253625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 04/21/2024] [Indexed: 05/29/2024] Open
Abstract
Background Palliative care, which aims to alleviate physical and emotional distress from cancer, is underutilized in many African healthcare systems. Therefore, there is a lack of data on the need and utilization of palliative care services among women with breast cancer in Ethiopia. Objectives The goal of this study was to identify the level of need and utilization of palliative care services and identify associated factors among women in an oncology department of Hawassa comprehensive and specialized hospitals. Design Hospital-based cross-sectional study. Methods A total of 121 women age ⩾18 years old with breast cancer participated from 1 August to 30 October 2021. A hospital-based consecutive sampling technique was used. Data regarding the need and utilization of palliative care services were collected via questionnaire and interview, entered using EpiData 4.6.0.6, and analyzed by SPSS version 25. Variables with p < 0.25 were considered for multivariate analysis, and those with p < 0.05 indicate an association with palliative care utilization. Result Seventy-two (59.5%) had worse utilization of palliative care services, with higher odds in rural areas (adjusted odds ratio = 11.82). Conclusion The study findings indicated that more than half of the study participants had worse utilization of palliative care services, with rural living being a contributing factor.
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Affiliation(s)
- Deriba Fetene
- Department of Nursing, School of Health Sciences, College of Medicine and Health Sciences, Madda Walabu University, Bale Robe, Oromia 247, Ethiopia
| | - Lesley Taylor
- Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Betty Ferrell
- Division of Nursing Research and Education, City of Hope Medical Center, Duarte, CA, USA
| | - Bedilu Deribe
- School of Nursing, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Jabir Abdella
- School of Nursing, College of Medicine and Health Sciences, Wachemo University, Hosanna, Ethiopia
| | - Amdehiwot Aynalem
- School of Nursing, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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Asuquo EO, Absolom K, Ebenso B, Allsop MJ. Symptoms, concerns, and experiences of women living with and beyond breast cancer in Africa: A mixed-methods systematic review. Psychooncology 2024; 33:e6342. [PMID: 38747633 DOI: 10.1002/pon.6342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 03/10/2024] [Accepted: 03/30/2024] [Indexed: 05/21/2024]
Abstract
OBJECTIVE A mixed-methods systematic review to determine reported symptoms, concerns, and experiences of women living with and beyond breast cancer in Africa. METHODS Literature searches were conducted in Medline, Embase, PsycINFO, Global Health, Web of Science, CINAHL, and the Cochrane Library. Quantitative and qualitative studies that comprised study populations of women with breast cancer from countries in Africa, detailing symptoms, concerns, and experiences of living with and beyond breast cancer were included. Inductive framework analysis was applied to organise existing literature with the Adversity, Restoration, and Compatibility framework and quality was assessed using the Mixed Methods Appraisal Tool. RESULTS In total, 48 studies were included, comprising quantitative (n = 24), qualitative (n = 23) and mixed method (n = 1) studies. Women reported multiple complex and burdensome symptoms at all stages of the breast cancer disease trajectory. Multiple pervasive factors influencing participants' experiences included a lack of cancer knowledge, being removed from decision-making, religion, and the presence and use of traditional medicines. Literature relating to benefit finding, understanding identity for the future, and broader perspectives of well-being was absent. CONCLUSIONS This review contributes insights and mapping of symptoms, concerns, and experiences of women with breast cancer in Africa. There is a great necessity to increase an understanding of the needs and experiences of women with breast cancer in Africa following cancer treatment, stages of remission, and longer-term monitoring and follow-up. This is required to ensure access to prompt and timely clinical and individualized supportive care for women with breast cancer in Africa.
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Affiliation(s)
- Eme O Asuquo
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Kate Absolom
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Bassey Ebenso
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Mathew J Allsop
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Limenih MA, Mekonnen EG, Birhanu F, Jima BR, Sisay BG, Kassahun EA, Hassen HY. Survival Patterns Among Patients With Breast Cancer in Sub-Saharan Africa: A Systematic Review and Meta-Analysis. JAMA Netw Open 2024; 7:e2410260. [PMID: 38743426 PMCID: PMC11094564 DOI: 10.1001/jamanetworkopen.2024.10260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/05/2024] [Indexed: 05/16/2024] Open
Abstract
Importance Breast cancer is the most prevalent cancer globally with tremendous disparities both within specific regions and across different contexts. The survival pattern of patients with breast cancer remains poorly understood in sub-Saharan African (SSA) countries. Objective To investigate the survival patterns of patients with breast cancer in SSA countries and compare the variation across countries and over time. Data Sources Embase, PubMed, Web of Science, Scopus, and ProQuest were searched from inception to December 31, 2022, with a manual search of the references. Study Selection Cohort studies of human participants that reported 1-, 2-, 3-, 4-, 5-, and 10-year survival from diagnosis among men, women, or both with breast cancer in SSA were included. Data Extraction and Synthesis Independent extraction of study characteristics by multiple observers was performed using open-source software, then exported to a standard spreadsheet. A random-effects model using the generalized linear mixed-effects model was used to pool data. The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guideline for reporting was followed. Main Outcome and Measures Survival time from diagnosis. Results Forty-nine studies were included in the review with a sample size ranging from 21 to 2311 (total, 14 459; 196 [1.35%] men, 13 556 [93.75%] women, and 707 [4.90%] unspecified; mean age range, 38 to 71 years), of which 40 were summarized using meta-analysis. The pooled 1-year survival rate of patients with breast cancer in SSA was 0.79 (95% CI, 0.67-0.88); 2-year survival rate, 0.70 (95% CI, 0.57-0.80); 3-year survival rate, 0.56 (95% CI, 0.45-0.67); 4-year survival rate, 0.54 (95% CI, 0.43-0.65); and 5-year survival rate, 0.40 (95% CI, 0.32-0.49). The subgroup analysis showed that the 5-year survival rate ranged from 0.26 (95% CI, 0.06-0.65) for studies conducted earlier than 2010 to 0.47 (95% CI, 0.32-0.64) for studies conducted later than 2020. Additionally, the 5-year survival rate was lower in countries with a low human development index (HDI) (0.36 [95% CI, 0.25-0.49) compared with a middle HDI (0.46 [95% CI, 0.33-0.60]) and a high HDI (0.54 [95% CI, 0.04-0.97]). Conclusions and Relevance In this systematic review and meta-analysis, the survival rates for patients with breast cancer in SSA were higher in countries with a high HDI compared with a low HDI. Enhancing patient survival necessitates a comprehensive approach that involves collaboration from all relevant stakeholders.
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Affiliation(s)
- Miteku Andualem Limenih
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Eskedar Getie Mekonnen
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Frehiwot Birhanu
- Department of Health Service Management, School of Public Health, College of Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Beshada Rago Jima
- Department of Nutrition and Dietetics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Binyam Girma Sisay
- School of Exercise and Nutritional Sciences, Faculty of Health, Deakin University, Melbourne, Victoria, Australia
| | - Eskeziaw Abebe Kassahun
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Hamid Yimam Hassen
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- VITO Health, Flemish Institute for Technological Research (VITO), Mol, Belgium
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Pizzato M, Santucci C, Parazzini F, Negri E, La Vecchia C. Cancer mortality patterns in selected Northern and Southern African countries. Eur J Cancer Prev 2024; 33:192-199. [PMID: 37997906 DOI: 10.1097/cej.0000000000000852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
BACKGROUND Non-communicable diseases have been rapidly increasing in African countries. We provided updated cancer death patterns in selected African countries over the last two decades. METHODS We extracted official death certifications and population data from the WHO and the United Nations Population Division databases. We computed country- and sex-specific age-standardized mortality rates per 100 000 person-years for all cancers combined and ten major cancer sites for the periods 2005-2007 and 2015-2017. RESULTS Lung cancer ranked first for male cancer mortality in all selected countries in the last available period (with the highest rates in Réunion 24/100 000), except for South Africa where prostate cancer was the leading cause of death (23/100 000). Prostate cancer ranked second in Morocco and Tunisia and third in Mauritius and Réunion. Among Egyptian men, leukemia ranked second (with a stable rate of 4.2/100 000) and bladder cancer third (3.5/100 000). Among women, the leading cancer-related cause of death was breast cancer in all selected countries (with the highest rates in Mauritius 19.6/100 000 in 2015-2017), except for South Africa where uterus cancer ranked first (17/100 000). In the second rank there were colorectal cancer in Tunisia (2/100 000), Réunion (9/100 000) and Mauritius (8/100 000), and leukemia in Egypt (3.2/100 000). Colorectal and pancreas cancer mortality rates increased, while stomach cancer mortality rates declined. CONCLUSION Certified cancer mortality rates are low on a global scale. However, mortality rates from selected screening detectable cancers, as well as from infection-related cancers, are comparatively high, calling for improvements in prevention strategies.
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Affiliation(s)
- Margherita Pizzato
- Department of Clinical Sciences and Community Health, University of Milan, Milan
| | - Claudia Santucci
- Department of Clinical Sciences and Community Health, University of Milan, Milan
| | - Fabio Parazzini
- Department of Clinical Sciences and Community Health, University of Milan, Milan
| | - Eva Negri
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milan
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Igbokwe KK. Comparative examination of breast cancer burden in sub-Saharan Africa, 1990-2019: estimates from Global Burden of Disease 2019 study. BMJ Open 2024; 14:e082492. [PMID: 38553071 PMCID: PMC10982725 DOI: 10.1136/bmjopen-2023-082492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 03/19/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVES In view of the widening gap in survival data between high-income and low-income countries, this study aimed to evaluate the most up-to-date burden of female breast cancer and analyse the leading risk factors in countries and regions in sub-Saharan Africa. DESIGN An analysis of Global Burden of Disease (GBD) data. SETTING The data of incidences, deaths, disability-adjusted life years (DALYs) and age-standardised rates (ASR) were retrieved from GBD Results Tool (1 January 1990─31 December 2019) covering 4 sub-Saharan African regions and 44 countries. The burden estimable to the risk factors of breast cancer was also estimated. All estimates were presented as counts and ASR per 100 000 population. PARTICIPANTS Participants included patients with female breast cancer. MAIN OUTCOMES AND MEASURES Absolute numbers and ASR/estimates of incidence, deaths and DALY of female breast cancer by location in 1990 and 2019, with their percentage changes from 1990 to 2019. The leading risk factors (eg, alcohol consumption) of breast cancer in sub-Saharan Africa. RESULTS In sub-Saharan Africa, the incidences of breast cancer increased by 247% in 2019 from 1990, with the highest incidence recorded in Nigeria. The deaths and DALYs of breast cancer increased by 184% and 178%, respectively. From 1990 to 2019, the mortality ASR and DALY ASR increased throughout the region, mostly in Equatorial and Gabon. With varying trends between countries, alcohol consumption and high fasting plasma glucose were noted to be significant contributors to breast cancer deaths between 1990 and 2019. CONCLUSION The results show the increasing burden of breast cancer in sub-Saharan Africa and provide valuable information on the trends of breast cancer and the risk factors attributable to breast cancer across sociodemographic index, region and country. These findings may inform health policies and improve the rational allocation of health resources.
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Nyamhanga T, Eustace RW, Makoye JP, Mutalemwa K. Multi-level barriers to early detection of breast cancer among rural midlife women in Tanzania: A qualitative case study. PLoS One 2024; 19:e0297798. [PMID: 38422068 PMCID: PMC10903879 DOI: 10.1371/journal.pone.0297798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 01/12/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Breast cancer is the second most common cause of cancer mortality among women in Tanzania and thus, early detection and treatment methods are central to improving breast cancer outcomes. However, in low- and middle-income countries in Sub-Saharan Africa, the survival rates remains low due to late presentation. Hence, a significant number of deaths could be prevented if barriers and facilitators to early detection are known. PURPOSE This qualitative case descriptive study explored the possible barriers to awareness and early breast cancer diagnostic services among midlife women in rural Tanzania. METHODS Ten key informant interviews with health systems managers and community health workers and eight focus group discussions with women aged 40-65 years and their spouses were conducted to elicit the study data conducted from July to August 2021. RESULTS The data revealed nine themes describing the barriers to early detection methods across five Socio-Ecological levels of influence, namely: 1) limited knowledge and 2) witchcraft beliefs (individual level); 3) limited male support (interpersonal level); 4) age and gender factors and 5) procrastination (community level) 6) limited availability of services 7) emphasis of curative over preventive care (institutional level); 8) poverty/inability to pay and 9) limitations of health insurance (societal/policy level). CONCLUSIONS The study findings suggest a need to further the design, implementation and evaluation of evidence-based community breast health awareness and education interventions to promote early detection of breast cancer in Tanzania. Specifically, the study highlights the need to address multiple level determinants of influence in breast cancer control as part of the country's Community Health Strategy.
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Affiliation(s)
- Tumaini Nyamhanga
- Department of Developmemt Studies, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Rosemary W. Eustace
- School of Nursing, Kinesiology, and Health Sciences, College of Health, Education and Human Services (CHEH), Wright State University, Dayton, OH, United States of America
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Guefack MGF, Talukdar D, Mukherjee R, Guha S, Mitra D, Saha D, Das G, Damen F, Kuete V, Murmu N. Hypericum roeperianum bark extract suppresses breast cancer proliferation via induction of apoptosis, downregulation of PI3K/Akt/mTOR signaling cascade and reversal of EMT. JOURNAL OF ETHNOPHARMACOLOGY 2024; 319:117093. [PMID: 37634746 DOI: 10.1016/j.jep.2023.117093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/20/2023] [Accepted: 08/24/2023] [Indexed: 08/29/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Hypericum roeperianum is a medicinal spice traditionally used in West Africa to treat female sterility, fungal infections, and cancer. It has previously been reported that H. roeperianum exhibits cytotoxic potential by reducing the viability of cancer cells involving multidrug-resistant phenotypes, but its underlying molecular mechanism remains unknown. AIM OF THE STUDY The mechanistic involvement of H. roeperianum methanolic crude extract (HRC) in attenuating breast cancer progression by exploring the effects on mitochondrial apoptosis and epithelial-mesenchymal transition (EMT) was investigated. MATERIALS AND METHODS In the present study, we examined the anticancer properties of HRC through MTT assay, colony formation, wound healing assay, spheroid formation, DNA fragmentation and flow cytometry for cell cycle arrest, apoptosis (Annexin V/PI staining) and mitochondrial membrane potential (MMP) (JC-1) detection. In addition, western blot analysis of various proteins and quantitative real time PCR of various genes involved in apoptosis, EMT and the PI3K/Akt/mToR signal transduction pathway were performed. RESULTS This study revealed that HRC treatment significantly decreased breast cancer cell viability, colony forming efficiency and reduced the ability of cell migration and spheroid formation. HRC also induced apoptosis in MDA-MB-231 and MCF-7 via promoting G0/G1 cell cycle arrest, disruption of mitochondrial membrane potential and induction of DNA damage. The crude extract induced apoptosis by activating the intrinsic pathway with a stronger effect that relies on the combined potency of associated molecular markers including Bax, Bad, Bcl-2, cytochrome C, caspase-9, and cleaved-PARP. It was also found that HRC regulates the PI3K/Akt/mToR pathway. In addition, HRC inhibited EMT by expressional alteration of Vimentin and E-cadherin, as well as the regulatory transcription factors such as Snail and Slug. The in vitro findings reflected similar mechanistic approach in 4T1 cell induced syngeneic mice model, indicating the reduction of tumor volume along with the significant expressional alteration of EMT and apoptotic markers. CONCLUSION Taken together the findings concluded that H. roeperianum is a potential source of cytotoxic phytochemicals that exhibit abortifacient effect on breast cancer, both in vitro and in vivo, thus could further be utilized in breast cancer therapy.
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Affiliation(s)
- Michel-Gael F Guefack
- Department of Signal Transduction and Biogenic Amines, 37, S. P. Mukherjee Road, Chittaranjan National Cancer Institute (CNCI), Kolkata, 700026, India; Department of Biochemistry, University of Dschang, Dschang, Cameroon, P.O. Box 67, Dschang, Cameroon.
| | - Debojit Talukdar
- Department of Signal Transduction and Biogenic Amines, 37, S. P. Mukherjee Road, Chittaranjan National Cancer Institute (CNCI), Kolkata, 700026, India.
| | - Rimi Mukherjee
- Department of Signal Transduction and Biogenic Amines, 37, S. P. Mukherjee Road, Chittaranjan National Cancer Institute (CNCI), Kolkata, 700026, India.
| | - Subhabrata Guha
- Department of Signal Transduction and Biogenic Amines, 37, S. P. Mukherjee Road, Chittaranjan National Cancer Institute (CNCI), Kolkata, 700026, India.
| | - Debarpan Mitra
- Department of Signal Transduction and Biogenic Amines, 37, S. P. Mukherjee Road, Chittaranjan National Cancer Institute (CNCI), Kolkata, 700026, India.
| | - Depanwita Saha
- Department of Signal Transduction and Biogenic Amines, 37, S. P. Mukherjee Road, Chittaranjan National Cancer Institute (CNCI), Kolkata, 700026, India.
| | - Gaurav Das
- Department of Signal Transduction and Biogenic Amines, 37, S. P. Mukherjee Road, Chittaranjan National Cancer Institute (CNCI), Kolkata, 700026, India.
| | - François Damen
- Department of Chemistry, University of Dschang, Dschang, Cameroon, P.O. Box 67, Dschang, Cameroon.
| | - Victor Kuete
- Department of Biochemistry, University of Dschang, Dschang, Cameroon, P.O. Box 67, Dschang, Cameroon.
| | - Nabendu Murmu
- Department of Signal Transduction and Biogenic Amines, 37, S. P. Mukherjee Road, Chittaranjan National Cancer Institute (CNCI), Kolkata, 700026, India.
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Kasgri KA, Abazari M, Badeleh SM, Badeleh KM, Peyman N. Comprehensive Review of Breast Cancer Consequences for the Patients and Their Coping Strategies: A Systematic Review. Cancer Control 2024; 31:10732748241249355. [PMID: 38767653 PMCID: PMC11107334 DOI: 10.1177/10732748241249355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 03/29/2024] [Accepted: 04/04/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Women with breast cancer usually face multiple short-term and long-term problems in dealing with their acute and chronic symptoms during and after cancer treatment. However, serious gaps remain in addressing these issues in clinical and public health practice. METHODS According to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, we conducted a systematic literature search from 2000-2021 in electronic databases, including Medline, PubMed, Embase, Scopus, Web of Knowledge, and Google Scholar databases using predefined keywords. RESULTS The review identified several significant and interconnected problems in breast cancer patient's treatment and supportive care. The results revealed that these issues are very common among breast cancer patients, and specific attention and serious measures are needed to address these problems. Despite implementing different protocols and programs for covering and addressing these problems, serious gaps still exist in supporting breast cancer patients during clinical and follow-up care. CONCLUSION Developing innovative and holistic approaches and programs based on the multifactorial assessment of symptoms are suggested for addressing and covering the multidimensional requirements of this population. Consequently, thorough evaluation, education, treatment, and referrals should be provided for the most common sequelae of these patients by including appropriate medication, exercise, counselling, occupational therapy, and complementary therapies. The present study provides a more comprehensive source of information about breast cancer patient's medical and supportive needs in comparison with individual studies on symptom experiences.
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Affiliation(s)
- Kobra A. Kasgri
- Department of Midwifery, Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Morteza Abazari
- Department of Pharmaceutical Nanotechnology, School of Pharmacy, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Safa M. Badeleh
- Department of Food and Drug Control, School of Pharmacy, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Kosar M. Badeleh
- Department of Sciences, Islamic Azad University, Sari Branch, Sari, Iran
| | - Nooshin Peyman
- Department of Health Education and Health Promotion, Faculty of Health, Mashhad University of Medical Sciences, Mashhad, Iran
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Daniel O, Ashrafi A, Muthoni MA, Njoki N, Eric H, Marilynn O, Faith AB, Beth WG, Nyakio M, Odero-Marah V, Ragin C, Llanos AAM. Delayed breast cancer presentation, diagnosis, and treatment in Kenya. Breast Cancer Res Treat 2023; 202:515-527. [PMID: 37668821 DOI: 10.1007/s10549-023-07067-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 05/08/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE In this mixed-methods study, we evaluated the factors that contribute to delayed breast cancer (BC) diagnosis and treatment at a Kenyan hospital. METHODS Individuals with a diagnosis of BC, either as a referral or index patient, were recruited to participate in this study through convenience sampling. Data were collected on sociodemographics, health history, and cancer history, diagnosis, and treatment of patients at Kenyatta National Hospital (KNH). For the quantitative analyses, the relationship between sociodemographic and health history factors with stage at diagnosis, number of visits before diagnosis, time to diagnosis, and time to initial intervention, stratified by time to onset of symptoms, were examined using regression analyses. For the qualitative analysis, in-depth interviews of every fifth patient were completed to assess reasons for delayed diagnosis and treatment. RESULTS The final analytic sample comprised of 378 female BC patients with an average age of 50. These females were generally of lower SES: 49.2% attained no or only primary-level education, 57.4% were unemployed, and the majority (74.6%) had a monthly household income of < 5000 Kenyan shillings (equivalent to ~ $41 USD). The median time from BC symptom onset to presentation at KNH was 13 (IQR = 3-36) weeks, from presentation to diagnosis was 17.5 (IQR = 7-36.5) weeks, and from diagnosis to receipt of the initial intervention was 6 (IQR = 3-13) weeks. Female BC patients who were never/unmarried, less educated, less affluent, users of hormonal contraception, and had ≥ 3 children were more likely to experience diagnosis and treatment delays. Qualitative data showed that financial constraints, lack of patient BC awareness, and healthcare practitioner misdiagnosis and/or strikes delayed patient diagnosis and treatment. CONCLUSIONS BC patients experience long healthcare system delays before diagnosis and treatment. Educating communities and providers about BC and expediting referrals may minimize such delays and subsequently BC mortality rates in Kenya.
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Affiliation(s)
- Ojuka Daniel
- Department of Surgery, University of Nairobi, P.O. Box, Nairobi, 19969-00202, Kenya.
- African Caribbean Cancer Consortium, Philadelphia, USA.
| | - Adiba Ashrafi
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Musibi Alice Muthoni
- Cancer Treatment Centre, Kenyatta National Hospital, Nairobi, Kenya
- African Caribbean Cancer Consortium, Philadelphia, USA
| | - Njiraini Njoki
- Cancer Treatment Centre, Kenyatta National Hospital, Nairobi, Kenya
| | - Hungu Eric
- Cancer Treatment Centre, Kenyatta National Hospital, Nairobi, Kenya
- Department of Surgery, Kenyatta National Hospital, Nairobi, Kenya
| | - Omondi Marilynn
- Cancer Treatment Centre, Kenyatta National Hospital, Nairobi, Kenya
- Department of Surgery, Kenyatta National Hospital, Nairobi, Kenya
| | - Aseta Bonareri Faith
- Department of Surgery, University of Nairobi, P.O. Box, Nairobi, 19969-00202, Kenya
| | - Wambui Githambo Beth
- Department of Surgery, University of Nairobi, P.O. Box, Nairobi, 19969-00202, Kenya
| | - Mburu Nyakio
- Department of Surgery, University of Nairobi, P.O. Box, Nairobi, 19969-00202, Kenya
| | - Valerie Odero-Marah
- Biology Department, Center for Urban Health Disparities Research and Innovation, Morgan State University, Baltimore, MD, USA
- African Caribbean Cancer Consortium, Philadelphia, USA
| | - Camille Ragin
- Fox Chase Cancer Center, Cancer Prevention and Control Program, Philadelphia, PA, USA
- African Caribbean Cancer Consortium, Philadelphia, USA
| | - Adana A M Llanos
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
- African Caribbean Cancer Consortium, Philadelphia, USA
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15
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Kinteh B, Kinteh SLS, Jammeh A, Touray E, Barrow A. Breast Cancer Screening: Knowledge, Attitudes, and Practices among Female University Students in The Gambia. BIOMED RESEARCH INTERNATIONAL 2023; 2023:9239431. [PMID: 38075302 PMCID: PMC10703522 DOI: 10.1155/2023/9239431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 06/26/2023] [Accepted: 11/17/2023] [Indexed: 12/18/2023]
Abstract
Background Breast cancer is the second most prevalent form of cancer in The Gambia, with an incidence rate of approximately 15% and a mortality rate exceeding 50% in 2020. The all-age prevalence stands at 11.25 per 100,000 population. In light of this, we conducted a study to assess the knowledge, attitude, and practice of breast cancer screening among female university students. Method We conducted an institutional cross-sectional study involving 361 randomly sampled female university students. Data collection was done using a pretested, self-administered questionnaire. We utilized descriptive statistics to describe the prevalence and burden of breast cancer screening among the participants. Results Our study revealed good knowledge regarding breast cancer screening among female university students, yet 82.8% had a negative attitude about the disease. More than three-quarters (76.6%) of the respondents had never practiced any form of breast cancer screening. Notably, there was a significant association between knowledge of breast cancer screening and attitude (p = 0.027), and factors such as level of study (p = 0.041), ethnicity (p = 0.026), parity (p = 0.018), and faculty of study (p = <0.001) influenced the participants' knowledge. Conclusion It is crucial to implement comprehensive awareness campaigns to address the negative attitude and poor screening practices among female university students regarding breast cancer. Additionally, providing free and widespread breast cancer screening services to students should be considered as a means to combat this disease.
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Affiliation(s)
- Bakary Kinteh
- School of Public Health, Gambia College, Brikama Campus, West Coast Region, Gambia
| | - Sambou L. S. Kinteh
- School of Public Health, Gambia College, Brikama Campus, West Coast Region, Gambia
| | - Amienata Jammeh
- School of Public Health, Gambia College, Brikama Campus, West Coast Region, Gambia
| | - Ebrima Touray
- School of Public Health, Gambia College, Brikama Campus, West Coast Region, Gambia
| | - Amadou Barrow
- School of Public Health, Gambia College, Brikama Campus, West Coast Region, Gambia
- Department of Public & Environmental Health, School of Medicine & Allied Health Sciences, University of The Gambia, Kanifing, Gambia
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Gao W, Wang D, Huang Y. Designing a Deep Learning-Driven Resource-Efficient Diagnostic System for Metastatic Breast Cancer: Reducing Long Delays of Clinical Diagnosis and Improving Patient Survival in Developing Countries. Cancer Inform 2023; 22:11769351231214446. [PMID: 38033362 PMCID: PMC10683375 DOI: 10.1177/11769351231214446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 10/27/2023] [Indexed: 12/02/2023] Open
Abstract
Breast cancer is one of the leading causes of cancer mortality. Breast cancer patients in developing countries, especially sub-Saharan Africa, South Asia, and South America, suffer from the highest mortality rate in the world. One crucial factor contributing to the global disparity in mortality rate is long delay of diagnosis due to a severe shortage of trained pathologists, which consequently has led to a large proportion of late-stage presentation at diagnosis. To tackle this critical healthcare disparity, we have developed a deep learning-based diagnosis system for metastatic breast cancer that can achieve high diagnostic accuracy as well as computational efficiency and mobile readiness suitable for an under-resourced environment. We evaluated 4 Convolutional Neural Network (CNN) architectures: MobileNetV2, VGG16, ResNet50 and ResNet101. The MobileNetV2-based diagnostic model outperformed the more complex VGG16, ResNet50 and ResNet101 models in diagnostic accuracy, model generalization, and model training efficiency. The ROC AUC of MobilenetV2 (0.933, 95% CI: 0.930, 0.936) was higher than VGG16 (0.911, 95% CI: 0.908, 0.915), ResNet50 (0.869, 95% CI: 0.866, 0.873), and ResNet101 (0.873, 95% CI: 0.869, 0.876). The time per inference step for the MobileNetV2 model (15 ms/step) was substantially lower than that of VGG16 (48 ms/step), ResNet50 (37 ms/step), and ResNet110 (56 ms/step). The visual comparisons between the model prediction and ground truth have demonstrated that the MobileNetV2 diagnostic models can identify very small cancerous nodes embedded in a large area of normal cells which is challenging for manual image analysis. Equally Important, the light weight MobleNetV2 models were computationally efficient and ready for mobile devices or devices of low computational power. These advances empower the development of a resource-efficient and high performing AI-based metastatic breast cancer diagnostic system that can adapt to under-resourced healthcare facilities in developing countries.
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Affiliation(s)
- William Gao
- Department of Mathematics and Statistics, University of Maryland, Baltimore County, Baltimore, MD, USA
| | | | - Yi Huang
- Department of Mathematics and Statistics, University of Maryland, Baltimore County, Baltimore, MD, USA
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Mapanga W, Ayeni OA, Chen WC, Jacobson JS, Neugut AI, Ruff P, Cubasch H, O’Neil DS, Buccimazza I, Čačala S, Stopforth LW, Farrow HA, Nietz S, Phakathi B, Chirwa T, McCormack VA, Joffe M. The South African breast cancer and HIV outcomes study: Profiling the cancer centres and cohort characteristics, diagnostic pathways, and treatment approaches. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002432. [PMID: 37874786 PMCID: PMC10597516 DOI: 10.1371/journal.pgph.0002432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/31/2023] [Indexed: 10/26/2023]
Abstract
The South African Breast Cancer and HIV Outcomes prospective cohort (SABCHO) study was established to investigate survival determinants among HIV-positive and HIV-negative SA women with breast cancer. This paper describes common and unique characteristics of the cancer centres and their participants, examining disparities in pathways to diagnosis, treatment resources and approaches adopted to mitigate resource constraints. The Johannesburg (Jhb), Soweto (Sow), and Durban (Dbn) sites treat mainly urban, relatively better educated and more socioeconomically advantaged patients whereas the Pietermaritzburg (Pmb) and Empangeni (Emp) sites treat predominantly rural, less educated and more impoverished communities The Sow, Jhb, and Emp sites had relatively younger patients (mean ages 54 ±14.5, 55±13.7 and 54±14.3 respectively), whereas patients at the Dbn and Pmb sites, with greater representation of Asian Indian women, were relatively older (mean age 57 ±13.9 and 58 ±14.6 respectively). HIV prevalence among the cohort was high, ranging from 15%-42%, (Cohort obesity (BMI ≥ 30 kg/m2) at 60%, self-reported hypertension (41%) and diabetes (13%). Direct referral of patients from primary care clinics to cancer centre occurred only at the Sow site which uniquely ran an open clinic and where early stage (I and II) proportions were highest at 48.5%. The other sites relied on indirect patient referral from regional hospitals where significant delays in diagnostics occurred and early-stage proportions were a low (15%- 37.3%). The Emp site referred patients for all treatments to the Dbn site located 200km away; the Sow site provided surgery and endocrine treatment services but referred patients to the Jhb site 30 Km away for chemo- and radiation therapy. The Jhb, Dbn and Pmb sites all provided complete oncology treatment services. All treatment centres followed international guidelines for their treatment approaches. Findings may inform policy interventions to address national and regional disparities in breast cancer care.
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Affiliation(s)
- Witness Mapanga
- Faculty of Health Sciences, Strengthening Oncology Services Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Faculty of Health Sciences, DSI-NRF Centre of Excellence in Human Development, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
- Faculty of Health Sciences, Department of Medicine, Division of Medical Oncology, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Oluwatosin A. Ayeni
- Faculty of Health Sciences, Strengthening Oncology Services Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Faculty of Health Sciences, Department of Radiation Oncology, University of the Witwatersrand, Johannesburg, South Africa
| | - Wenlong Carl Chen
- Faculty of Health Sciences, Strengthening Oncology Services Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
- Faculty of Health Sciences, Sydney Brenner Institute for Molecular Bioscience, University of the Witwatersrand, Johannesburg, South Africa
| | - Judith S. Jacobson
- Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Alfred I. Neugut
- Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
| | - Paul Ruff
- Faculty of Health Sciences, Strengthening Oncology Services Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Faculty of Health Sciences, Department of Medicine, Division of Medical Oncology, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
- South Africa Medical Research Council Common Epithelial Cancers Research Centre, University of Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | - Herbert Cubasch
- Faculty of Health Sciences, Strengthening Oncology Services Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- South Africa Medical Research Council Common Epithelial Cancers Research Centre, University of Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
- Faculty of Health Sciences, Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
| | - Daniel S. O’Neil
- Yale Cancer Center and Department of Medicine, Yale University, New Haven, CT, United States of America
| | - Ines Buccimazza
- Faculty of Health Sciences, Strengthening Oncology Services Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Specialized Surgery, Inkosi Albert Luthuli Central Hospital, Durban and Ngwelezane Hospital, University of KwaZulu-Natal, Empangeni, KwaZulu-Natal, South Africa
| | - Sharon Čačala
- Faculty of Health Sciences, Strengthening Oncology Services Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Departments of Surgery and Radiation Oncology, Grey’s Hospital, University of KwaZulu-Natal, Pietermaritzburg, KwaZulu-Natal, South Africa
| | - Laura W. Stopforth
- Faculty of Health Sciences, Strengthening Oncology Services Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Departments of Surgery and Radiation Oncology, Grey’s Hospital, University of KwaZulu-Natal, Pietermaritzburg, KwaZulu-Natal, South Africa
| | - Hayley A. Farrow
- Departments of Surgery and Radiation Oncology, Grey’s Hospital, University of KwaZulu-Natal, Pietermaritzburg, KwaZulu-Natal, South Africa
| | - Sarah Nietz
- Faculty of Health Sciences, Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
- Charlotte Maxeke Surgical Breast Unit, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Boitumelo Phakathi
- Charlotte Maxeke Surgical Breast Unit, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
- Faculty of Health Sciences, Department of Surgery, School of Clinical Medicine, University of Kwa-Zulu Natal, Durban, South Africa
| | - Tobias Chirwa
- Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Valerie A. McCormack
- Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France
| | - Maureen Joffe
- Faculty of Health Sciences, Strengthening Oncology Services Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- South Africa Medical Research Council Common Epithelial Cancers Research Centre, University of Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
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Magwesela FM, Msemakweli DO, Fearon D. Barriers and enablers of breast cancer screening among women in East Africa: a systematic review. BMC Public Health 2023; 23:1915. [PMID: 37794414 PMCID: PMC10548570 DOI: 10.1186/s12889-023-16831-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 09/25/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Breast cancer is among the most common cancers globally with a projected increase in incidence and mortality in low- and middle-income countries. The majority of the patients in East Africa present with advanced disease contributing to poor disease outcomes. Breast cancer screening enables earlier detection of the disease and therefore reduces the poor outcomes associated with the disease. This study aims to identify and synthesize the reported barriers and enablers of breast cancer screening among East African women. METHODS Medline, Embase, SCOPUS, and Cochrane library were searched for articles published on the subject from start to March 2022 using PRISMA guidelines. Also, forward citation, manual search of references and searching of relevant journals were done. A thematic synthesis was carried out on the "results/findings" sections of the identified qualitative papers followed by a multi-source synthesis with quantitative findings. RESULTS Of 4560 records identified, 51 were included in the review (5 qualitative and 46 quantitative), representing 33,523 women. Thematic synthesis identified two major themes - "Should I participate in breast cancer screening?" and "Is breast cancer screening worth it?". Knowledge of breast cancer and breast cancer screening among women was identified as the most influencing factor. CONCLUSION This review provides a rich description of factors influencing uptake of breast cancer screening among East African women. Findings from this review suggest that improving knowledge and awareness among both the public and providers may be the most effective strategy to improve breast cancer screening in Eastern Africa.
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Affiliation(s)
| | | | - David Fearon
- College of Medicine and Veterinary Medicine, University of Edinburgh, Old College, South Bridge, Edinburgh, EH8 9YL, UK
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Mwamba M, Lombe DC, Msadabwe S, Bond V, Simwinga M, Sentoogo Ssemata A, Muhumuza R, Seeley J, Mwaka AD, Aggarwal A. A Narrative Synthesis of Literature on the Barriers to Timely Diagnosis and Treatment of Cancer in Sub-Saharan Africa. Clin Oncol (R Coll Radiol) 2023; 35:e537-e548. [PMID: 37302880 DOI: 10.1016/j.clon.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 02/13/2023] [Accepted: 05/22/2023] [Indexed: 06/13/2023]
Abstract
Poor cancer survival outcomes in sub-Saharan Africa (SSA) have been linked to delays in diagnosis and treatment. Here we present a detailed overview of the qualitative literature evaluating the barriers to receiving timely diagnosis and treatment of cancer in SSA. The PubMed, EMBASE, CINAHL, PsycINFO databases were searched to identify qualitative studies reporting on barriers to timely diagnosis of cancer in SSA published between 1995 and 2020. A systematic review methodology was applied, including quality assessment and narrative data synthesis. We identified 39 studies, of which 24 focused on breast or cervical cancer. Only one study focused on prostate cancer and one on lung cancer. When exploring factors contributing to delays, six key themes emerged from the data. The first theme was health service barriers, which included: (i) inadequate numbers of trained specialists; (ii) limited knowledge of cancer among healthcare providers; (iii) poor co-ordination of care; (iv) inadequately resourced health facilities; (v) negative attitudes of healthcare providers towards patients; (vi) high cost of diagnostic and treatment services. The second key theme was patient preference for complementary and alternative medicine; the third was the limited understanding of cancer among the population. The fourth barrier was a patient's personal and family obligations; the fifth was the perceived impact of cancer and its treatment on sexuality, body image and relationships. Finally, the sixth was the stigma and discrimination faced by patients following a diagnosis of cancer. In conclusion, health system, patient level and societal factors all influence the likelihood of timely diagnosis and treatment for cancer in SSA. The results provide a focus for targeting health system interventions, particular with regards to awareness and understanding of cancer in the region.
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Affiliation(s)
- M Mwamba
- Zambart, School of Public Health, Ridgeway Campus, University of Zambia, Lusaka, Zambia.
| | - D C Lombe
- Regional Cancer Treatment Services MidCentral District Health Board, New Zealand
| | - S Msadabwe
- Cancer Diseases Hospital, Lusaka, Zambia
| | - V Bond
- Zambart, School of Public Health, Ridgeway Campus, University of Zambia, Lusaka, Zambia; London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - M Simwinga
- Zambart, School of Public Health, Ridgeway Campus, University of Zambia, Lusaka, Zambia
| | - A Sentoogo Ssemata
- The Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine (MRC/UVRI & LSHTM), Uganda Research Unit, Entebbe, Uganda
| | - R Muhumuza
- The Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine (MRC/UVRI & LSHTM), Uganda Research Unit, Entebbe, Uganda
| | - J Seeley
- The Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine (MRC/UVRI & LSHTM), Uganda Research Unit, Entebbe, Uganda
| | - A D Mwaka
- Department of Medicine, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - A Aggarwal
- London School of Hygiene & Tropical Medicine (LSHTM), London, UK; Institute of Cancer Policy, King's College London, London, UK
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Zamisa SJ, Adeleke AA, Devnarain N, Rhman MA, Owira PMO, Omondi B. The link between relative stability constant of DNA- and BSA-chromenopyrimidine complexes and cytotoxicity towards human breast cancer cells (MCF-7). RSC Adv 2023; 13:21820-21837. [PMID: 37475760 PMCID: PMC10354499 DOI: 10.1039/d3ra01741a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/11/2023] [Indexed: 07/22/2023] Open
Abstract
In this study, we synthesized and characterized ten chromenopyrimidine derivatives using analytical and spectroscopic methods. Studies on DNA and albumin binding affinity, as well as cytotoxicity tests on human breast cancer (MCF-7) cells, of the chromenopyrimidines, were conducted. The natural logarithm of the relative stability constant of DNA- and BSA-chromenopyrimidine complexes [ln(KDNA/KBSA)] was used as a criterion for selecting compounds for cytotoxicity studies. We found that ln(KDNA/KBSA) was inversely related to IC50 values of the compounds in MCF-7 cells. The antiproliferative effects of the compounds were found to induce apoptosis in MCF-7 cells, which is a desired mechanism of cell death. Correlations between the DNA and albumin binding affinities of chromenopyrimidines were established. We propose that this relationship approach can, for a given set of compounds, assist in predicting the cytotoxicity of potential drug candidates towards MCF-7 cells based on their experimentally determined CT-DNA and BSA binding affinities.
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Affiliation(s)
- Sizwe J Zamisa
- School of Chemistry and Physics, University of KwaZulu-Natal Private Bag X54001 Durban 4000 South Africa
| | - Adesola A Adeleke
- School of Chemistry and Physics, University of KwaZulu-Natal Private Bag X54001 Durban 4000 South Africa
| | - Nikita Devnarain
- Molecular and Clinical Pharmacology Research Laboratory, Department of Pharmacology, Discipline of Pharmaceutical Science, University of KwaZulu-Natal Private Bag X54001 Durban 4000 South Africa
| | - Mahasin Abdel Rhman
- Molecular and Clinical Pharmacology Research Laboratory, Department of Pharmacology, Discipline of Pharmaceutical Science, University of KwaZulu-Natal Private Bag X54001 Durban 4000 South Africa
| | - Peter M O Owira
- Molecular and Clinical Pharmacology Research Laboratory, Department of Pharmacology, Discipline of Pharmaceutical Science, University of KwaZulu-Natal Private Bag X54001 Durban 4000 South Africa
| | - Bernard Omondi
- School of Chemistry and Physics, University of KwaZulu-Natal Private Bag X54001 Durban 4000 South Africa
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21
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Marcelin HN, Dasse RS, Yeboah RO, Tariam AD, Kagambega AGZ, Oseni AM, Kouassi YKK, Bilé MA, Toure M, Thakar M, Adoubi I, Kizub D. Circulating natural killer cells and their association with breast cancer and its clinico-pathological characteristics. Ecancermedicalscience 2023; 17:1567. [PMID: 37533944 PMCID: PMC10393315 DOI: 10.3332/ecancer.2023.1567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Indexed: 08/04/2023] Open
Abstract
Purpose Natural killer (NK) cells play a critical role in cancer immunosurveillance and hold promise as both therapies and prognostic markers in advanced disease. We explore factors that may influence NK cell concentration in the peripheral blood of women with breast cancer in Côte d'Ivoire compared to healthy controls and implications for future research in our context. Methods In this cross-sectional case-control study, blood samples were taken from 30 women diagnosed with breast cancer within 6 months of diagnosis and fifteen healthy women at University Teaching Hospital [Centre Hospitalier Universitaire (CHU)] Treichville in Abidjan, Côte d'Ivoire, from March to September 2018. The blood draw could take place at any time following diagnosis and through treatment. Demographic and clinical data were collected. NK cells were isolated, stained, analysed and counted using the flow cytometer at the Department of Immunology at CHU of Cocody. All p-values were two-sided. Results Mean age among 30 women with breast cancer was 49 years old compared to 45 years old for 15 controls (p = 0.41). Among 30 women with breast cancer, 4 (13.3%) had Stage 2 disease, 14 (46.7 %) at Stage 3, and 12 (40%) at Stage 4. Fourteen (46.7%) had breast cancer that was hormone receptor-positive (HR+) HER2-negative, 10 (33.3%) had triple-negative cancer, three (10.0%) had HR+HER2+ disease, and three (10.0%) HR-HER2+ cancer. NK cell concentration was not associated with cancer diagnosis, age, cancer stage, subtype, or type of treatment patients received (p > 0.05). Conclusion Although we did not find an association between NK cell concentration, cancer characteristics or treatment, our results be limited by the small sample size and timing of blood draw. Our next steps include a larger study to explore circulating NK cells prior to any treatment and NK cell infiltration within breast cancer tumour and correlating this with response to treatment and prognosis.
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Affiliation(s)
- Homian N’da Marcelin
- Department of Oncology, Centre Hospitalier Universitaire de Treichville, 7XVV+5P4, Abidjan, Côte d’Ivoire
| | - Romuald S Dasse
- Department of Immunology, Centre Hospitalier Universitaire de Cocody, BP V 3, Abidjan, Côte d’Ivoire
| | - Richard O Yeboah
- Department of Immunology, Centre Hospitalier Universitaire de Cocody, BP V 3, Abidjan, Côte d’Ivoire
| | - Agnès D Tariam
- Department of Immunology, Centre Hospitalier Universitaire de Cocody, BP V 3, Abidjan, Côte d’Ivoire
| | - Arsène G Z Kagambega
- Department of Oncology, Centre Hospitalier Universitaire de Treichville, 7XVV+5P4, Abidjan, Côte d’Ivoire
| | - Akandji M Oseni
- Department of Oncology, Centre Hospitalier Universitaire de Treichville, 7XVV+5P4, Abidjan, Côte d’Ivoire
| | - Y K K Kouassi
- Department of Oncology, Centre Hospitalier Universitaire de Treichville, 7XVV+5P4, Abidjan, Côte d’Ivoire
| | - Michel A Bilé
- Department of Oncology, Centre Hospitalier Universitaire de Treichville, 7XVV+5P4, Abidjan, Côte d’Ivoire
| | - Moctar Toure
- Department of Oncology, Centre Hospitalier Universitaire de Treichville, 7XVV+5P4, Abidjan, Côte d’Ivoire
| | - Monica Thakar
- The Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
| | - Innocent Adoubi
- Department of Oncology, Centre Hospitalier Universitaire de Treichville, 7XVV+5P4, Abidjan, Côte d’Ivoire
| | - Darya Kizub
- University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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22
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Azadnajafabad S, Saeedi Moghaddam S, Mohammadi E, Delazar S, Rashedi S, Baradaran HR, Mansourian M. Patterns of better breast cancer care in countries with higher human development index and healthcare expenditure: Insights from GLOBOCAN 2020. Front Public Health 2023; 11:1137286. [PMID: 37124828 PMCID: PMC10130425 DOI: 10.3389/fpubh.2023.1137286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/07/2023] [Indexed: 05/02/2023] Open
Abstract
Background The huge burden of breast cancer (BC) necessitates the profound and accurate knowledge of the most recent cancer epidemiology and quality of care provided. We aimed to evaluate BC epidemiology and quality of care and examine the effects of socioeconomic development and healthcare expenditure on disparities in BC care. Methods The results from the GLOBOCAN 2020 study were utilized to extract data on female BC, including incidence and mortality numbers, crude rates, and age-standardized rates [age-standardized incidence rates (ASIRs) and age-standardized mortality rates (ASMRs)]. The mortality-to-incidence ratio (MIR) was calculated for different locations and socioeconomic stratifications to examine disparities in BC care, with higher values reflecting poor quality of care and vice versa. In both descriptive and analytic approaches, the human development index (HDI) and the proportion of current healthcare expenditure (CHE) to gross domestic product (CHE/GDP%) were used to evaluate the values of MIR. Results Globally, 2,261,419 (95% uncertainty interval (UI): 2,244,260-2,278,710) new cases of female BC were diagnosed in 2020, with a crude rate of 58.5/100,000 population, and caused 684,996 (675,493-694,633) deaths, with a crude rate of 17.7. The WHO region with the highest BC ASIR (69.7) was Europe, and the WHO region with the highest ASMR (19.1) was Africa. The very high HDI category had the highest BC ASIR (75.6), and low HDI areas had the highest ASMR (20.1). The overall calculated value of female BC MIR in 2020 was 0.30, with Africa having the highest value (0.48) and the low HDI category (0.53). A strong statistically significant inverse correlation was observed between the MIR and HDI values for countries/territories (Pearson's coefficient = -0.850, p-value < 0.001). A significant moderate inverse correlation was observed between the MIR and CHE/GDP values (Pearson's coefficient = -0.431, p-value < 0.001). Conclusions This study highlighted that MIR of BC was higher in less developed areas and less wealthy countries. MIR as an indicator of the quality of care showed that locations with higher healthcare expenditure had better BC care. More focused interventions in developing regions and in those with limited resources are needed to alleviate the burden of BC and resolve disparities in BC care.
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Affiliation(s)
- Sina Azadnajafabad
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
- Non-communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Saeedi Moghaddam
- Non-communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Kiel Institute for the World Economy, Kiel, Germany
| | - Esmaeil Mohammadi
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
- Department of Neurosurgery, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma, OK, United States
| | - Sina Delazar
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sina Rashedi
- Non-communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Rajai Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Baradaran
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
- Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Morteza Mansourian
- Health Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran
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Darré T, Tchandikou L, Simgban P, Bombone M, Djiwa T, N’Timon B, Sama B, Ketevi A, Douaguibe B, N’Bortche BK, Seddoh Y, Tchaou M, Napo-Koura G. Factors associated with late diagnosis of breast cancer in women in Togo, Sub-Saharan Africa. BMC Womens Health 2023; 23:106. [PMID: 36918873 PMCID: PMC10012487 DOI: 10.1186/s12905-023-02257-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/03/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Breast cancer is the most frequently diagnosed cancer in women worldwide. The objective of this study was to identify factors associated with late diagnosis of breast cancer in Togolese women. METHODS We conducted a prospective cross-sectional study with descriptive and analytical purposes on cases of breast cancer in women in 2021, in Togo. The patients included in this study were women followed in the gynecology department for stages III and IV breast cancer. RESULTS We included 62 cases of breast cancer. The average age of the patients was 38.6 ± 12.5 years with extremes of 17 and 76 years. The breast nodule was the most common reason for consultation in 75.8% of cases. The histological types diagnosed were invasive carcinoma of non-specific type (58; 93.55%), mucinous carcinoma (3; 4.84%) and lobular carcinoma (1; 1.61%). For the stage of the cancer, 43 patients were stage III (69.4%) and 19 stage IV (30.6%). In multivariate analysis, the factors associated with late diagnosis of breast cancer were: fear of diagnosis (aOR = 1.29; p = 0.0014), long delay in diagnosis (aOR = 2.62; p = 0.0001) and failure to perform breast self-examination (aOR = 1.68; p = 0.0022). CONCLUSION The fear of the diagnosis, the absence of self-examination of the breasts and the use of traditional treatment and self-medication in first intention constituted the essential factors of the late diagnosis of breast cancer. Strategies should be put in place at the national level to impact on these factors for an early diagnosis of breast cancer.
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Affiliation(s)
- Tchin Darré
- Department of Pathology, University Teaching Hospital of Lomé, Lomé, Togo
- Faculty of Health Sciences, University of Lomé, BP 1515, Lomé, Togo
| | - Lantam Tchandikou
- Department of Pathology, University Teaching Hospital of Lomé, Lomé, Togo
| | - Panakinao Simgban
- Department of Pathology, University Teaching Hospital of Lomé, Lomé, Togo
| | - Mayi Bombone
- Department of Pathology, University Teaching Hospital of Lomé, Lomé, Togo
| | - Toukilnan Djiwa
- Department of Pathology, University Teaching Hospital of Lomé, Lomé, Togo
| | - Bidamin N’Timon
- Department of Imaging, University Teaching Hospital of Lomé and Kara, Lomé, Togo
| | - Bagassam Sama
- Department of Pathology, University Teaching Hospital of Lomé, Lomé, Togo
| | - Ayoko Ketevi
- Department Obstetrics and Gynecology, University Teaching Hospital of Lomé, Lomé, Togo
| | - Baguilane Douaguibe
- Department Obstetrics and Gynecology, University Teaching Hospital of Lomé, Lomé, Togo
| | - Bingo K. N’Bortche
- Department Obstetrics and Gynecology, University Teaching Hospital of Lomé, Lomé, Togo
| | - Yao Seddoh
- Department Obstetrics and Gynecology, University Teaching Hospital of Lomé, Lomé, Togo
| | - Mazamaesso Tchaou
- Department of Imaging, University Teaching Hospital of Lomé and Kara, Lomé, Togo
| | - Gado Napo-Koura
- Department of Pathology, University Teaching Hospital of Lomé, Lomé, Togo
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Misganaw M, Zeleke H, Mulugeta H, Assefa B. Mortality rate and predictors among patients with breast cancer at a referral hospital in northwest Ethiopia: A retrospective follow-up study. PLoS One 2023; 18:e0279656. [PMID: 36701343 PMCID: PMC9879427 DOI: 10.1371/journal.pone.0279656] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/12/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Breast cancer is one of the common global health concerns that affects2.1 million women each year and causes the highest number of cancer-related morbidity and mortality among women. The objective of this study was to determine the mortality rate and its predictors among breast cancer patients at the referral hospitals, in northwest Ethiopia. METHODS A retrospective follow-up study was conducted on breast cancer patients registered between February 01, 2015 and February 28, 2018. They were selected by simple random sampling using computer-generated method and followed until February 29, 2020, in Amhara region referral hospital. A pre-tested data extraction checklist was used to collect data from the registration book and patient medical records. The collected data were entered into Epi-Data version 3.1 and exported to STATA version 14 for analysis. The mortality rate by person-year observation was computed. The Kaplan-Meier survival curve with the log-rank test was used to estimate the survival probabilities of the patients. Bivariate and multivariate Cox regression model was used to identify predictors of mortality. RESULTS The overall mortality rate of breast cancer was 16.9 per 100 person-years observation. The median survival time was 38.3 (IQR: 26.23, 49.4) months. Independent predictors of breast cancer mortality was; Clinical stage IV and stage III (aHR:10.44,95% CI: 8.02,11.93 and aHR: 9.43, 95% CI: 6.29,11.03respectively), number of positive lymph node in the category of 10 and more and number of positive lymph node within the category of 4-9 (aHR:12.58, 95%CI: 5.2, 30.46 and aHR: 4.78, 95% CI: 2.19, 10.43respectively), co-morbidities (aHR:1.5, 95%CI: 1.01,2.21), Postmenopausal (aHR:2.03,95% CI: 1.37, 3), histologic grade III (aHR:2.12, 95% CI: 1.26,3.55) and not received hormonal therapy (aHR: 2.19, 95%CI: 1.52,3.15) were independent predictors of mortality. CONCLUSION The overall mortality rate was 16.9 per 100 person-years. The finding was higher compared to high-income countries. Advanced clinical stage, co-morbidities, menopausal status, and hormonal therapy are the significant predictors of mortality. Early detection and treatment of breast cancer is needed to reduce the mortality rate.
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Affiliation(s)
- Mekides Misganaw
- Department of Adult Health Nursing, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Haymanote Zeleke
- Department of Nursing, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Henok Mulugeta
- Department of Nursing, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
- School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia
| | - Birtukan Assefa
- Department of Pediatric Nursing, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
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Tshabalala G, Blanchard C, Mmoledi K, Malope D, O'Neil DS, Norris SA, Joffe M, Dietrich JJ. A qualitative study to explore healthcare providers' perspectives on barriers and enablers to early detection of breast and cervical cancers among women attending primary healthcare clinics in Johannesburg, South Africa. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001826. [PMID: 37159437 PMCID: PMC10168575 DOI: 10.1371/journal.pgph.0001826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 03/15/2023] [Indexed: 05/11/2023]
Abstract
Low-and-middle income countries (LMICs) contribute approximately 70% of global cancer deaths, and the cancer incidence in these countries is rapidly increasing. Sub-Saharan African (SSA) countries, including South Africa (SA), bear some of the world's highest cancer case fatality rates, largely attributed to late diagnosis. We explored contextual enablers and barriers for early detection of breast and cervical cancers according to facility managers and clinical staff at primary healthcare clinics in the Soweto neighbourhood of Johannesburg, South Africa. We conducted qualitative in-depth interviews (IDIs) between August and November 2021 amongst 13 healthcare provider nurses and doctors as well as 9 facility managers at eight public healthcare clinics in Johannesburg. IDIs were audio-recorded, transcribed verbatim, and entered into NVIVO for framework data analysis. Analysis was stratified by healthcare provider role and identified apriori around the themes of barriers and facilitators for early detection and management of breast and cervical cancers. Findings were conceptualised within the socioecological model and then explored within the capability, opportunity and motivation model of behaviour (COM-B) for pathways that potentially influence the low screening provision and uptake. The findings revealed provider perceptions of insufficient South African Department of Health (SA DOH) training support and staff rotations resulting in providers lacking knowledge and skills on cancer, screening policies and techniques. This coupled with provider perceptions of poor patient cancer and screening knowledge revealed low capacity for cancer screening. Providers also perceived opportunity for cancer screening to be undermined by the limited screening services mandated by the SA DOH, insufficient providers, inadequate facilities, supplies and barriers to accessing laboratory results. Providers perceived women to prefer to self-medicate and consult with traditional healers and access primary care for curative services only. These findings compound the low opportunity to provide and demand cancer screening services. And because the National SA Health Department is perceived by providers not to prioritize cancer nor involve primary care stakeholders in policy and performance indicator development, overworked, unwelcoming providers have little motivation to learn screening skills and provide screening services. Providers reported that patients preferred to go elsewhere and that women perceived cervical cancer screening as painful. These perceptions must be confirmed for veracity among policy and patient stakeholders. Nevertheless, cost-effective interventions can be implemented to address these perceived barriers including multistakeholder education, mobile and tent screening facilities and using existing community fieldworkers and NGO partners in providing screening services. Our results revealed provider perspectives of complex barriers to the early detection and management of breast and cervical cancers in primary health clinic settings in Greater Soweto. These barriers together appear potentially to produce compounding effects, and therefore there is a need to research the cumulative impact but also engage with stakeholder groups to verify findings and create awareness. Additionally, opportunities do exist to intervene across the cancer care continuum in South Africa to address these barriers by improving the quality and volume of provider cancer screening services, and in turn, increasing the community demand and uptake for these services.
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Affiliation(s)
- Gugulethu Tshabalala
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Charmaine Blanchard
- Strengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Centre for Palliative Care, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Keletso Mmoledi
- Strengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Centre for Palliative Care, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Desiree Malope
- Strengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- SAMRC Developmental Pathways to Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Daniel S O'Neil
- Yale Cancer Center, Department of Medicine, Yale School of Medicine, Yale University, New Haven, United States of America
| | - Shane A Norris
- South African Medical Research Council Common Epithelial Cancer Research Centre, Tygerberg, South Africa
| | - Maureen Joffe
- Strengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- SAMRC Developmental Pathways to Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Yale Cancer Center, Department of Medicine, Yale School of Medicine, Yale University, New Haven, United States of America
| | - Janan Janine Dietrich
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Health Systems Research Unit, South African Medical Research Council, Bellville, South Africa; and African Social Sciences Unit of Research and Evaluation (ASSURE), division of Wits Health Consortium, Johannesburg, South Africa
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Ajibade SSM, Zaidi A, Tapales CP, Ngo-Hoang DL, Ayaz M, Dayupay JP, Aminu Dodo Y, Chaudhury S, Adediran AO. Data Mining Analysis of Online Drug Reviews. 2022 IEEE 10TH CONFERENCE ON SYSTEMS, PROCESS & CONTROL (ICSPC) 2022. [DOI: 10.1109/icspc55597.2022.10001810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/19/2023]
Affiliation(s)
| | - Abdelhamid Zaidi
- Qassim University,College of Science,Department of Mathematics,Qassim,Saudi Arabia
| | | | - Dai-Long Ngo-Hoang
- Vietnam National University,An-Hoi Enterprise Pharmacy, Ben Tre,Ho Chi, Minh City – Ben Tre,Vietnam
| | - Muhammad Ayaz
- Monash University,School of Information Technology,Australia
| | | | - Yakubu Aminu Dodo
- Najran University,College of Engineering,Architectural Engineering Department,Saudi Arabia
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Murphy NJ, Groen RS. Interprofessional Care in Obstetrics and Gynecology. Obstet Gynecol Clin North Am 2022; 49:841-868. [DOI: 10.1016/j.ogc.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Shubayr N, Khmees R, Alyami A, Majrashi N, Alomairy N, Abdelwahab S. Knowledge and Factors Associated with Breast Cancer Self-Screening Intention among Saudi Female College Students: Utilization of the Health Belief Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192013615. [PMID: 36294192 PMCID: PMC9603714 DOI: 10.3390/ijerph192013615] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 09/17/2022] [Accepted: 10/08/2022] [Indexed: 06/01/2023]
Abstract
Breast cancer (BC) screening is vital, as it is linked to a greater likelihood of survival, more effective treatment, and better quality of life. One of the most extensively applied models for conceptualizing probable barriers and facilitators to the adoption of desired health behavior is the health belief model (HBM). This study aimed to assess the impact of health perception and knowledge on breast self-examination intention (BSE) using HBM. HBM measures specific factors (perceived susceptibility, severity, barriers, benefits, cues to action, and self-efficacy) that impact one's intention to use BSE. Data were collected from female undergraduate students (n = 680) using a cross-sectional design, stratified simple random sampling, and a self-administered structured online questionnaire. We used multivariable logistic regression to evaluate our assumptions for students who intended to self-examine for BC. For demographic factors, we modified the multivariate model. Most respondents (93%) were under the age of 24 years. Female students from health colleges (48.5%), in their fourth academic year (42.6%), and from the southern region (57.6%) accounted for the majority of the sample. Respondents with a family history of BC were 9.7% of the total. Categories for age, college, region, residency, and BSE intention showed significant differences in their average knowledge scores. The survey revealed that 72.4% were aware of abnormal breast changes. Three constructs of the health belief model (perceived benefit, perceived barriers, and self-efficacy) are good predictors of BSE intention. Theory-based behavioral change interventions are urgently required for students to improve their prevention practices. Furthermore, these interventions will be effective if they are designed to remove barriers to BSE intention, improve female students' self-efficacy, and enlighten them on the benefits of self-examination.
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Affiliation(s)
- Nasser Shubayr
- Department of Diagnostic Radiography Technology, College of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia
- Medical Research Centre, Jazan University, Jazan 45142, Saudi Arabia
| | - Rola Khmees
- College of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Ali Alyami
- Department of Diagnostic Radiography Technology, College of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia
| | - Naif Majrashi
- Department of Diagnostic Radiography Technology, College of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia
| | - Nada Alomairy
- Department of Diagnostic Radiography Technology, College of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia
| | - Siddig Abdelwahab
- Medical Research Centre, Jazan University, Jazan 45142, Saudi Arabia
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29
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Kizub DA, Naik S, Abogan AA, Pain D, Sammut S, Shulman LN, Martei YM. Access to and Affordability of World Health Organization Essential Medicines for Cancer in Sub-Saharan Africa: Examples from Kenya, Rwanda, and Uganda. Oncologist 2022; 27:958-970. [PMID: 36094141 PMCID: PMC9632308 DOI: 10.1093/oncolo/oyac143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/24/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Cancer mortality is high in sub-Saharan Africa (SSA), partly due to inadequate treatment access. We explored access to and affordability of cancer treatment regimens for the top 10 cancers utilizing examples from Kenya, Uganda, and Rwanda. MATERIALS AND METHODS Population, healthcare financing, minimum wage, and cancer incidence and mortality data were obtained from the WHO, World Bank, public sources, and GLOBOCAN. National Essential Medicines List (NEML) alignment with 2019 WHO EML was assessed as a proportion. Cancer regimen pricing was calculated using public and proprietary sources and methods from prior studies. Affordability through universal healthcare coverage (UHC) was assessed as 1-year cost <3× gross national income per capita; and to patients out-of-pocket (OOP), as 30-day treatment course cost <1 day of minimum wage work. RESULTS A total of 93.4% of the WHO EML cancer medicines were listed on the 2019 Kenya NEML, and 70.5% and 41.1% on Uganda (2016) and Rwanda (2015) NEMLs, respectively. Generic chemotherapies were available and affordable to governments through UHC to treat non-Hodgkin's lymphoma, cervical, breast, prostate, colorectal, ovarian cancers, and select leukemias. Newer targeted agents were not affordable through government UHC purchasing, while some capecitabine-based regimens were not affordable in Uganda and Rwanda. All therapies were not affordable OOP. CONCLUSION All cancer treatment regimens were not affordable OOP and some were not covered by governments. Newer targeted drugs were not affordable to all 3 governments. UHC of cancer drugs and improving targeted therapy affordability to LMIC governments in SSA are key to improving treatment access and health outcomes.
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Affiliation(s)
- Darya A Kizub
- Corresponding author: Darya A. Kizub, UT MD Anderson Cancer Center, Cancer Med—Fellowship Prog, 1515 Holcombe Blvd, Houston, TX 77030-4009, USA. Tel: +1 832 729 1709;
| | | | | | - Debanjan Pain
- Department of Medicine (Hematology-Oncology), University of Pennsylvania, Philadelphia, PA, USA
| | - Stephen Sammut
- Department of Health Care Management, Wharton School, University of Pennsylvania, Philadelphia, PA, USA
| | - Lawrence N Shulman
- Department of Medicine (Hematology-Oncology), University of Pennsylvania, Philadelphia, PA, USA
| | - Yehoda M Martei
- Department of Medicine (Hematology-Oncology), University of Pennsylvania, Philadelphia, PA, USA
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Ren W, Chen M, Qiao Y, Zhao F. Global guidelines for breast cancer screening: A systematic review. Breast 2022; 64:85-99. [PMID: 35636342 PMCID: PMC9142711 DOI: 10.1016/j.breast.2022.04.003] [Citation(s) in RCA: 84] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/28/2022] [Accepted: 04/09/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives Breast cancer screening guidelines could provide valuable tools for clinical decision making by reviewing the available evidence and providing recommendations. Little information is known about how many countries have issued breast cancer screening guidelines and the differences among existing guidelines. We systematically reviewed current guidelines and summarized corresponding recommendations, to provide references for good clinical practice in different countries. Methods Systematic searches of MEDLINE, EMBASE, Web of Science, and Scopus from inception to March 27th, 2021 were conducted and supplemented by reviewing the guideline development organizations. The quality of screening guidelines was assessed from six domains of the Appraisal of Guidelines for Research and Evaluation Ⅱ (AGREE Ⅱ) instrument by two appraisers. The basic information and recommendations of the issued guidelines were extracted and summarized. Results A total of 23 guidelines issued between 2010 and 2021 in 11 countries or regions were identified for further review. The content and quality varied across the guidelines. The average AGREE Ⅱ scores of the guidelines ranged from 33.3% to 87.5%. The highest domain score was "clarity of presentation" while the domain with the lowest score was "applicability". For average-risk women, most of the guidelines recommended mammographic screening for those aged 40–74 years, specifically, those aged 50–69 years were regarded as the optimal age group for screening. Nine of 23 guidelines recommended against an upper age limit for breast cancer screening. Mammography (MAM) was recommended as the primary screening modality for average-risk women by all included guidelines. Most guidelines suggested annual or biennial mammographic screening. Risk factors of breast cancer identified in the guidelines mainly fell within five categories which could be broadly summarized as the personal history of pre-cancerous lesions and/or breast cancer; the family history of breast cancer; the known genetic predisposition of breast cancer; the history of mantle or chest radiation therapy; and dense breasts. For women at higher risk, there was a consensus among most guidelines that annual MAM or annual magnetic resonance imaging (MRI) should be given, and the screening should begin earlier than the average-risk group. Conclusions The majority of 23 included international guidelines were issued by developed countries which contained roughly the same but not identical recommendations on breast cancer screening age, methods, and intervals. Most guidelines recommended annual or biennial mammographic screening between 40 and 74 years for average-risk populations and annual MAM or annual MRI starting from a younger age for high-risk populations. Current guidelines varied in quality and increased efforts are needed to improve the methodological quality of guidance documents. Due to lacking clinical practice guidelines tailored to different economic levels, low- and middle-income countries (LMICs) should apply and implement the evidence-based guidelines with higher AGREE Ⅱ scores considering local adaption. This systematic review comprehensively maps the recommendations of the latest international breast screening guidelines, providing valuable tools for clinical decision making in different settings. Most guidelines recommend annual or biennial mammographic screening between 40 and 74 years for the average-risk populations and annual MAM or annual MRI starting from a younger age for the high-risk populations. However, there are indeed discrepancies in screening age, methods, and intervals among countries. High-quality evidence and rigorous methodology are the keys to guidance development, but current guidelines vary in methodological quality.
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Affiliation(s)
- Wenhui Ren
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Mingyang Chen
- Center for Global Health, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
| | - Youlin Qiao
- Center for Global Health, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
| | - Fanghui Zhao
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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31
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Pace LE, Dusengimana JMV, Hategekimana V, Rugema V, Umwizerwa A, Frost E, Kwait D, Schleimer LE, Huang C, Shyirambere C, Bigirimana JB, Shulman LN, Mpunga T, Raza S. Clinical Diagnoses and Outcomes After Diagnostic Breast Ultrasound by Nurses and General Practitioner Physicians in Rural Rwanda. J Am Coll Radiol 2022; 19:983-989. [PMID: 35738413 DOI: 10.1016/j.jacr.2022.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/24/2022] [Accepted: 04/26/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To scale up early detection of breast cancer in low- and middle-income countries, research is needed to inform the role of diagnostic breast ultrasound performed by nonradiologists in resource-constrained settings. The authors examined 2-year clinical follow-up and outcomes among women who underwent diagnostic breast ultrasound performed by nonradiologist clinicians participating in a breast ultrasound training and mentorship program at a rural Rwandan hospital. METHODS Imaging findings, management plans, and pathologic results were prospectively collected during the training using a standardized form. Data on follow-up and outcomes for patients receiving breast ultrasound between January 2016 and March 2017 were retrospectively collected through medical record review. RESULTS Two hundred twenty-nine breast palpable findings (199 patients) met the study's eligibility criteria. Of 104 lesions initially biopsied, 38 were malignant on initial biopsy; 3 lesions were identified as malignant on repeat biopsy. All 34 patients ultimately diagnosed with cancer received initial recommendations for either biopsy or aspiration by trainees. The positive predictive value of trainee biopsy recommendation was 34.8% (95% confidence interval, 24.8%-45.0%). The sensitivity of trainees' biopsy recommendation for identifying malignant lesions was 92.7% (95% confidence interval, 84.2%-100%). Of 46 patients who did not receive biopsy and were told to return for clinical or imaging follow-up, 37.0% did not return. CONCLUSIONS Trained nonradiologist clinicians in Rwanda successfully identified suspicious breast lesions on diagnostic breast ultrasound. Loss to follow-up was common among patients instructed to return for surveillance, so lower biopsy thresholds, decentralized surveillance, or patient navigation should be considered for patients with low- or intermediate-suspicion lesions.
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Affiliation(s)
- Lydia E Pace
- Director of Women's Health Policy and Advocacy and Director of the Global Women's Health Fellowship, Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | | | | | | | | | - Elisabeth Frost
- Director of Women's Health Policy and Advocacy and Director of the Global Women's Health Fellowship, Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Dylan Kwait
- Director of Women's Health Policy and Advocacy and Director of the Global Women's Health Fellowship, Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | | | - ChuanChin Huang
- Director of Women's Health Policy and Advocacy and Director of the Global Women's Health Fellowship, Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | | | | | - Lawrence N Shulman
- Deputy Director for Clinical Services and Director of Global Cancer Medicine, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Tharcisse Mpunga
- Minister of State for Public Health and Primary Care, Government of Rwanda, Rwanda
| | - Sughra Raza
- Director of Global Radiology, University of Massachusetts Medical Center, Worcester, Massachusetts
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Rweyemamu LP, Gültaşlar BK, Akan G, Dharsee N, Namkinga LA, Lyantagaye SL, Yazıcı H, Atalar F. Breast cancer in East Africa: Prevalence and spectrum of germline SNV/indel and CNVs in BRCA1 and BRCA2 genes among breast cancer patients in Tanzania. Cancer Med 2022; 12:3395-3409. [PMID: 35908255 PMCID: PMC9939169 DOI: 10.1002/cam4.5091] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/08/2022] [Accepted: 07/19/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Growing prevalence and aggressiveness of breast cancer (BC) among East African women strongly indicate that the genetic risk factor implicated in the etiology of the disease may have a key role. Germline pathogenic variants in BRCA1 and BRCA2 (BRCA1/2) are known to increase the lifetime risk of BC. This study investigated the prevalence and spectrum of germline single nucleotide variant/insertion and deletion (SNV/indel), and copy number variations (CNVs) in BRCA1/2 among Tanzanian BC patients, and evaluated the associations of identified variants with patient's socio-demographic and histopathological characteristics. METHODS One hundred BC patients were examined for BRCA1/2 variants using next-generation sequencing (NGS). Sanger sequencing and multiplex ligation-dependent probe amplification (MLPA) assay were performed for the confirmation of SNV/indel and CNVs, respectively. RESULTS Six germline SNV/indel pathogenic variants were detected from six unrelated patients. Five of these variants were identified in BRCA1, and one in BRCA2. We also identified, in one patient, one variant of uncertain clinical significance (VUS). CNV was not detected in any of the BC patients. Furthermore, we found that in our cohort, BRCA1/2 variant carriers were triple-negative BC patients (p = 0.019). CONCLUSIONS Our study provides first insight into BC genetic landscape by the use of NGS in the under-represented East African Tanzanian populations. Our findings support the importance of genetic risk factors in BC etiology in Tanzania and showed a relatively high overall prevalence (6%) of germline BRCA1/2 pathogenic variants in BC patients. Therefore, our results indicate that BRCA1/2 pathogenic variants may well contribute to BC incidence in Tanzania. Thus, the identification of frequent variants in BRCA1/2 genes will enable implementation of rapid, inexpensive population-specific BRCA1/2 genetic testing, particularly for triple-negative BC patients known for their high prevalence in Tanzania. This will, in turn, greatly contributes to provide effective therapeutic strategies.
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Affiliation(s)
- Linus P. Rweyemamu
- Department of Molecular Biology and BiotechnologyUniversity of Dar es SalaamDar es SalaamTanzania,Mbeya College of Health and Allied SciencesUniversity of Dar es SalaamMbeyaTanzania
| | - Büşra K. Gültaşlar
- Division of Cancer Genetics, Department of Basic Oncology, Institute of OncologyIstanbul UniversityIstanbulTurkiye
| | - Gokce Akan
- DESAM Research InstituteNear East UniversityNicosiaCyprus,MUHAS Genetic Laboratory, Department of BiochemistryMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
| | - Nazima Dharsee
- Academic, Research and Consultancy UnitOcean Road Cancer InstituteDar es SalaamTanzania
| | - Lucy A. Namkinga
- Department of Molecular Biology and BiotechnologyUniversity of Dar es SalaamDar es SalaamTanzania
| | - Sylvester L. Lyantagaye
- Department of Molecular Biology and BiotechnologyUniversity of Dar es SalaamDar es SalaamTanzania,Mbeya College of Health and Allied SciencesUniversity of Dar es SalaamMbeyaTanzania
| | - Hülya Yazıcı
- Division of Cancer Genetics, Department of Basic Oncology, Institute of OncologyIstanbul UniversityIstanbulTurkiye,Department of Medical Biology and Genetics, Faculty of MedicineIstanbul Arel UniversityIstanbulTurkiye
| | - Fatmahan Atalar
- MUHAS Genetic Laboratory, Department of BiochemistryMuhimbili University of Health and Allied SciencesDar es SalaamTanzania,Department of Rare Diseases, Child Health InstituteIstanbul UniversityIstanbulTurkiye
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Brahim SM, Zein EE, Bonnet C, Hamed CT, Salame M, Zein MV, Khyatti M, Tolba A, Houmeida A. Screening of BRCA1/2 variants in Mauritanian breast cancer patients. BMC Cancer 2022; 22:802. [PMID: 35858847 PMCID: PMC9301826 DOI: 10.1186/s12885-022-09903-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/04/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND STUDY AIM Carrying a pathogenic BRCA1/2 variant increases greatly young women's risk of developing breast cancer (BC). This study aimed to provide the first genetic data on BC in Mauritania. METHODS Using NGS based screening; we searched for BRCA1/2 variants in DNA samples from 137 patients diagnosed for hereditary BC. RESULTS We identified 16 pathogenic or likely pathogenic (PV) variants carried by 38 patients. Two predominant BRCA1 PV variants were found: c.815_824dup and c.4986 + 6 T > C in 13 and 7 patients, respectively. Interestingly, three novels BRCA1/2 predicted pathogenic variants have also been detected. Notably, no specific distribution of BRCA1/2 variants was observed regarding triple negative breast cancer (TNBC) or patient gender status. CONCLUSIONS In this first genetic profiling of BC in Mauritania, we identified a substantial number of BRCA1/2 pathogenic variants. This finding could be important in the future diagnosis and prevention policy of hereditary BC in Mauritania.
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Affiliation(s)
- Selma Mohamed Brahim
- Unité de Recherche sur les Biomarqueurs dans la Population Mauritanienne. UNA-FST. Unité URBPM Nouakchott-Mauritanie, Nouakchott-Mauritanie, France
- Centre National d'Oncologie (CNO). Unité de Recherche et d'Enseignement, Nouakchott-Mauritanie, France
| | - Ekht Elbenina Zein
- Centre National d'Oncologie (CNO). Unité de Recherche et d'Enseignement, Nouakchott-Mauritanie, France
| | - Crystel Bonnet
- Institut de l'Audition, Institut Pasteur, Inserm, Paris, France
| | | | - Malak Salame
- Unité de Recherche sur les Biomarqueurs dans la Population Mauritanienne. UNA-FST. Unité URBPM Nouakchott-Mauritanie, Nouakchott-Mauritanie, France
| | - Mohamed Vall Zein
- Centre National d'Oncologie (CNO). Unité de Recherche et d'Enseignement, Nouakchott-Mauritanie, France
| | - Meriem Khyatti
- Institut Pasteur du Maroc. Laboratoire Oncologie et Thérapie Cellulaire, Casablanca -aroc, Morocco
| | - Ahmedou Tolba
- Centre National d'Oncologie (CNO). Unité de Recherche et d'Enseignement, Nouakchott-Mauritanie, France
| | - Ahmed Houmeida
- Unité de Recherche sur les Biomarqueurs dans la Population Mauritanienne. UNA-FST. Unité URBPM Nouakchott-Mauritanie, Nouakchott-Mauritanie, France.
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Nthontho KC, Ndlovu AK, Sharma K, Kasvosve I, Hertz DL, Paganotti GM. Pharmacogenetics of Breast Cancer Treatments: A Sub-Saharan Africa Perspective. Pharmgenomics Pers Med 2022; 15:613-652. [PMID: 35761855 PMCID: PMC9233488 DOI: 10.2147/pgpm.s308531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/31/2022] [Indexed: 11/30/2022] Open
Abstract
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.
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Affiliation(s)
- Keneuoe Cecilia Nthontho
- School of Allied Health Professions, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
| | - Andrew Khulekani Ndlovu
- School of Allied Health Professions, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
| | | | - Ishmael Kasvosve
- School of Allied Health Professions, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
| | - Daniel Louis Hertz
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Giacomo Maria Paganotti
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
- Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Biomedical Sciences, Faculty of Medicine, University of Botswana, Gaborone, Botswana
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35
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Heisler Z, Eastwood B, Mwaiselage J, Kahesa C, Msami K, Soliman AS. Return on Investment of a Breast Cancer Screening Program in Tanzania: Opportunity for Patient and Public Education. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:701-708. [PMID: 32980979 PMCID: PMC7997813 DOI: 10.1007/s13187-020-01871-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/04/2020] [Indexed: 06/03/2023]
Abstract
Breast cancer is the second incident and second cause of cancer mortality among women in Tanzania due to late-stage presentation. The screening clinic at the Ocean Road Cancer Institute (ORCI) can help detect cases early and reduce cost of treatment. We calculated the return on investment (ROI) of the ORCI breast screening clinic. Screening and treatment data of all newly diagnosed breast cancer patients seen at ORCI during 2016-2018 were abstracted from the medical records. Also, data on time, resources, and cost of screening and treatment were obtained. The cost of treating screened patients was compared with cost of treating unscreened patients, and differences in cost of treatment were compared with cost of operating the screening program. Of the 730 total patients, 58 were screened prior to treatment, and 672 were not. There was no significant difference between stage at diagnosis and treatments received by screened and unscreened patients (79.3% late- stage vs 72.2% late-stage diagnosis, respectively (p = .531), or cost of treatment between the two groups (cost, in Tanzanian Shillings, for screened (2,167,155.14 or $954.27) vs unscreened (1,918,592.28 or $844.52), (p = .355). There was also no significant difference in cost of treatment between the screened and unscreened groups and a slightly negative ROI (- 0.05%) from implementing the program. The breast screening clinic in Tanzania has not yet proven its cost-effectiveness in reducing stage with screening. The likelihood that patients have utilized the clinic for treatment rather than early detection is a possible reason for the lack of cost-effectiveness. Future studies should focus on educational initiatives to encourage screening at early disease stage. Public education should increase awareness about the clinic for early detection. The experience of this program is ideal for dissemination to other low-income countries that are initiating cancer early detection and cancer education programs.
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Affiliation(s)
- Zoe Heisler
- Department of Health Policy & Management, City University of New York School of Public Health, New York, NY, USA
| | - Betsy Eastwood
- Department of Health Policy & Management, City University of New York School of Public Health, New York, NY, USA
| | | | | | - Khadija Msami
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Amr S Soliman
- Community Health and Social Medicine Department, CUNY School of Medicine, The City College of New York, New York City, NY, USA.
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Hercules SM, Alnajar M, Chen C, Mladjenovic SM, Shipeolu BA, Perkovic O, Pond GR, Mbuagbaw L, Blenman KR, Daniel JM. Triple-negative breast cancer prevalence in Africa: a systematic review and meta-analysis. BMJ Open 2022; 12:e055735. [PMID: 35623750 PMCID: PMC9150263 DOI: 10.1136/bmjopen-2021-055735] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE The aggressive triple-negative breast cancer (TNBC) subtype disproportionately affects women of African ancestry across the diaspora, but its frequency across Africa has not been widely studied. This study seeks to estimate the frequency of TNBC among African populations. DESIGN Systematic review and meta-analysis using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. DATA SOURCES PubMed, EMBASE, African Journals Online and Web of Science were searched on 25 April 2021. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We included studies that use breast cancer tissue samples from indigenous African women with sample size of eligible participants ≥40 and full receptor status for all three receptors (oestrogen receptor (ER)/progesterone receptor (PR)/human epidermal growth factor receptor 2 (HER2)) reported. DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data and assessed risk of bias using the modified assessment tool by Hoy et al. (2012) for prevalence studies. A random-effects meta-analysis was performed, and data were pooled using the inverse-variance method and logit transformation. Pooled frequencies were reported with 95% CIs calculated with the Clopper-Pearson method and heterogeneity quantified with I2 statistic. GRADE assessed the certainty of the evidence. RESULTS 1808 potentially eligible studies were identified of which 67 were included in the systematic review and 60 were included in the meta- analysis. Pooled TNBC frequency across African countries represented was estimated to be 27.0%; 95% CI: 24.0% to 30.2%, I2=94%. Pooled TNBC frequency was highest across West Africa, 45.7% (n=15, 95% CI: 38.8% to 52.8%, I2=91%) and lowest in Central Africa, 14.9% (n=1, 95% CI: 8.9 % to 24.1%). Estimates for TNBC were higher for studies that used Allred guidelines for ER/PR status compared with American Society of Clinical Oncology(ASCO)/College of American Pathologists(CAP) guidelines, and for studies that used older versions of ASCO/CAP guidelines for assessing HER2 status. Certainty of evidence was assessed to be very low using GRADE approach. CONCLUSION TNBC frequency was variable with the highest frequency reported in West Africa. Greater emphasis should be placed on establishing protocols for assessing receptor status due to the variability among studies.
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Affiliation(s)
- Shawn M Hercules
- Biology, McMaster University, Hamilton, Ontario, Canada
- African-Caribbean Cancer Consortium, Philadelphia, Pennsylvania, USA
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Meena Alnajar
- Biology, McMaster University, Hamilton, Ontario, Canada
- Osgoode Hall Law School, York University, Toronto, Ontario, Canada
| | - Chen Chen
- Biology, McMaster University, Hamilton, Ontario, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Stefan M Mladjenovic
- Biology, McMaster University, Hamilton, Ontario, Canada
- Terrence Donnelly Centre for Cellular and Biomolecular Research, University of Toronto, Toronto, Ontario, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Bolade Ajarat Shipeolu
- Biology, McMaster University, Hamilton, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Olga Perkovic
- McMaster University Library, McMaster University, Hamilton, Ontario, Canada
| | - Greg R Pond
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St. Joseph's Healthcare, Hamilton, Ontario, Canada
- Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Kim Rm Blenman
- Department of Internal Medicine, Section of Medical Oncology, Yale University Yale Cancer Center, New Haven, Connecticut, USA
- Department of Computer Science, Yale School of Engineering and Applied Science, Yale University, New Haven, Connecticut, USA
| | - Juliet M Daniel
- Biology, McMaster University, Hamilton, Ontario, Canada
- African-Caribbean Cancer Consortium, Philadelphia, Pennsylvania, USA
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Breast Cancer Screening in Low-Income Countries: A New Program for Downstaging Breast Cancer in Tanzania. BIOMED RESEARCH INTERNATIONAL 2022; 2022:9795534. [PMID: 35425839 PMCID: PMC9005288 DOI: 10.1155/2022/9795534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 02/08/2022] [Accepted: 03/08/2022] [Indexed: 11/17/2022]
Abstract
Background. Most breast cancer diagnoses in Tanzania are in advanced stages. The Ocean Road Cancer Institute (ORCI) established a new breast cancer screening program in 2014 to reduce advanced-stage diagnoses. This study is aimed at describing the screening program’s referral process and at identifying patient and health system factors that contribute to patients completing diagnostic testing referrals. Methods. Six-hundred and forty patients were included in the study. Testing types, outcomes, and date of diagnostic results were abstracted from records at ORCI and Muhimbili National Hospital (MNH) to determine the proportion of testing completed and the duration between initial referrals and diagnostic tests. Prediction of completion of diagnostic testing was investigated in logistic regression. Results. Of the patients who received referrals for further testing, fifty-two percent completed the recommended ultrasound (USS), mammography (MMG), and fine-needle aspiration cytology (FNAC). Only 33.0% of patients completed the recommended MMG referrals compared to 55.0% for ultrasound and 68.7% for FNAC. The average number of days between initial screening and results was 42 days for MMG, 20 days for USS, and 18 days for FNAC. Significant predictors for completing referrals for USS, FNAC, and MMG included
and >55 years, presenting with symptoms at the initial appointment, and education. The odds of completing an USS was 3.03 (95% CI, 1.65-5.64) for patients 25–34, 2.27 (95% CI, 1.17-4.48) for patients 35–44, and 4.41 (95% CI, 1.66-10.11) for patients older than 55 years compared to the reference group (age 19–24). The presence of symptoms at the initial appointment was a significant predictor of FNAC. The odds of completing an FNAC was 1.55 (95% CI, 1.02-3.72) for symptomatic compared to nonsymptomatic patients. Education was a significant predictor of MMG. The odds of receiving MMG was 4.29 (95% CI, 1.05-21.00) for patients with tertiary education or higher compared to primary education or lower. Possession of health insurance for treatment and living in Dar es Salaam were not significant predictors. Discussion. Future research should focus on patients’ understanding of recommended referrals and factors that influence decision-making. Investigating the cost effectiveness of scaling up screening programs and setting up a patient navigation program that follow patients as they complete the recommended treatment plan will be crucial for Tanzania and other developing countries as they seek to launch and strengthen screening programs.
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Nduka IJ, Ejie IL, Okafor CE, Eleje GU, Ekwunife OI. Interventions to increase mammography screening uptake among women living in low-income and middle-income countries: a protocol for a systematic review. BMJ Open 2022; 12:e056901. [PMID: 35354628 PMCID: PMC8968630 DOI: 10.1136/bmjopen-2021-056901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Breast cancer is the most prevalent cancer and the second leading cause of cancer-related deaths among women in low and middle-income countries (LMICs), including sub-Saharan Africa. Mammography screening is the most effective screening method for the early detection of breast cancers in asymptomatic individuals and the only screening test that decreases the risk of breast cancer mortality. Despite the perceived benefits, it has a low utilisation rate in comparison with breast self-examination and clinical breast examination. Several interventions to increase the uptake of mammography have been assessed as well as systematic reviews on mammography uptake. Nonetheless, none of the published systematic reviews focused on women living in LMICs. The review aims to identify interventions that increase mammography screening uptake among women living in LMICs. METHODS AND ANALYSIS Relevant electronic databases will be systematically searched from 1 January 1990 to 30 June 2021 for published and grey literature, including citation and reference list tracking, on studies focusing on interventions to increase mammography screening uptake carried out in LMICs and written in the English language. The search will incorporate the key terms: mammography, interventions, low- and middle-income countries and their associated synonyms. Randomised controlled trials, observational studies and qualitative and mixed methods studies of interventions (carried out with and without comparison groups) reporting interventions to increase mammography screening uptake in LMICs will be identified, data extracted and assessed for methodological quality by two independent reviewers with disagreements to be resolved by consensus or by a third author. We will use narrative synthesis and/or meta-analysis depending on the characteristics of the data. ETHICS AND DISSEMINATION Ethical approval is not required as it is a protocol for a systematic review. Findings will be disseminated through peer-reviewed publications and conference presentations. PROSPERO REGISTRATION NUMBER CRD42021269556.
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Affiliation(s)
- Ifeoma Jovita Nduka
- Department of Clinical Pharmacy and Pharmacy Management, Nnamdi Azikiwe University, Awka, Anambra, Nigeria
- Research Group for Evidence-Based Health Care, Nnamdi Azikiwe University, Awka, Anambra, Nigeria
| | - Izuchukwu Loveth Ejie
- Department of Clinical Pharmacy and Pharmacy Management, Nnamdi Azikiwe University, Awka, Anambra, Nigeria
- Research Group for Evidence-Based Health Care, Nnamdi Azikiwe University, Awka, Anambra, Nigeria
| | - Charles Ebuka Okafor
- Centre for Applied Health Economics, Griffith University School of Medicine, Brisbane, Queensland, Australia
- Menzies Health Institute, Griffith University, Gold Coast, Queensland, Australia
| | - George Uchenna Eleje
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra, Nigeria
- Effective Care Research Unit, Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka, Anambra, Nigeria
| | - Obinna Ikechukwu Ekwunife
- Department of Clinical Pharmacy and Pharmacy Management, Nnamdi Azikiwe University, Awka, Anambra, Nigeria
- Research Group for Evidence-Based Health Care, Nnamdi Azikiwe University, Awka, Anambra, Nigeria
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Kosemani SO, Bakare AA, Adaramoye OA. Fraction from Calliandra portoricensis reduces 7, 12 dimethylbenz(a)anthracene-induced mammary tumors in Wistar rats. AVICENNA JOURNAL OF PHYTOMEDICINE 2022; 12:131-144. [PMID: 35614889 PMCID: PMC9090318 DOI: 10.22038/ajp.2021.18641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 06/14/2021] [Accepted: 06/14/2021] [Indexed: 12/02/2022]
Abstract
OBJECTIVE Calliandra portoricensis (CP) is used in Nigeria for the treatment of breast diseases. We investigated the effects of fraction from CP on 7, 12-dimethylbenz(a)anthracene (DMBA)-induced mammary gland tumors. MATERIALS AND METHODS Female Wistar rats (40) were allotted into five equal groups. Group 1 served as control, group 2 received DMBA (50 mg/kg), groups 3 and 4 received DMBA and were treated with CP at doses of 50 and 100 mg/kg respectively, and the group 5 received DMBA and vincristine (0.5 mg/kg). DMBA was injected intraperitoneally once while vincristine and CP were given twice and thrice per week, respectively. RESULTS Administration ofDMBA caused a significant decrease in body weight gain by 52%. In addition, DMBA significantly increased organo-somatic weight of mammary gland by 4.0 folds. Also, DMBA significantly increased inflammatory and oxidative stress markers serum interleukin-1β (IL-1β), lipid peroxidation (LPO) and myeloperoxidase (MPO) by 27, 18 and 435%, respectively. Similarly, mammary NO (nitric oxide) and LPO were increased by 468 and 21%, respectively. In contrast, DMBA decreased the levels of apoptotic markers BAX, caspases 3 and 9 by 20, 15 and 18%, and mammary superoxide dismutase (SOD), catalase (CAT) and glutathione-s-peroxidase (GPx) by 45, 51 and 68%, respectively. Histology revealed gland with malignant epithelial cells and high nucleo-cytoplasm in DMBA-administered rats. Treatment with CP 100 mg/kg decreased LPO, MPO, IL-1β and NO by 28, 35, 78 and 85%, respectively, and ameliorated DMBA-induced cyto-architectural anomalies. CONCLUSION Fraction of CP protects mammary gland from DMBA insults via antioxidative and anti-inflammatory mechanisms.
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Affiliation(s)
- Samson O. Kosemani
- Department of Biochemistry, Faculty of Basic Medical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Aminat A. Bakare
- Department of Biochemistry, Faculty of Basic Medical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Oluwatosin A. Adaramoye
- Department of Biochemistry, Faculty of Basic Medical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria,Department of Biochemistry, BOWEN University, Iwo, Nigeria,Corresponding Author: Tel: +234-8163047157, Fax: +234-28103043,
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Getachew S, Addissie A, Seife E, Wakuma T, Unverzagt S, Jemal A, Taylor L, Wienke A, Kantelhardt EJ. OUP accepted manuscript. Oncologist 2022; 27:e650-e660. [PMID: 35524760 PMCID: PMC9355816 DOI: 10.1093/oncolo/oyac081] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/09/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Many women in rural Ethiopia do not receive adjuvant therapy following breast cancer surgery despite the majority being diagnosed with estrogen-receptor-positive breast cancer and tamoxifen being available in the country. We aimed to compare a breast nurse intervention to improve adherence to tamoxifen therapy for breast cancer patients. Methods and Materials The 8 hospitals were randomized to intervention and control sites. Between February 2018 and December 2019, patients with breast cancer were recruited after their initial surgery. The primary outcome of the study was adherence to tamoxifen therapy by evaluating 12-month medication-refill data with medication possession ratio (MPR) and using a simplified medication adherence scale (SMAQ) in a subjective assessment. Results A total of 162 patients were recruited (87 intervention and 75 control). Trained nurses delivered education and provided literacy material, gave additional empathetic counselling, phone call reminders, and monitoring of medication refill at the intervention hospitals. Adherence according to MPR at 12 months was high in both the intervention (90%) and control sites (79.3%) (P = .302). The SMAQ revealed that adherence at intervention sites was 70% compared with 44.8% in the control sites (P = .036) at 12 months. Persistence to therapy was found to be 91.2% in the intervention and 77.8% in the control sites during the one-year period (P = .010). Conclusion Breast nurses can improve cost-effective endocrine therapy adherence at peripheral hospitals in low-resource settings. We recommend such task sharing to overcome the shortage of oncologists and distances to central cancer centers.
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Affiliation(s)
- Sefonias Getachew
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Ethiopia
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University (Saale), Halle, Germany
| | - Adamu Addissie
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Ethiopia
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University (Saale), Halle, Germany
| | - Edom Seife
- Radiotherapy Center, Tikur Anbessa Hospital, Addis Ababa University, Ethiopia
| | - Tariku Wakuma
- Department of Surgery, Aira General Hospital, Ethiopia
| | - Susanne Unverzagt
- Institute of General Practice and Family Medicine, Center of Health Sciences, Martin-Luther-UniversityHalle (Saale), Germany
| | | | - Lesley Taylor
- City of Hope National Medical Center, Duarte, CaliforniaUSA
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University (Saale), Halle, Germany
| | - Eva J Kantelhardt
- Corresponding author: Eva J. Kantelhardt, Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University, Magdeburgerstrasse 8; 06097 Halle, Germany. Tel: +493455571847
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Qan'ir Y, Guan T, Idiagbonya E, Dobias C, Conklin JL, Zimba CC, Bula A, Jumbo W, Wella K, Mapulanga P, Bingo S, Chilemba E, Haley J, Montano NP, Bryant AL, Song L. Quality of life among patients with cancer and their family caregivers in the Sub-Saharan region: A systematic review of quantitative studies. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000098. [PMID: 36962119 PMCID: PMC10021310 DOI: 10.1371/journal.pgph.0000098] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 01/19/2022] [Indexed: 11/18/2022]
Abstract
Guided by the World Health Organization quality of life (WHOQOL) framework, this systematic review aimed to examine evidence about the prevalence and severity of QOL-related health problems and their influencing factors in Sub-Saharan Africa (SSA). We identified eligible publications in English language from PubMed, Cumulative Index of Nursing and Allied Health Literature Plus with Full Text, Embase, APA PsycInfo, Scopus, and African Index Medicus databases. We included quantitative descriptive studies that measured overall and subdomains of QOL as the outcome in adult patients/survivors with cancer in SSA. Twenty-six descriptive cross-sectional studies (27 papers) that were conducted since 1988 in different SSA countries among patients with various types of cancer met our inclusion criteria. We found inconsistencies in how the prevalence and severity of QOL-related health problems have been researched and reported across studies, which complicated comparing findings and drawing conclusions. The most common factors that influenced the overall and subdomains of QOL included coping; internal and external locus of control; symptoms and symptom management; and religious beliefs and religious care. Demographics (e.g., age and marital status), cancer-related factors (cancer stage and type of treatment), and social determinants of health (e.g., education, access to information and resources, financial distress, and urban vs rural residency) also impacted QOL and its subdomains. Our findings indicate the significant need for recognizing and managing QOL-related problems for cancer patients and caregivers in SSA. Research needs to use culturally adapted, standardized assessment tools and analysis approaches to better understand the QOL challenges this population faces. Comprehensive supportive care is needed to address the complex QOL issues in resource-limited SSA.
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Affiliation(s)
- Yousef Qan'ir
- School of Nursing, University of North Carolina (UNC), Chapel Hill, NC, United States of America
| | - Ting Guan
- School of Social Work, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Eno Idiagbonya
- School of Nursing, University of North Carolina (UNC), Chapel Hill, NC, United States of America
| | - Cloie Dobias
- School of Nursing, University of North Carolina (UNC), Chapel Hill, NC, United States of America
| | - Jamie L Conklin
- Health Sciences Library, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | | | - Agatha Bula
- University of North Carolina (UNC) Project, Lilongwe, Malawi
| | - Wongani Jumbo
- University of North Carolina (UNC) Project, Lilongwe, Malawi
| | | | | | | | | | - Jennifer Haley
- School of Nursing, University of North Carolina (UNC), Chapel Hill, NC, United States of America
| | - Nilda Peragallo Montano
- School of Nursing, University of North Carolina (UNC), Chapel Hill, NC, United States of America
| | - Ashley Leak Bryant
- School of Nursing, University of North Carolina (UNC), Chapel Hill, NC, United States of America
| | - Lixin Song
- School of Nursing, University of North Carolina (UNC), Chapel Hill, NC, United States of America
- Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, NC, United States of America
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Rweyemamu LP, Akan G, Adolf IC, Magorosa EP, Mosha IJ, Dharsee N, Namkinga LA, Lyantagaye SL, Nateri AS, Atalar F. The distribution of reproductive risk factors disclosed the heterogeneity of receptor-defined breast cancer subtypes among Tanzanian women. BMC Womens Health 2021; 21:423. [PMID: 34930226 PMCID: PMC8686374 DOI: 10.1186/s12905-021-01536-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 11/08/2021] [Indexed: 12/29/2022] Open
Abstract
Background Recent epidemiological studies suggest that reproductive factors are associated with breast cancer (BC) molecular subtypes. However, these associations have not been thoroughly studied in the African populations. The present study aimed to investigate the prevalence of BC molecular subtypes and assess their association with reproductive factors in Tanzanian BC patients. Methods This hospital-based case-only cross-sectional study consisted of 263 histologically confirmed BC patients in Tanzania. Clinico-pathological data, socio-demographic characteristics, anthropometric measurements, and reproductive risk factors were examined using the Chi-square test and one-way ANOVA. The association among reproductive factors and BC molecular subtypes was analyzed using multinomial logistic regression. The heterogeneity of the associations was assessed using the Wald test. Results We found evident subtype heterogeneity for reproductive factors. We observed that post-menopausal status was more prevalent in luminal-A subtype, while compared to luminal-A subtype, luminal-B and HER-2 enriched subtypes were less likely to be found in post-menopausal women (OR: 0.21, 95%CI 0.10–0.41, p = 0.001; OR: 0.39, 95%CI 0.17–0.89, p = 0.026, respectively). Also, the luminal-B subtype was more likely to be diagnosed in patients aged ≤ 40 years than the luminal-A subtype (OR: 2.80, 95%CI 1.46–5.32, p = 0.002). Women who had their first full-term pregnancy at < 30 years were more likely to be of luminal-B (OR: 2.71, 95%CI 1.18–4.17, p = 0.018), and triple-negative (OR: 2.28, 95%CI 1.02–4.07, p = 0.044) subtypes relative to luminal-A subtype. Furthermore, we observed that breastfeeding might have reduced odds of developing luminal-A, luminal-B and triple-negative subtypes. Women who never breastfed were more likely to be diagnosed with luminal-B and triple-negative subtypes when compared to luminal-A subtype (OR: 0.46, 95%CI 0.22–0.95, p = 0.035; OR: 0.41, 95%CI 0.20–0.85, p = 0.017, respectively). . Conclusion Our results are the first data reporting reproductive factors heterogeneity among BC molecular subtypes in Tanzania. Our findings suggest that breast-feeding may reduce the likelihood of developing luminal-A, luminal-B, and triple-negative subtypes. Meanwhile, the first full-term pregnancy after 30 years of age could increase the chance of developing luminal-A subtype, a highly prevalent subtype in Tanzania. More interventions to promote modifiable risk factors across multiple levels may most successfully reduce BC incidence in Africa. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-021-01536-6.
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Affiliation(s)
- Linus P Rweyemamu
- Department of Molecular Biology and Biotechnology, University of Dar es Salaam, P.O Box 35179, Dar es Salaam, Tanzania.,Mbeya College of Health and Allied Sciences, University of Dar es Salaam, P.O Box 608, Mbeya, Tanzania
| | - Gokce Akan
- MUHAS Genetic Laboratory, Department of Biochemistry, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
| | - Ismael C Adolf
- Mbeya College of Health and Allied Sciences, University of Dar es Salaam, P.O Box 608, Mbeya, Tanzania
| | - Erick P Magorosa
- Department of Anatomical Pathology, Muhimbili National Hospital, P.O Box 65000, Dar es Salaam, Tanzania
| | - Innocent J Mosha
- Department of Anatomical Pathology, Muhimbili National Hospital, P.O Box 65000, Dar es Salaam, Tanzania
| | - Nazima Dharsee
- Academic, Research and Consultancy Unit, Ocean Road Cancer Institute, P.O Box 3592, Dar es Salaam, Tanzania
| | - Lucy A Namkinga
- Department of Molecular Biology and Biotechnology, University of Dar es Salaam, P.O Box 35179, Dar es Salaam, Tanzania
| | - Sylvester L Lyantagaye
- Mbeya College of Health and Allied Sciences, University of Dar es Salaam, P.O Box 608, Mbeya, Tanzania
| | - Abdolrahman S Nateri
- Cancer Genetics and Stem Cell Group, Division of Cancer and Stem Cells, School of Medicine, BioDiscovery Institute, University of Nottingham, Nottingham, NG7 2UH, UK.
| | - Fatmahan Atalar
- MUHAS Genetic Laboratory, Department of Biochemistry, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania. .,Department of Rare Diseases, Child Health Institute, Istanbul University, Istanbul, 34093, Turkey.
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Opoku F, Bedu-Addo K, Titiloye NA, Atta Manu E, Ameh-Mensah C, Duduyemi BM. Expression profile of tumour suppressor protein p53 and its regulator MDM2 in a cohort of breast cancer patients in a Tertiary Hospital in Ghana. PLoS One 2021; 16:e0258543. [PMID: 34695137 PMCID: PMC8544835 DOI: 10.1371/journal.pone.0258543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 09/29/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Inactivation or mutation of the tumour suppressor gene p53 or its regulator mouse double minute 2 (MDM2) is the commonest event in breast cancer. These altered genes usually express abnormally high levels of their proteins in many carcinomas. The phenotypic expression of p53 and MDM2 in breast cancer cases in our setting is not known. This study investigated the expression of the tumour suppressor protein p53 and its regulator MDM2, using immunohistochemistry in a Ghana breast cancer cohort. METHOD A 9-year retrospective cross-sectional study on archived tissue blocks-formalin fixed paraffin embedded tissue (FFPE) was carried out. Demographic data were abstracted. Based on complete clinical data and availability of FFPE archived blocks 203 cases were selected for tissue micro array (TMA) construction. The TMA sections were subjected to immunohistochemistry (IHC) (ER, PR, HER2, p53, and MDM2). Expression of p53 and MDM2 were related to grade and molecular subtypes. RESULTS The age ranged from 17 to 92 years (mean = 49.34 ± 13.74). Most of the cases were high grade; grade II (34.9%) and grade III (55.7%). Fifty-four percent of the cases were triple negative. Invasive ductal carcinoma no special type was the commonest histotype (87.1%). Thirty-six percent (36%) of the cases expressed p53. Significant associations were found between p53 overexpression and histological grade (p = 0.034), triple negative (p = 0.0333) and luminal B (p<0.01) tumors. Most cases (93.1%) were negative for MDM2 expression. Significant association was found between MDM2 and HER2 over-expression as well as Ki-67. There was no significant positive correlation between MDM2 and p53 co-expression (p>0.05). CONCLUSION The elevated level of p53 expression in the aggressive breast cancer phenotypes (high histological grade and triple negative) in our cohort suggest that P53 elevation may be a poor prognostic marker in our setting. High expression of MDM2 in our cohort with high Ki67; also in cases with Her2/neu overexpression known with predictable poor prognosis in the absence of target therapy suggest MDM2 may be associated with aggressive biological behaviour in our breast cancer cases. The non-significant association of p53 and MDM2 expression in the same cases as also documented by previous studies suggest independent genetic pathway in tumourigenesis.
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Affiliation(s)
- Francis Opoku
- Department of Physiology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kweku Bedu-Addo
- Department of Physiology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Elijah Atta Manu
- Department of Physiology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Charity Ameh-Mensah
- Department of Physiology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Babatunde Moses Duduyemi
- Department of Pathology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Department of Pathology, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone
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Gbenonsi G, Boucham M, Belrhiti Z, Nejjari C, Huybrechts I, Khalis M. Health system factors that influence diagnostic and treatment intervals in women with breast cancer in sub-Saharan Africa: a systematic review. BMC Public Health 2021; 21:1325. [PMID: 34229634 PMCID: PMC8259007 DOI: 10.1186/s12889-021-11296-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 06/15/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Breast cancer patients in sub-Saharan Africa experience long time intervals between their first presentation to a health care facility and the start of cancer treatment. The role of the health system in the increasing treatment time intervals has not been widely investigated. This review aimed to identify existing information on health system factors that influence diagnostic and treatment intervals in women with breast cancer in sub-Saharan Africa to contribute to the reorientation of health policies in the region. METHODS PubMed, ScienceDirect, African Journals Online, Mendeley, ResearchGate and Google Scholar were searched to identify relevant studies published between 2010 and July 2020. We performed a qualitative synthesis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Related health system factors were extracted and classified according to the World Health Organization's six health system building blocks. The quality of qualitative and quantitative studies was assessed by using the Critical Appraisal Skills Program Quality-Assessment Tool and the National Institute of Health Quality Assessment Tool, respectively. In addition, we used the Confidence in the Evidence from Reviews of Qualitative Research tool to assess the evidence for each qualitative finding. RESULTS From 14,184 identified studies, this systematic review included 28 articles. We identified a total of 36 barriers and 8 facilitators that may influence diagnostic and treatment intervals in women with breast cancer. The principal health system factors identified were mainly related to human resources and service delivery, particularly difficulty accessing health care, diagnostic errors, poor management, and treatment cost. CONCLUSION The present review shows that diagnostic and treatment intervals among women with breast cancer in sub-Saharan Africa are influenced by many related health system factors. Policy makers in sub-Saharan Africa need to tackle the financial accessibility to breast cancer treatment by adequate universal health coverage policies and reinforce the clinical competencies for health workers to ensure timely diagnosis and appropriate care for women with breast cancer in this region.
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Affiliation(s)
- Gloria Gbenonsi
- International School of Public Health, Mohammed VI University of Health Sciences, Casablanca, Morocco.
| | - Mouna Boucham
- International School of Public Health, Mohammed VI University of Health Sciences, Casablanca, Morocco
| | | | - Chakib Nejjari
- International School of Public Health, Mohammed VI University of Health Sciences, Casablanca, Morocco
| | | | - Mohamed Khalis
- International School of Public Health, Mohammed VI University of Health Sciences, Casablanca, Morocco
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Nwagu GC, Bhattarai S, Swahn M, Ahmed S, Aneja R. Prevalence and Mortality of Triple-Negative Breast Cancer in West Africa: Biologic and Sociocultural Factors. JCO Glob Oncol 2021; 7:1129-1140. [PMID: 34264759 PMCID: PMC8457872 DOI: 10.1200/go.21.00082] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/05/2021] [Accepted: 06/08/2021] [Indexed: 12/24/2022] Open
Affiliation(s)
- Gift C. Nwagu
- Department of Biology, Georgia State University, Atlanta, GA
| | | | - Monica Swahn
- International Consortium for Advancing Research on Triple Negative Breast Cancer, Georgia State University, Atlanta, GA
- Department of Population Health Sciences, Georgia State University, Atlanta, GA
| | - Saad Ahmed
- International Consortium for Advancing Research on Triple Negative Breast Cancer, Georgia State University, Atlanta, GA
- Department of Pathology, Ahmadu Bello University, Zaria, Nigeria
| | - Ritu Aneja
- Department of Biology, Georgia State University, Atlanta, GA
- International Consortium for Advancing Research on Triple Negative Breast Cancer, Georgia State University, Atlanta, GA
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Kassie AM, Abate BB, Kassaw MW, Shiferaw WS. Breast Self-Examination Practice Among Female University Students in Ethiopia: A Systematic Review and Meta-Analysis. Cancer Control 2021; 28:10732748211019137. [PMID: 34169755 PMCID: PMC8236787 DOI: 10.1177/10732748211019137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Breast self-examination (BSE) is one of the most feasible methods of screening for early stages of breast cancer. However, the practice rate is insufficient in many low and middle-income countries including Ethiopia. Hence, this study aimed to estimate the pooled prevalence of BSE practice among female university students in Ethiopia. Methods: PubMed, Cochrane Library, Scopus, and Google Scholar were searched for studies that assessed BSE practice among female students in Ethiopian universities. The study included articles published from January 1st, 2010 to June 16th, 2020. The Cochran’s Q chi-square and the respective I2 test statistics were used to check heterogeneity among the included studies. To assess publication biases, the funnel plot and Egger’s regression tests were employed. Subgroup analysis was done by using different characteristics of studies. Sensitivity analysis was also run to assess the effect of a single study on the pooled outcome. STATA™ Version 14 software packages were employed for data analysis. Results: Sixteen (n = 16) studies with 5,743 participants were included to estimate the pooled prevalence of BSE practice. The prevalence of regular BSE practice reported in the studies ranges from 0% to 26.4%. The estimated pooled prevalence of regular BSE practice among university students in Ethiopia is 11.23% which is very low. The prevalence of BSE practice was high, 13.6% in studies published before 2015, 12.0% among health science students, and 12.6% in studies with a sample size of 384 participants and above. In addition, the estimated pooled prevalence of irregular self-breast-examination practice was 33.28%. Conclusion: The rate of BSE practice among female university students is low. Thus, awareness strategies need to be designed to increase the practice rate among women in the country as BSE is one of the most feasible strategies in early detection of breast cancer if properly implemented.
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Affiliation(s)
- Ayelign Mengesha Kassie
- Department of Nursing, College of Health Sciences, 487515Woldia University, Woldia, Ethiopia
| | - Biruk Beletew Abate
- Department of Nursing, College of Health Sciences, 487515Woldia University, Woldia, Ethiopia
| | - Mesfin Wudu Kassaw
- Department of Nursing, College of Health Sciences, 487515Woldia University, Woldia, Ethiopia
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Romanoff A, Olasehinde O, Goldman DA, Alatise OI, Constable J, Monu N, Knapp GC, Odujoko O, Onabanjo E, Adisa AO, Arowolo AO, Omisore AD, Famurewa OC, Anderson BO, Gemignani ML, Kingham TP. Opportunities for Improvement in the Administration of Neoadjuvant Chemotherapy for T4 Breast Cancer: A Comparison of the U.S. and Nigeria. Oncologist 2021; 26:e1589-e1598. [PMID: 33955123 DOI: 10.1002/onco.13814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 04/08/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Neoadjuvant chemotherapy (NAC) is an integral component of T4 breast cancer (BCa) treatment. We compared response to NAC for T4 BCa in the U.S. and Nigeria to direct future interventions. MATERIALS AND METHODS Cross-sectional retrospective analysis included all patients with non-metastatic T4 BCa treated from 2010 to 2016 at Memorial Sloan Kettering Cancer Center (New York, New York) and Obafemi Awolowo University Teaching Hospitals Complex (Ile Ife, Nigeria). Pathologic complete response (pCR) and survival were compared and factors contributing to disparities evaluated. RESULTS Three hundred and eight patients met inclusion criteria: 157 (51%) in the U.S. and 151 (49%) in Nigeria. All U.S. patients received NAC and surgery compared with 93 (62%) Nigerian patients. Fifty-six out of ninety-three (60%) Nigerian patients completed their prescribed course of NAC. In Nigeria, older age and higher socioeconomic status were associated with treatment receipt. Fewer patients in Nigeria had immunohistochemistry performed (100% U.S. vs. 18% Nigeria). Of those with available receptor subtype, 18% (28/157) of U.S. patients were triple negative versus 39% (9/23) of Nigerian patients. Overall pCR was seen in 27% (42/155) of U.S. patients and 5% (4/76) of Nigerian patients. Five-year survival was significantly shorter in Nigeria versus the U.S. (61% vs. 72%). However, among the subset of patients who received multimodality therapy, including NAC and surgery with curative intent, 5-year survival (67% vs. 72%) and 5-year recurrence-free survival (48% vs. 61%) did not significantly differ between countries. CONCLUSION Addressing health system, socioeconomic, and psychosocial barriers is necessary for administration of complete NAC to improve BCa outcomes in Nigeria. IMPLICATIONS FOR PRACTICE This cross-sectional retrospective analysis of patients with T4 breast cancer in Nigeria and the U.S. found a significant difference in pathologic complete response to neoadjuvant chemotherapy (5% Nigeria vs. 27% U.S.). Five-year survival was shorter in Nigeria, but in patients receiving multimodality treatment, including neoadjuvant chemotherapy and surgery with curative intent, 5-year overall and recurrence-free survival did not differ between countries. Capacity-building efforts in Nigeria should focus on access to pathology services to direct systemic therapy and promoting receipt of complete chemotherapy to improve outcomes.
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Affiliation(s)
- Anya Romanoff
- Department of Global Health and Health System Design, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Surgery, Global Cancer Disparities Initiatives, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Olalekan Olasehinde
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
| | - Debra A Goldman
- Department of Epidemiology and Biostatics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Olusegun I Alatise
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
| | - Jeremy Constable
- Department of Surgery, Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ngozi Monu
- Weill Cornell School of Medicine, New York, New York, USA
| | - Gregory C Knapp
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Oluwole Odujoko
- Department of Pathology, Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
| | - Emmanuella Onabanjo
- African Research Group for Oncology, Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
| | - Adewale O Adisa
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
| | - Adeolu O Arowolo
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
| | - Adeleye D Omisore
- Department of Radiology, Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
| | - Olusola C Famurewa
- Department of Radiology, Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
| | - Benjamin O Anderson
- Departments of Surgery and Global Health, University of Washington, Seattle, Washington, USA.,Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Mary L Gemignani
- Department of Surgery, Breast Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - T Peter Kingham
- Department of Surgery, Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Darré T, Tchaou M, Djiwa T, Douaguibe B, Bassowa A, Adani-Ifé S, Amavi AK, N'Timon B, Amadou A, Simgban P, N'Bortche BK, Amégbor K, Aboubakari AS, Napo-Koura G. Breast Cancer in Togolese Women: Imaging and Clinicopathological Findings. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2021; 15:11782234211020242. [PMID: 34103923 PMCID: PMC8170281 DOI: 10.1177/11782234211020242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 05/05/2021] [Indexed: 12/09/2022]
Abstract
Background: Breast cancer is the most common cancer in women, and its incidence and
mortality rates are expected to increase significantly over the next few
years, particularly in developing countries. The aim of this study was to
describe the epidemiological, clinical, radiological, histopathological, and
prognostic aspects of breast cancer in Togo. Materials and methods: We retrospectively analyzed at our Department of Pathology of Lomé all cases
of breast cancer in women confirmed by histology over a period of 20 years
(2000-2019). Results: We collected 804 cases of breast cancer in women. The median age was 46.7
years (range, 12-86 years). Patients aged <40 years represented 48.38% of
cases, and the left breast was more affected (51.24%). Most women were
sexually active (71.52%) and resided in urban areas (66.29%). Carcinomas
represented the predominant histological group (796 cases, 99.00%) with a
predominance of invasive nonspecific type carcinoma (92.34%). These cancers
were diagnosed at late stage III using Nottingham grading (55.10%). The TNM
classification showed a predominance of grades T2NxMx (72.45%) and T4N1Mx
(17.76%). The luminal B profile (40.85%) was found mostly, and the mutation
of BRCA2 and BRCA1 genes was found in 2.61% of cases. Mastectomy was
performed in 7.59%, radiotherapy in 3.61%, and chemotherapy in 18.66%. Conclusion: Breast cancer is a frequent pathology in Togolese women, predominant in young
adults, often diagnosed at a late stage with limited possibilities of
treatment. The establishment of early care programs is essential.
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Affiliation(s)
- Tchin Darré
- Department of Pathology, University Teaching Hospital of Lomé, Lomé, Togo.,Faculty of Health Sciences, University of Lomé, Lomé, Togo
| | - Mazamaesso Tchaou
- Department of Imaging, University Teaching Hospital of Lomé and Kara, Kara, Togo
| | - Toukilnan Djiwa
- Department of Pathology, University Teaching Hospital of Lomé, Lomé, Togo
| | - Baguilane Douaguibe
- Department Obstetrics and Gynecology, University Teaching Hospital of Lomé and Kara, Kara, Togo
| | - Akila Bassowa
- Department of Imaging, University Teaching Hospital of Lomé and Kara, Kara, Togo
| | - Solange Adani-Ifé
- Department of Clinical Oncology, University Teaching Hospital of Lomé, Lomé, Togo
| | | | - Bidamin N'Timon
- Department of Imaging, University Teaching Hospital of Lomé and Kara, Kara, Togo
| | - Abdoulatif Amadou
- Department of Imaging, University Teaching Hospital of Lomé and Kara, Kara, Togo
| | - Panakinao Simgban
- Department of Pathology, University Teaching Hospital of Lomé, Lomé, Togo
| | - Bingo K N'Bortche
- Department Obstetrics and Gynecology, University Teaching Hospital of Lomé and Kara, Kara, Togo
| | - Koffi Amégbor
- Department of Pathology, University Teaching Hospital of Lomé, Lomé, Togo
| | | | - Gado Napo-Koura
- Department of Pathology, University Teaching Hospital of Lomé, Lomé, Togo
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Rositch AF, Unger-Saldaña K, DeBoer RJ, Ng'ang'a A, Weiner BJ. The role of dissemination and implementation science in global breast cancer control programs: Frameworks, methods, and examples. Cancer 2021; 126 Suppl 10:2394-2404. [PMID: 32348574 DOI: 10.1002/cncr.32877] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 02/11/2020] [Accepted: 03/11/2020] [Indexed: 01/24/2023]
Abstract
Global disparities in breast cancer outcomes are attributable to a sizable gap between evidence and practice in breast cancer control and management. Dissemination and implementation science (D&IS) seeks to understand how to promote the systematic uptake of evidence-based interventions and/or practices into real-world contexts. D&IS methods are useful for selecting strategies to implement evidence-based interventions, adapting their implementation to new settings, and evaluating the implementation process as well as its outcomes to determine success and failure, and adjust accordingly. Process models, explanatory theories, and evaluation frameworks are used in D&IS to develop implementation strategies, identify implementation outcomes, and design studies to evaluate these outcomes. In breast cancer control and management, research has been translated into evidence-based, resource-stratified guidelines by the Breast Health Global Initiative and others. D&IS should be leveraged to optimize the implementation of these guidelines, and other evidence-based interventions, into practice across the breast cancer care continuum, from optimizing public education to promoting early detection, increasing guideline-concordant clinical practice among providers, and analyzing and addressing barriers and facilitators in health care systems. Stakeholder engagement through processes such as co-creation is critical. In this article, the authors have provided a primer on the contribution of D&IS to phased implementation of global breast cancer control programs, provided 2 case examples of ongoing D&IS research projects in Tanzania, and concluded with recommendations for best practices for researchers undertaking this work.
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Affiliation(s)
- Anne F Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Rebecca J DeBoer
- Global Cancer Program, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Anne Ng'ang'a
- National Cancer Control Program, Ministry of Health, Nairobi, Kenya
| | - Bryan J Weiner
- Department of Global Health, University of Washington, Seattle, Washington
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50
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Parham GP, Mathieu KM, YouYou TG, Hicks ML, Henry-Tillman R, Mutombo A, Anaclet MM, Sylvain MK, Pinder L, Hicks MM, Kanda L, Kanda M. Establishing women's cancer care services in a fragile, conflict and violence affected ecosystem in Africa. Ecancermedicalscience 2021; 15:1231. [PMID: 34221114 PMCID: PMC8225336 DOI: 10.3332/ecancer.2021.1231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The majority of the world's poorest women (income < $1.90/day) reside in fragile, conflict and violence (FCV)-affected countries, like the Democratic Republic of the Congo. Health services in these settings have traditionally focused on immediate relief efforts, communicable diseases and malnutrition. Recent data suggests there is need to widen the focus to include cancer, as its incidence and mortality rates are rising. METHODS Employing competency-based learning strategies, Congolese health professionals were trained to perform same-day cervical cancer screening and treatment of precancerous lesions of the cervix; same-day clinical breast examination and breast ultrasound diagnostics; surgical treatment of invasive cancers of the breast and cervix; and infusion of cytotoxic chemotherapy. Outpatient breast and cervical cancer care clinics, a chemotherapy suite and surgical theatres were outfitted with equipment and supplies. RESULTS Combining local and regional hands-on training seminars with wise infrastructure investments, a team of US and Zambian oncology experts successfully implemented a clinical service platform for women's cancers in a private sector health facility in the Democratic Republic of the Congo. CONCLUSION We forged a novel partnership between oncology health professionals from Africa and its Diaspora, international philanthropic organisations, a cancer medicine access initiative and an established African cancer centre to build women's cancer services in a FVC-affected African setting.
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Affiliation(s)
- Groesbeck Preer Parham
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, 101 Manning Dr, Chapel Hill, NC 27514, USA
- Department of Obstetrics and Gynecology, University Teaching Hospital – Women and Newborn Hospital, 10101 Nationalist Way, Lusaka, Zambia
- https://orcid.org/0000-0001-5922-5990
| | - Kabongo Mukuta Mathieu
- Biamba Marie Mutombo Hospital, No. 9777, Boulevard Lumumba, Commune de Masina, Kinshasa, Democratic Republic of the Congo
| | - Tankoy Gombo YouYou
- Biamba Marie Mutombo Hospital, No. 9777, Boulevard Lumumba, Commune de Masina, Kinshasa, Democratic Republic of the Congo
| | - Michael L Hicks
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, 101 Manning Dr, Chapel Hill, NC 27514, USA
- Department of Obstetrics and Gynecology, University Teaching Hospital – Women and Newborn Hospital, 10101 Nationalist Way, Lusaka, Zambia
- St Mary Mercy Cancer Center, 36475 Five Mile Rd, Livonia, MI 48154, USA
- St Joseph Mercy Oakland Cancer Center, 44405 Woodward Ave, Suite 202, Pontiac, MI 48324, USA
- McLaren Macomb Medical Center, 1000 Harrington Blvd, Mount Clemens, MI 48043, USA
- https://orcid.org/0000-0002-1819-155X
| | - Ronda Henry-Tillman
- Winthrop P Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, 4301 West Markham St, Slot #725, Little Rock, AR 72205, USA
- https://orcid.org/0000-0002-1782-9523
| | - Alex Mutombo
- Biamba Marie Mutombo Hospital, No. 9777, Boulevard Lumumba, Commune de Masina, Kinshasa, Democratic Republic of the Congo
| | - Mukanya Mpalata Anaclet
- Biamba Marie Mutombo Hospital, No. 9777, Boulevard Lumumba, Commune de Masina, Kinshasa, Democratic Republic of the Congo
| | - Mulumba Kapuku Sylvain
- Biamba Marie Mutombo Hospital, No. 9777, Boulevard Lumumba, Commune de Masina, Kinshasa, Democratic Republic of the Congo
| | - Leeya Pinder
- Department of Obstetrics and Gynecology, University Teaching Hospital – Women and Newborn Hospital, 10101 Nationalist Way, Lusaka, Zambia
- Department of Oncology, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA
- https://orcid.org/0000-0002-8929-7810
| | - Maya M Hicks
- Howard University College of Medicine, 520 W St NW, Washington, DC 20059, USA
- https://orcid.org/0000-0002-1993-3367
| | - Louis Kanda
- Dikembe Mutombo Foundation, 400 Interstate N Pkwy, Suite 1040, Atlanta, GA 30339, USA
| | - Mirielle Kanda
- Dikembe Mutombo Foundation, 400 Interstate N Pkwy, Suite 1040, Atlanta, GA 30339, USA
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