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Sinha S, Bhatia R, Narasimamurthy M, Rayne S, Grover S. Epidemiology of Breast Cancer Presentation in Botswana, South Africa, and the United States. J Surg Res 2022; 279:533-539. [PMID: 35868037 PMCID: PMC10033457 DOI: 10.1016/j.jss.2022.04.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 04/01/2022] [Accepted: 04/08/2022] [Indexed: 10/31/2022]
Abstract
INTRODUCTION This study sought to compare the clinicopathologic features of women with breast cancer presenting in South Africa, Botswana, and the United States (US). METHODS Breast cancer samples from Botswana (n = 384, 2011-2015), South Africa (n = 475, 2016-2017), and the US (n = 361,353, 2011-2012) were retrospectively reviewed. RESULTS The median age of sub-Saharan African women presenting with breast cancer (age 54 in Botswana and South Africa) was younger than that of those in the US (age 61) (P < 0.001). Sub-Saharan women were more likely to present with advanced stage disease than US counterparts (64.7% in Botswana, 63.3% in South Africa, 13% in the US, P < 0.001). Triple negative disease was highest in Botswana (21.3%) compared to South Africa (11.4%) and the US (12.94%) (P < 0.001). Differences in receptor status at presentation among the three cohorts (P < 0.001) were not observed when the cohorts were stratified by ethnicity. Black/multiracial patients in Botswana and the US were the most likely subsets to present with the adverse characteristic of triple negative disease (21.3% and 23.2%, respectively). No correlation was found between HIV and receptor status in the Botswana (P = 0.513) or South African (P = 0.352) cohorts. CONCLUSIONS Here we report receptor status patterns at presentation in Botswana and South Africa. This study reveals important similarities and differences which may inform policy and provide context for future epidemiologic trends of breast cancer in low- and-middle-income countries particularly in sub-Saharan Africa.
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Affiliation(s)
- Sumi Sinha
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Rohini Bhatia
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland
| | | | - Sarah Rayne
- Department of Surgery, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
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Songiso M, Pinder LF, Munalula J, Cabanes A, Rayne S, Kapambwe S, Shibemba A, Parham GP. Minimizing Delays in the Breast Cancer Pathway by Integrating Breast Specialty Care Services at the Primary Health Care Level in Zambia. JCO Glob Oncol 2021; 6:859-865. [PMID: 32579485 PMCID: PMC7328108 DOI: 10.1200/go.20.00083] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE In Zambia, more than two-thirds of female patients with breast cancer present with late-stage disease, leading to high mortality rates. Most of the underlying causes are associated with delays in symptom recognition and diagnosis. By implementing breast care specialty services at the primary health care level, we hypothesized that some of the delays could be minimized. METHODS In March 2018, we established a breast care specialty clinic for women with symptomatic disease within 1 of the 5 district hospitals in Lusaka. The clinic offers breast self-awareness education, clinical breast examination, breast ultrasound, ultrasound-guided breast biopsy, surgery, referral for chemoradiation, follow-up care, and electronic medical records. RESULTS Between March 2018 and April 2019, of 1,790 symptomatic women who presented to the clinic, 176 (10%) had clinical and/or ultrasound indications for histologic evaluation. Biopsy specimens were obtained using ultrasound-guided core-needle procedures, all of which were performed on the same day as the initial visit. Of the 176 women who underwent biopsy, 112 (64%) had pathologic findings compatible with a primary breast cancer, and of these, 42 (37%) were early-stage (stage I/II) disease. Surgery for early-stage cancers was performed at the district hospital within 2 weeks of the time of definitive pathologic diagnosis. Patients with advanced disease were referred to the national cancer center for multimodality therapy, within a similar time frame. CONCLUSION Breast care specialty services for symptomatic women were established in a district-level hospital in a resource-constrained setting in Africa. As a result, the following time intervals were minimized: initial presentation and performance of clinical diagnostics; receipt of a definitive pathologic diagnosis and initiation of surgery; receipt of a definitive pathologic diagnosis and referral.
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Affiliation(s)
| | - Leeya F Pinder
- University of Zambia, Lusaka, Zambia.,University of Washington, Seattle, WA
| | | | | | - Sarah Rayne
- Helen Joseph Hospital, Johannesburg, South Africa.,University of Witwatersrand, Johannesburg, South Africa
| | | | | | - Groesbeck P Parham
- University of Zambia, Lusaka, Zambia.,University of North Carolina at Chapel Hill, Chapel Hill, NC
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M, Koco H, Lawani S, Kassa MW, Santos Bezerra T, Gribnev P, Dimitrov D, Krastev P, Oum S, Bonghaseh DT, Al Farsi M, Alsharqawi N, Agarwal A, Acevedo V, Castillo Barbosa AC, Giron F, Leon Rodriguez JP, Kucan D, Rosko D, Barsic N, Župan D, Hegazi A, Truncíková V, Fryba V, Mohamed M, Sultan A, Nagi A, Rashad Temerik A, Elshawy ME, Mahmoud MI, Omar S, Anwar M, Rageh T, Elmokadem A, Gaballa K, Teppo S, Turunen A, Pengermä P, Ballouhey Q, Bergeat D, Weyl A, Hain E, Gyedu A, Yenli E, Osei-Poku D, Rompou VA, Zoikas A, Gaitanidis A, Koukis G, Perivoliotis K, Tavlas P, Galanos-Demiris K, Zografos G, Karavokyros I, Xanthopoulou G, Iordanidou E, Ayau F, Garcia A, Damján P, Wason D, B L A, Rangganata E, Kamath P, O'Connor DB, Pinto M, Perrone F, Tropeano FP, Troilo F, Bossi D, Scala D, Pulitanò L, Carella M, Pietrabissa A, Gori A, Giraudo G, De Simone V, Russo AA, Braccio B, Al-Taher R, Athamneh S, Parker A, Sawiee A, Kattia A, Salem M, Tababa O, Shaeeb Z, Syminas V, Jurgaitis J, Damuleviciene G, Svagzdys S, Poskus T, Razafimanjato NNM, Chieng Loo L, Tiong IC, Wan Muhmad WF, Vijeyan H, Li Ying T, Grech G, Arrangoiz R, Jimenez Ley VB, Arizpe D, Jimenez Ley VB, Lagunes Lara E, Castro López EV, Eaazim J, Gordinou de Gouberville M, Bastiaenen V, Rottier S, Nahab F, Ji MY, Seyoji M, Nwachukwu C, Emeghara O, Muhammed SE, Idowu A, Sowemimo O, Ogundoyin O, Akande O, Lott A, Nadeem M, Laghari AA, Loya A, Mushtaq H, Abdullah MT, Abuhilal B, Atawneh M, Hamdan H, Alhabil B, Srour A, Mousa I, Da Silva Medina L, Sacdalan MD, Lapitan MC, Sacdalan MD, Sacdalan MD, Bartosiak K, Ferreira P, Francisco V, Lemos R, Frutuoso L, Fernandes S, Fonseca T, Pereira J, Rachadell J, Torre A, Madeira Martins F, Carvalho AC, Rodrigues Ferreira J, Ribeiro da Silva B, Devesa H, Vieira A, Mónica I, Amaro M, Sousa D, Reia M, Louro J, Martins A, Dominguez J, Santos I, Freitas Oliveira NM, Pereira JC, Silva-Vaz P, Freire L, Escrevente R, Negoita VM, Shakhmatov D, Nezerwa Y, Radulovic R, Moore R, Obery G, Viljoen F, Mendes T, Suarez A, Moncada E, Fernandez-Hevia M, Curtis Martínez C, Gil Garcia JM, González Zunzarren M, Idris T, Eklöv K, Grahn O, Amin L, Blomqvist M, Ajani C, Kraus R, Seeger N, Willemin M, Rayya F, Ayash M, Msouti R, Kannas I, Abazid E, Esper A, Slim S, Kavcar AS, Aytac E, Dural AC, Ilker A, Eray IC, Kurnaz E, Altiner S, Tepe MD, Sahin C, Savli E, Innocent A, Babirye L, Diachenko A, Hordoskiy V, Curry H, Chau CYC, Robertson H, Mahmoud A, Lennon H, Loi L, Kirkham E, McCann C, Watts D, Gurung B, Wilson M, Tribedi T, Garofalo E, Zahra B, MacDonald S, Daniels I, Ng N, Khosla S, Olivier J, Yue SYP, Suresh G, Wellington J, Lorejo E, Mossaad M, Tryliskyy Y, Crutcher M, Alimi M, Baiu I, Abdou H, Conway A, Peck C, Wagner G, Perdomo Perez MA, Trostchansky I, Zulu S, Nakazwe M, Knight SR, Drake TM, Nepogodiev D, Fitzgerald JE, Ademuyiwa A, Alexander P, Ingabire JA, Al-Saqqa SW, Biccard BM, Borda-Luque G, Borowski DW, Burger S, Chu K, Clarke D, Costas-Chavarri A, Davies J, Donaldson R, Ede C, Garden OJ, Ghosh D, Glasbey J, Kingham TP, Salem HK, Anyomih TTK, Koto MZ, Lapitan MC, Lawani I, Lesetedi C, Aguilera-Arevalo ML, Mabedi C, Maimbo M, Magill L, Makinde Alakaloko F, Makupe A, Martin J, Ramos-De la Medina A, Monahan M, Moore R, Msosa V, Mulira S, Mutabazi AZ, Muller E, Musowoyo J, Adisa AO, Olory-Togbe JL, Pius R, Qureshi AU, Rayne S, Roberts T, Sacdalan MD, Shaw CA, Smart N, Smith M, Spence R, Van Straten S, Tabiri S, Tayler V, Weiser TG, Windsor J, Yorke J, Yepez R, Lilford R, Morton D, Bhangu A, Sundar S, Harrison EM, Runigamugabo E, Verjee A, Chen J, Daya L, El Aroussi N, Farina V, Gnintedeme Olivier T, Gonzales Nacarino M, Hammani A, Honjo S, Jacobs R, Kimura H, Litvin A, Nkoronko M, Nour I, Oscullo Yepez JJ, Pagano G, Pata F, Pin Hung W, Raj A, Romani Pozo A, Rommaneh M, Sassamela Fabiano SC, Shiroma Gago CM, Shu Yip S, Srinivas A, Sung CY, Tai A, Valle Aranda YC, Venturini S, Vervoort D, Wilguens Lartigue J. Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries. Lancet 2021; 397:387-397. [PMID: 33485461 PMCID: PMC7846817 DOI: 10.1016/s0140-6736(21)00001-5] [Citation(s) in RCA: 104] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/02/2020] [Accepted: 12/17/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. METHODS This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. FINDINGS Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70-8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39-8·80) and upper-middle-income countries (2·06, 1·11-3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26-11·59) and upper-middle-income countries (3·89, 2·08-7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. INTERPRETATION Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. FUNDING National Institute for Health Research Global Health Research Unit.
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Chu KM, Dell AJ, Moultrie H, Day C, Naidoo M, van Straten S, Rayne S. A geospatial analysis of two-hour surgical access to district hospitals in South Africa. BMC Health Serv Res 2020; 20:744. [PMID: 32791995 PMCID: PMC7425023 DOI: 10.1186/s12913-020-05637-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 08/09/2020] [Indexed: 11/10/2022] Open
Abstract
Background In a robust health care system, at least 80% of a country’s population should be able to access a district hospital that provides surgical care within 2 hours. The objective was to identify the proportion of the population living within 2 hours of a district hospital with surgical capacity in South Africa. Methods All government hospitals in the country were identified. Surgical district hospitals were defined as district hospitals with a surgical provider, a functional operating theatre, and the provision of at least one caesarean section annually. The proportion of the population within two-hour access was estimated using service area methods. Results Ninety-eight percent of the population had two-hour access to any government hospital in South Africa. One hundred and thirty-eight of 240 (58%) district hospitals had surgical capacity and 86% of the population had two-hour access to these facilities. Conclusion Improving equitable surgical access is urgently needed in sub-Saharan Africa. This study demonstrated that in South Africa, just over half of district hospitals had surgical capacity but more than 80% of the population had two-hour access to these facilities. Strengthening district hospital surgical capacity is an international mandate and needed to improve access.
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Affiliation(s)
- Kathryn M Chu
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa. .,Department of Surgery, University of Cape Town, Cape Town, South Africa. .,Department of Global Health, University of Stellenbosch, Francie Van Zijl Dr Tygerberg Hospital, Cape Town, 7505, South Africa.
| | - Angela J Dell
- Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Harry Moultrie
- School of Pathology, University of the Witwatersrand, Johannesburg, South Africa.,Respiratory and Meningeal Pathogens Research Unit, Medical Research Council, Cape Town, South Africa
| | - Candy Day
- Health Systems Research Unit, Health Systems Trust, Cape Town, South Africa
| | - Megan Naidoo
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | | | - Sarah Rayne
- Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
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Mathew D, Rubin G, Mahomed N, Rayne S. Imaging and clinical features of breast tuberculosis: a review series of 62 cases. Clin Radiol 2020; 75:561.e13-561.e24. [PMID: 32321647 DOI: 10.1016/j.crad.2020.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 03/10/2020] [Indexed: 01/09/2023]
Abstract
AIM To outline the disease burden of breast tuberculosis (TB) as a quantitative analysis amongst three tertiary hospitals in South Africa, with correlation to their clinical, demographic, and imaging features. MATERIALS AND METHODS A retrospective analysis was undertaken over an 18-month period (01/01/2017-30/06/2018) of all patients undergoing laboratory investigations for breast disease at the mammography departments of these three tertiary centres. RESULTS The prevalence of breast TB was 2.5% (n=62) of 2,516 patients. The median age of presentation was 38.5 years (interquartile range [IQR] 33-45). HIV status was known in 45 patients, of whom 36 were HIV infected (80%, 95% CI: 0.65-0.90, p<0.0001). Based on the ultrasound and/or mammogram findings, the patients were classified into five categories: TB breast abscess (40.3%), inflammatory/disseminated (24.2%), isolated TB lymphadenitis (22.6%), nodular (11.3%), and sclerosing form (1.6%). Histology demonstrated necrotising granulomatous inflammation in 57 cases (92%). Acid-fast bacilli (AFB) were positive in 8.1% (n=5) of the cytology and 16.1% (n=10) of the histology specimens. Culture for Mycobacterium tuberculosis was positive in 27% (17 cases), and in 12.9% (n=8). AFB were detected histologically using polymerase chain reaction (PCR) testing. CONCLUSION Knowledge of the varied clinical and radiological features is necessary to maintain a high degree of suspicion to prevent misdiagnoses, inappropriate management, and complications. Ultrasound-guided core biopsy rather than fine-needle aspiration (FNA) is advocated as the first-line intervention in diagnosing or excluding this disease, as it yields a better tissue sample and more often a positive diagnosis.
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Affiliation(s)
- D Mathew
- Department of Diagnostic Radiology, University of the Witwatersrand, Johannesburg, South Africa; Charlotte Maxeke Johannesburg Academic Hospital, Private Bag X39, Johannesburg, 2000, South Africa; Chris Hani Baragwanath Academic Hospital, PO Bertsham, Chris Hani, Johannesburg, 2013, South Africa; Helen Joseph Hospital, Private Bag X47, Auckland Park, 2006, Johannesburg, South Africa.
| | - G Rubin
- Department of Diagnostic Radiology, University of the Witwatersrand, Johannesburg, South Africa; Helen Joseph Hospital, Private Bag X47, Auckland Park, 2006, Johannesburg, South Africa
| | - N Mahomed
- Department of Diagnostic Radiology, University of the Witwatersrand, Johannesburg, South Africa; Department of Diagnostic Radiology, Rahima Moosa Mother and Child Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - S Rayne
- Department of Breast Surgery, Helen Joseph Hospital, University of the Witwatersrand, Johannesburg, South Africa
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Dunlop JL, Slemming W, Schnippel K, Makura C, Levin LJ, Rayne S, Vujovic M, Firnhaber C. Breast abnormalities in adolescents receiving antiretroviral therapy. South Afr J HIV Med 2019; 20:1017. [PMID: 31745435 PMCID: PMC6852609 DOI: 10.4102/sajhivmed.v20i1.1017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 08/30/2019] [Indexed: 11/04/2022] Open
Abstract
Background Antiretrovirals, particularly efavirenz (EFV), have been shown to cause breast abnormalities in adults. Little is known about the prevalence of these adverse effects among adolescents receiving antiretroviral therapy (ART). Objectives The aim of this article was to examine the extent of breast abnormalities in adolescents receiving ART and determine any clinical associations. Methods A retrospective record review describing breast conditions in adolescents receiving ART at three facilities in Johannesburg was conducted. Patients aged 10–19 years, who presented from January to December 2014, were included in the study. Analyses were conducted to determine whether EFV was associated with increased breast conditions. Results Of the 631 patient records reviewed, 37 (6%) had an abnormal breast event documented; with 24/37 (65%) being male patients. Patients with abnormal breast conditions were 1.5 years older than patients with normal breast development (p < 0.0005). Forty-one abnormal breast events were observed in 37 patients, with 20 described as gynaecomastia or lipomastia (49%). Of the 37 patients, 44% (n = 19) had concurrent generalised lipodystrophy. Of those with an abnormal breast event, 71% of patients had CD4 counts > 500 cells/µL and were virologically suppressed (n = 29). Those on EFV had a significantly higher prevalence of breast abnormalities compared to other regimens (p = 0.016). Conclusion Of the studied patients, 6% had an abnormal breast condition. The use of EFV and increased age were associated with breast abnormalities in this population. Further research is needed to better understand the implications of this potential side effect.
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Affiliation(s)
- Jackie L Dunlop
- Right to Care, Johannesburg, South Africa.,Division of Child Health, School of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa
| | - Wiedaad Slemming
- Division of Child Health, School of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathryn Schnippel
- Right to Care, Johannesburg, South Africa.,Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | | | | | - Sarah Rayne
- Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Cynthia Firnhaber
- Right to Care, Johannesburg, South Africa.,School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa.,School of Internal Medicine, University of Colorado, Aurora, United States
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Anakwenze C, Bhatia R, Rate W, Bakwenabatsile L, Ngoni K, Rayne S, Dhillon P, Narasimhamurthy M, Ho-Foster A, Ramogola-Masire D, Grover S. Factors Related to Advanced Stage of Cancer Presentation in Botswana. J Glob Oncol 2019; 4:1-9. [PMID: 30532993 PMCID: PMC6818282 DOI: 10.1200/jgo.18.00129] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Botswana, a country with a high prevalence of HIV, has an increasing
incidence of cancer-related mortality in the post–antiretroviral
therapy era. Despite universal access to free health care, the majority of
Botswana patients with cancer present at advanced stages. This study was
designed to explore the factors related to advanced-stage cancer
presentation in Botswana. Methods Patients attending an oncology clinic between December 2015 and January 2017
at Princess Marina Hospital in Gaborone, Botswana, completed a questionnaire
on sociodemographic and clinical factors as well as cancer-related fears,
attitudes, beliefs, and stigma. Odds ratios (ORs) were calculated to
identify factors significantly associated with advanced stage (stage III and
IV) at diagnosis. Results Of 214 patients, 18.7% were men and 81.3% were women. The median age at
diagnosis was 46 years, with 71.9% of patients older than 40 years. The most
commonly represented cancers included cervical (42.3%), breast (16%), and
head and neck (15.5%). Cancer stages represented in the study group included
8.4% at stage I, 19.2% at stage II, 24.1% at stage III, 11.9% at stage IV,
and 36.4% at an unknown stage. Patients who presented at advanced stages
were significantly more likely to not be afraid of having cancer (OR, 3.48;
P < .05), believe that their family would not care
for them if they needed treatment (OR, 6.35; P = .05), and
believe that they could not afford to develop cancer (OR, 2.73;
P < .05). The perception that symptoms were less
serious was also significantly related to advanced stage (P
< .05). Patients with non–female-specific cancers were more likely
to present in advanced stages (OR, 5.67; P < .05). Conclusion Future cancer mortality reduction efforts should emphasize cancer symptom
awareness and early detection through routine cancer screening, as well as
increasing the acceptability of care-seeking, especially among male
patients.
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Affiliation(s)
- Chidinma Anakwenze
- Chidinma Anakwenze, MD Anderson Cancer Center, Houston, TX; Rohini Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile, Ari Ho-Foster, and Surbhi Grover, Botswana-University of Pennsylvania Partnership, Gaborone, Botswana, and Philadelphia, PA; Kebatshabile Ngoni, Mohan Narasimhamurthy, and Doreen Ramogola-Masire, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; Preet Dhillon, Public Health Foundation of India, Gurgaon, Haryana, India; and Ari Ho-Foster, Doreen Ramogola-Masire and Surbhi Grover, University of Pennsylvania, Philadelphia, PA
| | - Rohini Bhatia
- Chidinma Anakwenze, MD Anderson Cancer Center, Houston, TX; Rohini Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile, Ari Ho-Foster, and Surbhi Grover, Botswana-University of Pennsylvania Partnership, Gaborone, Botswana, and Philadelphia, PA; Kebatshabile Ngoni, Mohan Narasimhamurthy, and Doreen Ramogola-Masire, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; Preet Dhillon, Public Health Foundation of India, Gurgaon, Haryana, India; and Ari Ho-Foster, Doreen Ramogola-Masire and Surbhi Grover, University of Pennsylvania, Philadelphia, PA
| | - William Rate
- Chidinma Anakwenze, MD Anderson Cancer Center, Houston, TX; Rohini Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile, Ari Ho-Foster, and Surbhi Grover, Botswana-University of Pennsylvania Partnership, Gaborone, Botswana, and Philadelphia, PA; Kebatshabile Ngoni, Mohan Narasimhamurthy, and Doreen Ramogola-Masire, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; Preet Dhillon, Public Health Foundation of India, Gurgaon, Haryana, India; and Ari Ho-Foster, Doreen Ramogola-Masire and Surbhi Grover, University of Pennsylvania, Philadelphia, PA
| | - Lame Bakwenabatsile
- Chidinma Anakwenze, MD Anderson Cancer Center, Houston, TX; Rohini Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile, Ari Ho-Foster, and Surbhi Grover, Botswana-University of Pennsylvania Partnership, Gaborone, Botswana, and Philadelphia, PA; Kebatshabile Ngoni, Mohan Narasimhamurthy, and Doreen Ramogola-Masire, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; Preet Dhillon, Public Health Foundation of India, Gurgaon, Haryana, India; and Ari Ho-Foster, Doreen Ramogola-Masire and Surbhi Grover, University of Pennsylvania, Philadelphia, PA
| | - Kebatshabile Ngoni
- Chidinma Anakwenze, MD Anderson Cancer Center, Houston, TX; Rohini Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile, Ari Ho-Foster, and Surbhi Grover, Botswana-University of Pennsylvania Partnership, Gaborone, Botswana, and Philadelphia, PA; Kebatshabile Ngoni, Mohan Narasimhamurthy, and Doreen Ramogola-Masire, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; Preet Dhillon, Public Health Foundation of India, Gurgaon, Haryana, India; and Ari Ho-Foster, Doreen Ramogola-Masire and Surbhi Grover, University of Pennsylvania, Philadelphia, PA
| | - Sarah Rayne
- Chidinma Anakwenze, MD Anderson Cancer Center, Houston, TX; Rohini Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile, Ari Ho-Foster, and Surbhi Grover, Botswana-University of Pennsylvania Partnership, Gaborone, Botswana, and Philadelphia, PA; Kebatshabile Ngoni, Mohan Narasimhamurthy, and Doreen Ramogola-Masire, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; Preet Dhillon, Public Health Foundation of India, Gurgaon, Haryana, India; and Ari Ho-Foster, Doreen Ramogola-Masire and Surbhi Grover, University of Pennsylvania, Philadelphia, PA
| | - Preet Dhillon
- Chidinma Anakwenze, MD Anderson Cancer Center, Houston, TX; Rohini Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile, Ari Ho-Foster, and Surbhi Grover, Botswana-University of Pennsylvania Partnership, Gaborone, Botswana, and Philadelphia, PA; Kebatshabile Ngoni, Mohan Narasimhamurthy, and Doreen Ramogola-Masire, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; Preet Dhillon, Public Health Foundation of India, Gurgaon, Haryana, India; and Ari Ho-Foster, Doreen Ramogola-Masire and Surbhi Grover, University of Pennsylvania, Philadelphia, PA
| | - Mohan Narasimhamurthy
- Chidinma Anakwenze, MD Anderson Cancer Center, Houston, TX; Rohini Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile, Ari Ho-Foster, and Surbhi Grover, Botswana-University of Pennsylvania Partnership, Gaborone, Botswana, and Philadelphia, PA; Kebatshabile Ngoni, Mohan Narasimhamurthy, and Doreen Ramogola-Masire, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; Preet Dhillon, Public Health Foundation of India, Gurgaon, Haryana, India; and Ari Ho-Foster, Doreen Ramogola-Masire and Surbhi Grover, University of Pennsylvania, Philadelphia, PA
| | - Ari Ho-Foster
- Chidinma Anakwenze, MD Anderson Cancer Center, Houston, TX; Rohini Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile, Ari Ho-Foster, and Surbhi Grover, Botswana-University of Pennsylvania Partnership, Gaborone, Botswana, and Philadelphia, PA; Kebatshabile Ngoni, Mohan Narasimhamurthy, and Doreen Ramogola-Masire, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; Preet Dhillon, Public Health Foundation of India, Gurgaon, Haryana, India; and Ari Ho-Foster, Doreen Ramogola-Masire and Surbhi Grover, University of Pennsylvania, Philadelphia, PA
| | - Doreen Ramogola-Masire
- Chidinma Anakwenze, MD Anderson Cancer Center, Houston, TX; Rohini Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile, Ari Ho-Foster, and Surbhi Grover, Botswana-University of Pennsylvania Partnership, Gaborone, Botswana, and Philadelphia, PA; Kebatshabile Ngoni, Mohan Narasimhamurthy, and Doreen Ramogola-Masire, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; Preet Dhillon, Public Health Foundation of India, Gurgaon, Haryana, India; and Ari Ho-Foster, Doreen Ramogola-Masire and Surbhi Grover, University of Pennsylvania, Philadelphia, PA
| | - Surbhi Grover
- Chidinma Anakwenze, MD Anderson Cancer Center, Houston, TX; Rohini Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile, Ari Ho-Foster, and Surbhi Grover, Botswana-University of Pennsylvania Partnership, Gaborone, Botswana, and Philadelphia, PA; Kebatshabile Ngoni, Mohan Narasimhamurthy, and Doreen Ramogola-Masire, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; Preet Dhillon, Public Health Foundation of India, Gurgaon, Haryana, India; and Ari Ho-Foster, Doreen Ramogola-Masire and Surbhi Grover, University of Pennsylvania, Philadelphia, PA
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Ede C, Benn CA, Fearnhead K, Nayler S, Rayne S. Should all lobular breast carcinoma undergo staging gastrointestinal endoscopy? Breast J 2019; 25:340-342. [PMID: 30788875 DOI: 10.1111/tbj.13229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 10/31/2017] [Accepted: 11/07/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Chikwendu Ede
- Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Carol-Ann Benn
- Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kirstin Fearnhead
- Department of Anatomical pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Simon Nayler
- Department of Anatomical pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Sarah Rayne
- Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Rayne S, Schnippel K, Grover S, Kruger D, Benn C, Firnhaber C. The effect of beliefs about breast cancer on stage and delay to presentation: results from a prospective study in urban South Africa. S AFR J SURG 2019. [DOI: 10.17159/2078-5151/2018/v56n2a2704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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10
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Chu KM, Karjiker P, Naidu P, Kruger D, Taylor A, Trelles M, Dominguez L, Rayne S. South African General Surgeon Preparedness for Humanitarian Disasters. World J Surg 2018; 43:973-977. [DOI: 10.1007/s00268-018-04881-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Anakwenze C, Bhatia R, Rate W, Bakwenabatsile L, Ngoni K, Rayne S, Dhillon P, Narasimhamurthy M, Foster A, Grover S. Factors Related to Advanced Stage of Cancer Presentation in Botswana. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Rayne S, Schnippel K, Grover S, Fearnhead K, Kruger D, Benn C, Firnhaber C. Unraveling the South African Breast Cancer Story: The Relationship of Patients, Delay to Diagnosis, and Tumor Biology With Stage at Presentation in an Urban Setting. J Surg Res 2018; 235:181-189. [PMID: 30691793 DOI: 10.1016/j.jss.2018.09.087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/13/2018] [Accepted: 09/28/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Adverse outcomes from breast cancer disproportionately affect women in sub-Saharan Africa, with delay the most studied contribution to advanced stage at presentation. However, tumor molecular biology and its contribution to advanced stage are yet to be explored. MATERIALS AND METHODS Patients newly diagnosed with breast cancer in a South African tertiary breast center completed a questionnaire and file review concerning socioeconomics, delay to care, stage at presentation, and molecular characteristics. Logistic regression was done to determine the relative risk of advanced stage presentation. RESULTS Advanced stage was present in 70.1% (n = 162) of the 231 participants, with 55.8% stage III (n = 129) and 32% (n = 72) having a T4 tumor. The median age was 56 y with 21.6% (n = 47) aged <45 y. Most common subtype was luminal B (57.7%, n = 128) followed by luminal A (21.6%, n = 48), triple negative (13.9%, n = 31), and HER2 positive (6.7%, n = 15). Lobular cancer (incidence risk ratio [IRR], 1.29; 95% confidence interval [CI], 1.03-1.62), high grade and intermediate grade tumors (IRR, 1.90; 95% CI, 1.15-3.13 and IRR, 1.95; 95% CI, 1.18-3.22, respectively), high Ki67 proliferation index (IRR, 1.30; 95% CI, 1.02-1.66), and HER2 overexpression (IRR, 1.32; 95% CI, 1.12-1.55) were more likely to present with advanced disease, as were luminal B (HER2+) cancers (adjusted IRR [aIRR], 1.46; 95% CI, 1.10-1.95). Although on univariate analysis Black and young participants were both more likely to have advanced stage (IRR, 1.23; 95% CI, 1.01-1.49 and IRR, 1.25; 95% CI, 1.04-1.51, respectively), in multivariate analysis controlling for tumor biology and delay, these were no longer significant (aIRR, 1.12; 95% CI, 0.91-1.37 and aIRR, 1.17; 95% CI, 0.94-1.48, respectively). CONCLUSIONS Tumor biology has a compelling role in the etiology of advanced-stage disease irrespective of socioeconomic factors. Accurate pathologic assessment is important in planning breast cancer care in Africa.
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Affiliation(s)
- Sarah Rayne
- Department of Surgery, Helen Joseph Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Kathryn Schnippel
- Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Princess Marina Hospital, Gaborone, Botswana, Botswana-UPENN Partnership, Gaborone, Botswana
| | - Kirstin Fearnhead
- Department of Anatomical Pathology, National Health Laboratory Services, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Deirdre Kruger
- Department of Surgery, Helen Joseph Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Carol Benn
- Department of Surgery, Helen Joseph Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Cynthia Firnhaber
- Clinical HIV Research Unit, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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LaVigne A, Grover S, Rayne S. Knowledge and Screening Practices of Breast and Cervical Cancer in Rural and Urban South Africa. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.38000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: The South African government has recently released cancer policies for breast and cervical cancer—the most common types and causes of cancer-related death in South African women. Increased mortality rates and advanced disease at presentation in comparison with developed countries suggests a need for greater awareness of risk factors, screening and preventative methods individualized for the population at risk. Aim: To characterize and compare the knowledge base and perceptions of women in urban and rural settings, we assessed these factors in two different cohorts in South Africa. Methods: A cross-sectional sample was taken in South Africa of women invited to participate in a survey regarding breast and cervical cancer knowledge, and awareness of risk factors, prevention and screening. Participants were approached in shopping malls and health facilities in urban Johannesburg in 2015 (“urban”) and semirural Bushbuckridge, 450 km northeast of Johannesburg (“rural”) in 2016. Results: 600 total women were surveyed, with 300 from each cohort. 83% of the urban cohort completed matriculation or higher, versus 60% of rural participants for whom high school was their highest level of education. Both groups demonstrated comparable levels of cancer awareness, and > 70% felt that cervical cancer is preventable. While the urban cohort was more knowledgeable about Pap smears (76% vs. 66%, P = 0.004), > 75% of both cohorts were willing to get one. Although both groups were largely unfamiliar with the role of HPV in cervical cancer, rural women were more aware of HIV (38% vs. 59%, P < 0.0001), smoking (43% vs. 62%, P < 0.0001) and parity (39% vs. 54%, P = 0.00019) as risk factors. Nevertheless, urban participants were more knowledgeable about breast self exams (71% vs. 59%, P = 0.001) and mammograms (62% vs. 42%, P < 0.0001), and more likely to undergo one (79% vs. 66%, P = 0.0002). Both groups identified family history and genetics as risk factors, but rural women appeared more aware of the roles of diet (30.67% vs. 39.93%, P = .011), oral contraceptives (17.33% vs. 34.77%, P < .0001), alcohol (26.67% vs. 52.15%, P < .0001) and lack of exercise (8.67% vs. 55.12%, P < .0001). Conclusion: Overall knowledge of breast and cervical cancer did not differ between both groups, despite varying levels of education and geographic setting. Women in the rural cohort demonstrated more awareness of several oncologic risk factors. Yet, the greater familiarity with and uptake of screening methods, especially for breast cancer, among women in the urban cohort may point to the benefits of proximity to health care infrastructure, such as tertiary care centers. This data supports a need for further implementation and distribution of cancer care services within cancer policies, to capitalize on increasingly sufficient levels of awareness among South African women.
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Affiliation(s)
- A. LaVigne
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - S. Grover
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - S. Rayne
- Johns Hopkins University School of Medicine, Baltimore, MD
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Rayne S, Meyerowitz J, Even-Tov G, Rae H, Tapela N, Klipin M, Mare I. Let the Data Serve the Patient: Using Big-Scale Data Collection to Improve Small-Scale Patient Interactions. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.32200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background and context: Breast cancer is one of the most common cancers in most resource-constrained environments worldwide. Although breast awareness has improved, lack of understanding of the diagnosis and management can cause patient anxiety, noncompliance and ultimately may affect survival through compromised or delayed care. South African women attending government hospitals are diverse, with differing levels of income, education and support available. Often there is a lack of access for them to appropriate information for their cancer care. Aim: A novel bioinformatics data management system was conceived through an innovative close collaboration between Wits Biomedical Informatics and Translational Science (Wits-BITS) and academic breast cancer surgeons. The aim was to develop a platform to allow acquisition of epidemiologic data but synchronously convert this into a personalised cancer plan and “take-home” information sheet for the patient. Strategy/Tactics: The concept of a clinician “customer” was used, in which the “currency” in which they rewarded the database service was accurate data. For this payment they received the “product” of an immediate personalised information sheet for their patient. Program/Policy process: A custom software module was developed to generate individualized patient letters containing a mixture of template text and information from the patient's medical record. The letter is populated with the patient's name and where they were seen, and an personalised explanation of the patient's specific cancer stage according to the TNM system. Outcomes: Through a process of continuous use with patient and clinician feedback, the quality of data in the system was improved. Patients enjoyed the personalised information sheet, allowing patient and family to comprehend and be reassured by the management plan. Clinicians found that the quality of the information sheet was instant feedback as to the comprehensiveness of their data input, and thus assured compliance and quality of data points. What was learned: Using a consumer model, through a process of cross-discipline collaboration, where there is normally poor access to appropriate patient information and poor data entry by overburdened clinicians, a low-cost model of high-quality data collection was achieved, in real-time, by clinicians best qualified to input correct data points. Patients also benefitted from participation in a database immediately, through personalised information sheets improving their understanding of their cancer care.
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Affiliation(s)
- S. Rayne
- University of the Witwatersrand, Department of Surgery, Johannesburg, South Africa
| | - J. Meyerowitz
- University of the Witwatersrand, Wits Biomedical Informatics and Translational Science, Johannesburg, South Africa
| | - G. Even-Tov
- University of the Witwatersrand, Wits Biomedical Informatics and Translational Science, Johannesburg, South Africa
| | - H. Rae
- University of the Witwatersrand, Helen Joseph Breast Care Clinic, Helen Joseph Hospital, Johannesburg, South Africa
| | - N. Tapela
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Brigham and Women's Hospital, Division of Global Health Equity, Boston, MA
| | - M. Klipin
- University of the Witwatersrand, Wits Biomedical Informatics and Translational Science, Johannesburg, South Africa
| | - I. Mare
- University of the Witwatersrand, Wits Biomedical Informatics and Translational Science, Johannesburg, South Africa
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Chu KM, Karjiker P, Kruger D, Rayne S. South African Surgeons Are Appropriately Trained for Humanitarian Surgery. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.08.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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16
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Chaka B, Sayed AR, Goeieman B, Rayne S. A survey of knowledge and attitudes relating to cervical and breast cancer among women in Ethiopia. BMC Public Health 2018; 18:1072. [PMID: 30157813 PMCID: PMC6114489 DOI: 10.1186/s12889-018-5958-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 08/13/2018] [Indexed: 11/17/2022] Open
Abstract
Background Breast cancer and cervical cancer are the two leading cancers among women in Ethiopia. This study investigated knowledge and attitudes related to these two types of cancer among women in 4 zones of Ethiopia. This is the first study employing a validated questionnaire to investigate knowledge and attitudes relating to breast and cervical cancer in Ethiopia. Methods A community based cross-sectional study was conducted from September to November 2015 in the North Shewa zone (Amhara region), Gamo Gofa zone (Southern Nations, Nationalities and Peoples’ region) and zones 1 and 3 (Afar region) of Ethiopia. A total of 799 women aged 18 years and older participated in the survey. Multiple logistic regression analysis was used to investigate the association of possible predictors with breast and cervical cancer knowledge. Results A total of 799 women aged 18 years and older participated in the survey. Of the women interviewed, 63.0% had heard of breast cancer and 42.2% had heard of cervical cancer. Among those who had heard of breast cancer, 21.3% (107/503) had heard of breast cancer screening and 1.4% of women aged 40 years and older had undergone at least one breast screening examination. Fewer than half of the participants provided the correct response to questions related to risk factors for breast and cervical cancer. Among those who had heard of cervical cancer, 41.5% (140/337) had heard of cervical cancer screening and 3.3% had undergone at least one cervical cancer screening examination. Women with primary and higher levels of education were more likely to have heard of breast cancers (OR = 3.0; 95% CI: 2.1–4.2; p < 0.001) and cervical cancer (OR = 1.9; 95% CI: 1.4–2.6; p < 0.001). From the overall attitude score, the majority of the women were found to have negative attitudes towards breast cancer (67.4%) and cervical cancer (70.6%). Conclusions This study found that the overall knowledge of risk factors for breast cancer and cervical cancer among women was low. Lack of cancer awareness, and lack of education in general, are the most potent barriers to access and care, and should be addressed through multi-faceted strategies including peer-education, mass media and other community-based interventions.
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Affiliation(s)
| | - Abdul-Rauf Sayed
- School of Public Health, University of Cape Town, Cape Town, South Africa
| | | | - Sarah Rayne
- Department of Surgery, Helen Joseph Hospital, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa.
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Bhatia RK, Rayne S, Rate W, Bakwenabatsile L, Monare B, Anakwenze C, Dhillon P, Narasimhamurthy M, Dryden-Peterson S, Grover S. Patient Factors Associated With Delays in Obtaining Cancer Care in Botswana. J Glob Oncol 2018; 4:1-13. [PMID: 30199305 PMCID: PMC6223504 DOI: 10.1200/jgo.18.00088] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Purpose Delays in diagnosis and treatment of cancers can lead to poor survival. These delays represent a multifaceted problem attributable to patient, provider, and systemic factors. We aim to quantify intervals from symptom onset to treatment start among patients with cancer in Botswana and to understand potential risk factors for delay. Patients and Methods From December 2015 to January 2017, we surveyed patients seen in an oncology clinic in Botswana. We calculated proportions of patients who experienced delays in appraisal (between detecting symptoms and perceiving a reason to discuss them with provider, defined as > 1 month), help seeking (between discussing symptoms and first consultation with provider, defined as > 1 month), diagnosis (between first consultation and receiving a diagnosis, defined as > 3 months), and treatment (between diagnosis and starting treatment, defined as > 3 months). Results Among 214 patients with cancer who completed the survey, median age at diagnosis was 46 years, and the most common cancer was cancer of the cervix (42.2%). Eighty-one percent of patients were women, 60.7% were HIV infected, and 56.6% presented with advanced cancer (stage III or IV). Twenty-six percent of patients experienced delays in appraisal, 35.5% experienced delays help seeking, 63.1% experienced delays in diagnosis, and 50.4% experienced delays in treatment. Patient income, education, and age were not associated with delays. In univariable analysis, patients living with larger families were less likely to experience a help-seeking delay (odds ratio [OR], 0.31; P = .03), women and patients with perceived very serious symptoms were less likely to experience an appraisal delay (OR, 0.45; P = .032 and OR, 0.14; P = .02, respectively). Conclusion Nearly all patients surveyed experienced a delay in obtaining cancer care. In a setting where care is provided without charge, cancer type and male sex were more important predictors of delays than socioeconomic factors.
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Affiliation(s)
- Rohini K. Bhatia
- Rohini K. Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile and Barati Monare, Botswana-University of Pennsylvania Partnership; Mohan Narasimhamurthy, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; Chidinma Anakwenze, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX; Preet Dhillon, Public Health Foundation of India, Gurgaon, India; Scott Dryden-Peterson, Brigham and Women’s Hospital and Botswana Harvard AIDS Institute, Harvard TH Chan School of Public Health, Boston, MA
| | - Sarah Rayne
- Rohini K. Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile and Barati Monare, Botswana-University of Pennsylvania Partnership; Mohan Narasimhamurthy, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; Chidinma Anakwenze, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX; Preet Dhillon, Public Health Foundation of India, Gurgaon, India; Scott Dryden-Peterson, Brigham and Women’s Hospital and Botswana Harvard AIDS Institute, Harvard TH Chan School of Public Health, Boston, MA
| | - William Rate
- Rohini K. Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile and Barati Monare, Botswana-University of Pennsylvania Partnership; Mohan Narasimhamurthy, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; Chidinma Anakwenze, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX; Preet Dhillon, Public Health Foundation of India, Gurgaon, India; Scott Dryden-Peterson, Brigham and Women’s Hospital and Botswana Harvard AIDS Institute, Harvard TH Chan School of Public Health, Boston, MA
| | - Lame Bakwenabatsile
- Rohini K. Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile and Barati Monare, Botswana-University of Pennsylvania Partnership; Mohan Narasimhamurthy, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; Chidinma Anakwenze, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX; Preet Dhillon, Public Health Foundation of India, Gurgaon, India; Scott Dryden-Peterson, Brigham and Women’s Hospital and Botswana Harvard AIDS Institute, Harvard TH Chan School of Public Health, Boston, MA
| | - Barati Monare
- Rohini K. Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile and Barati Monare, Botswana-University of Pennsylvania Partnership; Mohan Narasimhamurthy, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; Chidinma Anakwenze, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX; Preet Dhillon, Public Health Foundation of India, Gurgaon, India; Scott Dryden-Peterson, Brigham and Women’s Hospital and Botswana Harvard AIDS Institute, Harvard TH Chan School of Public Health, Boston, MA
| | - Chidinma Anakwenze
- Rohini K. Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile and Barati Monare, Botswana-University of Pennsylvania Partnership; Mohan Narasimhamurthy, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; Chidinma Anakwenze, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX; Preet Dhillon, Public Health Foundation of India, Gurgaon, India; Scott Dryden-Peterson, Brigham and Women’s Hospital and Botswana Harvard AIDS Institute, Harvard TH Chan School of Public Health, Boston, MA
| | - Preet Dhillon
- Rohini K. Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile and Barati Monare, Botswana-University of Pennsylvania Partnership; Mohan Narasimhamurthy, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; Chidinma Anakwenze, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX; Preet Dhillon, Public Health Foundation of India, Gurgaon, India; Scott Dryden-Peterson, Brigham and Women’s Hospital and Botswana Harvard AIDS Institute, Harvard TH Chan School of Public Health, Boston, MA
| | - Mohan Narasimhamurthy
- Rohini K. Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile and Barati Monare, Botswana-University of Pennsylvania Partnership; Mohan Narasimhamurthy, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; Chidinma Anakwenze, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX; Preet Dhillon, Public Health Foundation of India, Gurgaon, India; Scott Dryden-Peterson, Brigham and Women’s Hospital and Botswana Harvard AIDS Institute, Harvard TH Chan School of Public Health, Boston, MA
| | - Scott Dryden-Peterson
- Rohini K. Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile and Barati Monare, Botswana-University of Pennsylvania Partnership; Mohan Narasimhamurthy, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; Chidinma Anakwenze, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX; Preet Dhillon, Public Health Foundation of India, Gurgaon, India; Scott Dryden-Peterson, Brigham and Women’s Hospital and Botswana Harvard AIDS Institute, Harvard TH Chan School of Public Health, Boston, MA
| | - Surbhi Grover
- Rohini K. Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile and Barati Monare, Botswana-University of Pennsylvania Partnership; Mohan Narasimhamurthy, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; Chidinma Anakwenze, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX; Preet Dhillon, Public Health Foundation of India, Gurgaon, India; Scott Dryden-Peterson, Brigham and Women’s Hospital and Botswana Harvard AIDS Institute, Harvard TH Chan School of Public Health, Boston, MA
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Rayne S, Schnippel K, Benn C, Kruger D, Wright K, Firnhaber C. The Effect of Access to Information on Beliefs Surrounding Breast Cancer in South Africa. J Cancer Educ 2018; 33:806-813. [PMID: 28540645 DOI: 10.1007/s13187-017-1234-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Breast cancer is the most common cancer affecting women in South Africa. There is little knowledge of beliefs to help identify key areas to improve support and education in this demographically and culturally diverse population. Women with a variety of demographic and socioeconomic characteristics accessing care for breast cancer were asked their agreement to statements of knowledge and beliefs about breast cancer. Of the 259 participants, positive statements of medical cure (87.9%) and family support (90.5%) were most commonly believed. Beliefs in faith-based cure and alternative treatments were also present (79.5 and 24.9%, respectively). Negative beliefs were initially more likely in black patients (RR: 11.57, 95%CI: 1.37-97.69) as was belief of cancer as a punishment (RR: 6.85, 95%CI: 1.41-33.21). However, in multivariate analysis adjusting for age, education and access to information (by newspaper, Internet and confidence in reading and writing), there was no difference between racial groups or hospital attended. Reading a newspaper or accessing the Internet was the most protective against belief that cancer was a punishment or curse (Internet use: aRR: 0.12, 95%CI: 0.02-0.99), belief in alternative methods of cure (newspaper use: aRR: 0.51, 95%CI: 0.27-0.96) and the negative beliefs of death and disfigurement (Internet use: aRR: 0.00, 95%CI: 0.00-0.00). Positive expressions of cure and beating cancer were found equally in all women. Attitudes and beliefs about cancer showed little independent demographic or socioeconomic variance. Negative beliefs were mitigated by access to information and confidence in literacy.
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Affiliation(s)
- Sarah Rayne
- Department of Surgery, Helen Joseph Hospital, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa.
| | - Kathryn Schnippel
- Right to Care, Johannesburg, South Africa
- Clinical HIV Research Unit, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa
| | - Carol Benn
- Department of Surgery, Helen Joseph Hospital, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa
| | - Deirdre Kruger
- Department of Surgery, Helen Joseph Hospital, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa
| | - Kathryne Wright
- Department of Surgery, Helen Joseph Hospital, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa
| | - Cynthia Firnhaber
- Right to Care, Johannesburg, South Africa
- Clinical HIV Research Unit, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa
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Rubin G, Rayne S, Lince-Deroche N, Hendrickson C, Shearer K, Moyo F, Michelow P, Benn C, Finhaber C. Characterization and costs of breast conditions at an open access breast clinic in South Africa. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e13570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Grace Rubin
- University of Witwatersrand - Faculty of Health Sciences, Johannesburg, South Africa
| | - Sarah Rayne
- University of Witwatersrand, Johannesburg, ZA
| | - Naomi Lince-Deroche
- University of Witwatersrand - Faculty of Health Sciences, Johannesburg, South Africa
| | | | - Kate Shearer
- University of Witwatersrand, Johannesburg, South Africa
| | - Faith Moyo
- Wits Health Consortium, Johannesburg, South Africa
| | | | - Carol Benn
- University of the Witwatersrand, Johannesburg, South Africa
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Bhangu A, Ademuyiwa AO, Aguilera ML, Alexander P, Al-Saqqa SW, Borda-Luque G, Costas-Chavarri A, Drake TM, Ntirenganya F, Fitzgerald JE, Fergusson SJ, Glasbey J, Ingabire JCA, Ismaïl L, Salem HK, Kojo ATT, Lapitan MC, Lilford R, Mihaljevic AL, Morton D, Mutabazi AZ, Nepogodiev D, Adisa AO, Ots R, Pata F, Pinkney T, Poškus T, Qureshi AU, Ramos-De la Medina A, Rayne S, Shaw CA, Shu S, Spence R, Smart N, Tabiri S, Harrison EM, Khatri C, Mohan M, Jaffry Z, Altamini A, Kirby A, Søreide K, Recinos G, Cornick J, Modolo MM, Iyer D, King S, Arthur T, Nahar SN, Waterman A, Walsh M, Agarwal A, Zani A, Firdouse M, Rouse T, Liu Q, Correa JC, Talving P, Worku M, Arnaud A, Kalles V, Kumar B, Kumar S, Amandito R, Quek R, Ansaloni L, Altibi A, Venskutonis D, Zilinskas J, Poskus T, Whitaker J, Msosa V, Tew YY, Farrugia A, Borg E, Bentounsi Z, Gala T, Al-Slaibi I, Tahboub H, Alser OH, Romani D, Shu S, Major P, Mironescu A, Bratu M, Kourdouli A, Ndajiwo A, Altwijri A, Alsaggaf MU, Gudal A, Jubran AF, 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Azzie G, Kushwaha S, Chen TL, Yip C, Montes I, Zapata F, Sierra S, Villegas Lanau MI, Mendoza Arango MC, Mendoza Restrepo I, Restrepo Giraldo RS, Domini E, Karlo R, Mihanovic J, Youssef M, Elfeki H, Thabet W, Sanad A, Tawfik G, Zaki A, Abdel-Hameed N, Mostafa M, Omar MFW, Ghanem A, Abdallah E, Denewer A, Emara E, Rashad E, Sakr A, Elashry R, Emile S, Khafagy T, Elhamouly S, Elfarargy A, Mamdouh Mohamed A, Saied Nagy G, Esam A, Elwy E, Hammad A, Khallaf S, Ibrahim E, Said Badr A, Moustafa A, Eldosouky Mohammed A, Elgheriany M, Abdelmageed E, Al Raouf EA, Samir Elbanby E, Elmasry M, Morsy Farahat M, Yahya Mansor E, Magdy Hegazy E, Gamal E, Gamal H, Kandil H, Maher Abdelrouf D, Moaty M, Gamal D, El-Sagheer N, Salah M, Magdy S, Salah A, Essam A, Ali A, Badawy M, Ahmed S, Mohamed M, Assal A, Sleem M, Ebidy M, Abd-Elrazek A, Zahran D, Adam N, Nazir M, Hassanein AB, Ismail A, Elsawy A, Mamdouh R, Mabrouk M, Ahmed LAM, Hassab Alnaby M, Magdy E, Abd-Elmawla M, Fahim M, Mowafy B, Ibrahim Mahmoud 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A, Adelshone A, Bin Hasnan M, Zulkifli A, Kamarulzamil SNA, Elhendawy A, Latif A, Bin Adnan A, Shaharuddin S, Haji Abdul Majid AH, Amreia M, Al-Marakby D, Salma M, Ismail MJB, Mohd Basir ER, Mohd Ali CD, Ata AY, Nasr M, Rezq A, Sheta A, Tariq S, Sallam AE, Darwish AKZ, Elmihy S, Elhadry S, Farag A, Hajeh H, Abdelaal A, Aglan A, Zohair A, Essam M, Moussa O, El-Gizawy E, Samy M, Ali S, El Halawany E, Ata A, El Halawany M, Nashat M, Soliman S, Elazab A, Samy M, Abdelaziz MA, Ibrahim K, Ibrahim AM, Gado A, Hantour U, Alm Eldeen E, Loaloa MR, Abouzaid A, Ahmed Bahaa Eldin M, Hashad E, Sroor F, Gamil D, Mahmoud Abdulhakeem E, Zakaria M, Mohamed F, Abubakr M, Ali E, Magdy H, Ramadan MT, Abdelaty Mohamed M, Mansour S, Abdul Aziz Amin H, Rabie Mohamed A, Saami M, Ahmed Reda Elsayed N, Tarek A, Mohy Eldeen Mahmoud S, Magdy El Sayed I, Reda A, Yusuf Shawky M, Mousa Salem M, Alaa El-Din S, Abdullah Soliman N, Talaat M, Alaael-Dein S, Abd Elmoen Elhusseiny A, Abdullah N, Elshaar M, Abdelfatah Ibraheem A, Abdulaziz H, Kamal Ismail M, Hamdy Madkor M, Abdelaty M, Mahmoud Abdel-Kader S, Mohamed Salah O, Eldafrawy M, Zaki Eldeeb A, Mahmoud Eid M, Attia A, Salah El-Dien K, Shwky A, Badenjki MA, Soliman A, Mahmoud Al Attar S, Sayed F, Abdel Sabour F, Azizeldine MG, Shawqi M, Hashim A, Aamer A, Abdelraouf AM, Abdelshakour M, Ibrahim A, Mahmoud B, Ali Mahmoud M, Qenawy M, Rashed AM, Dahy A, Sayed M, Shamsedine AW, Mohamed B, Hasan A, Saad MM, Abdul Bassit K, Khalid Abd El-Latif N, Elzahed N, El Kashash A, Bekhet NM, Hafez S, Gad A, Maher ME, Abd El-Sameea A, Hafez M, Sabe A, Ahmed A, Shahine A, Dawood K, Gaafar S, Husseiny R, Aboelmagd O, Soliman A, Mesbah N, Emadeldin H, Al Meligy A, Bekhet AH, Hasan D, Alhady K, Sabe AK, Elnajjar MA, Aboelella M, Hamsho W, Hassan I, Saad H, Abdelazim G, Mahmoud H, Wael N, Kandil AM, Magdy A, Said Elkholy S, Adel BE, Dabbour K, Elsherbiney S, Mattar O, Khaled AbdRabou A, Aly MYM, Geuoshy A, Elnagar A, Ahmed S, Abdelmotaleb I, Saleh AA, Mohammed Bakry H, Saeed M, Mahmoud S, Tawfik BA, Ismail SA, Zakaria E, Gad MO, Salah Elhelbawy M, Bassem M, Maraie N, Medhat Elhadary N, Semeda N, Rabie Mohamed S, Bakry HM, Essam AA, Tarek D, Ashour K, Elhadad A, Abdel-Aty A, Rakha I, Mamdouh Matter S, Abdelhamed R, Abdelkader O, Hassaan A, Soliman Y, Mohamed A, Ghanem S, Amr Mohamed Farouk S, Ibrahim EM, El-Taher E, Mostafa M, Mahrous Badr MF, Elsemelawy R, El-Sawy A, Bakr A, Al Rafati AAR, Saar S, Reinsoo A, Seyoum N, Worku T, Fitsum A, Tolonen M, Leppäniemi A, Sallinen V, Parmentier B, Peycelon M, Irtan S, Dardenne S, Robert E, Maillot B, Courboin E, Arnaud AP, Hascoet J, Abbo O, Ait Kaci A, Prudhomme T, Ballouhey Q, Grosos C, Fourcade L, Cecilia T, Jean-Francois C, Helene FC, Delforge X, Haraux E, Dousset B, Schiavone R, Gaujoux S, Marret JB, Haffreingue A, Rod J, Renaux-Petel M, Lecompte JF, Bréaud J, Gastaldi P, Taieb C, Claire R, Anis E, Bustangi N, Lopez M, Scalabre A, Grella MG, Mariani A, Podevin G, Schmitt F, Hervieux E, Broch A, 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A, Al Barrawi FE, Alkhatib A, Al-Faqawi M, Fares M, Elmashala A, Adawi M, Adawi I, Khreishi R, Khreishi R, Ashour A, Ghaben A, Machain Vega GM, Cardozo JT, Roche MO, Pertersen Servin GR, Segovia Lohse HA, Páez Lopez LI, Cardozo RAM, Espinoza F, Pérez Rojas AD, Sanchez D, Samaniego CS, Guevara Torres S, Calua AC, Razuri C, Ortiz N, Rodriguez X, Carrasco N, Saravia F, Shibao Miyasato H, Valcarcel-Saldaña M, Bermúdez YEA, Carpio J, Ruiz Panez W, Toribio Orbegozo PA, Guzmán Dueñas C, Turpo Espinoza K, Sandoval Barrantes AM, Chungui Bravo JA, Fuentes-Rivera L, Fernández C, Málaga B, Ye J, Velasquez R, Salcedo J, Contreras-Vergara AL, Vergara Mejia AG, Gonzales Montejo MS, Escalante Salas MDC, Alcca Ticona W, Vargas M, Manrique Sila GC, Mas R, del Pilar Paucar A, Román Velásquez AJ, Robledo-Rabanal A, Solis LAZ, Turpo Espinoza K, Hamasaki Hamaguchi JL, Florez Farfan ES, Madrid Barrientos LA, Herrera Matta JJ, Mora JJV, Redota MAP, Roxas MF, Maño MJB, Parreno-Sacdalan MD, Almanon CL, Walędziak M, Roszkowski R, Janik M, Lasek A, Radkowiak D, Rubinkiewicz M, Fernandes C, Costa-Maia J, Melo R, Muntean L, Mironescu AS, Vida LC, Popa M, Mircea H, Vartic M, Diaconescu B, Bratu MR, Negoi I, Beuran M, Ciubotaru C, Uzabumwana N, Duhoranenayo D, Jovine E, Zanini N, Landolfo G, Aljiffry M, Idris F, Alghamdi MSA, Maghrabi A, Altaf A, Alkaaki A, Khoja A, Nawawi A, Turkustani S, Khalifah E, Albiety A, Sahel S, Alshareef R, Najjar M, Alzahrani A, Alghamdi A, Alhazmi W, Al Saied G, Alamoudi M, Riaz MM, Hassanain M, Alhassan B, Altamimi A, Alyahya R, Al Subaie N, Al Bastawis F, Altamimi A, Nouh T, Khan R, Radojkovic M, Jeremic L, Nestorovic M, Law JH, Tan KSK, Tan RCK, Tan JK, Joel LWL, Chan XW, Leong FQH, Chong CS, Koh S, Lee KY, Lee KC, Pluke K, Dedekind B, Nashidengo P, Hampton MI, Joosten J, Sobnach S, Roodt L, Sander A, Pape J, Maistry N, Ndwambi P, Kinandu K, Tun M, Du Toit F, Ellison Q, Burger S, Grobler DC, Khulu LB, Moore R, Jennings V, Leusink A, Kariem N, Gouws J, Chu K, Bougard H, Noor F, Dell A, Van Straten S, Khamajeet A, Tshisola SK, Kabongo K, Kong V, Moodley Y, Anderson F, Madiba T, du Plooy F, Hartford L, Chilton G, Karjiker P, Mabitsela ME, Ndlovu SR, Badicel M, Jaich R, Ruiz-Tovar J, Garcia-Florez L, Otero-Díez JL, Ramos Pérez V, Aguado Suárez N, Minguez García J, Corral Moreno S, Collado MV, Jiménez Carneros V, García Septiem J, Gonzalez M, Picardo A, Esteban E, Ferrero E, Espin-Basany E, Blanco-Colino R, Andriola V, Solar García L, Contreras E, García Bernardo C, Pagnozzi J, Sanz S, Miyar de León A, Dorismé A, Rodicio J, Suarez A, Stuva J, Diaz Vico T, Fernandez-Vega L, Soldevila-Verdeguer C, Sena-Ruiz F, Pujol-Cano N, Diaz-Jover P, Garcia-Perez JM, Segura-Sampedro JJ, Pineño-Flores C, Ambrona-Zafra D, Craus-Miguel A, Jimenez-Morillas P, Mazzella A, Jayathilake AB, Thalgaspitiya SPB, Wijayarathna LS, Wimalge PMSN, Sanni HA, Okenabirhie O, Homeida A, Younis A, Omer OA, Abdulaziz M, Mussad A, Adam A, Björklund I, Ahlqvist S, Thorell A, Wogensen F, Sokratous A, Breistrand M, Thorarinsdottir H, Sigurdadottir J, Nikberg M, Chabok A, Hjertberg M, Elbe P, Saraste D, Rutkowski W, Forlin L, Niska K, Sund M, Oswald D, Peros G, Bluelle R, Reinisch K, Frey D, Palma A, Raptis DA, Zumbühl L, Zuber M, Schmid R, Werder G, Nocito A, Gerosa A, Mahanty S, Widmer LW, Müller J, Gübeli A, Zuk G, Gulcicek OB, Vartanoglu T, Kose E, Karahan SR, Aydin MC, Sahbaz NA, Halicioglu I, Alis H, Sapci I, Adiyaman C, Pektaş AM, Cengiz TB, Tansoker I, Işler V, Cevik M, Mutlu D, Ozben V, Ozmen BB, Bayram S, Yolcu S, Kobal BB, Toto ÖF, Çakaloğlu HC, Karabulut K, Mutlu V, Ozkan BB, Celik S, Semiz A, Bodur S, Gül E, Murutoglu B, Yildirim R, Baki BE, Arslan E, Ulusahin M, Guner A, Tomas K, Walker N, Shrimanker N, Cole S, Breslin R, Srinivasan R, Elshaer M, Hunter K, Al-Bahrani A, Liew I, Mairs NG, Rocke A, Dick L, Qureshi M, Chowdhury D, Wright N, Skerritt C, Kufeji D, Ho A, Dissanayake T, Tennakoon A, Ali W, Lim SJ, Tan C, O'Neill S, Jones C, Knight S, Nassif D, Sharma A, Warren O, White R, Mehdi A, Post N, Kalakouti E, Dashnyam E, Stourton F, Mykoniatis I, Currow C, Wong F, Gupta A, Shatkar V, Luck J, Kadiwar S, Smedley A, Wakefield R, Herrod P, Blackwell J, Lund J, Cohen F, Bandi A, Giuliani S, Bond-Smith G, Pezas T, Farhangmehr N, Urbonas T, Perenyei M, Ireland P, Blencowe N, Bowling K, Bunting D, Longstaff L, Keogh K, Jeon H, Iqbal MR, Khosla S, Jeffery A, Perera J, Ibrahem AA, Alhammali T, Salama Y, Oram S, Kidd T, Cullen F, Owen C, Wilson M, Chiu S, Sarafilovic H, Ploski J, Evans E, Abbas A, Kamya S, Ishak N, Bisset C, Andress C, Chin YR, Patel P, Evans D, Haslegrave A, Boggon A, Laurie K, Connor K, Mann T, Mansuri A, Davies R, Griffiths E, Shahbaz AR, Eng C, Din F, L'Heveder A, Park EHG, Ravishankar R, McIntosh K, Yau JD, Chan L, McGarvie S, Tang L, Lim H, Yap S, Park J, Ng ZH, Mirza S, Ang YL, Walls L, Roy C, Paterson-Brown S, Camilleri-Brennan J, Mclean K, D'Souza MS, Pronin S, Henshall DE, Ter EZ, Fouad D, Minocha A, English W, Morgan C, Townsend D, Maciejec L, Mahdi S, Akpenyi O, Hall E, Caydiid H, Rob Z, Abbott T, Torrance HD, Johnston R, Gani MA, Gravante G, Rajmohan S, Majid K, Dindyal S, Smith C, Palliyil M, Patel S, Nicholson L, Harvey N, Baillie K, Shillito S, Kershaw S, Bamford R, Orton P, Reunis E, Tyler R, Soon WC, Jama GM, Dhillon D, Patel K, Nanthakumaran S, Heard R, Chen KY, Barmayehvar B, Datta U, Kamarajah SK, Karandikar S, Iftekhar Tani S, Monaghan E, Donnelly P, Walker M, Parakh J, Blacker S, Kaul A, Paramasivan A, Farag S, Nessa A, Awadallah S, Lim J, Chean Khun Ng J, Kiran RP, Murray A, Etchill E, Dasari M, Puyana J, Haddad N, Zielinski M, Choudhry A, Caliman C, Beamon M, Duane T, Swaroop M, Myers J, Deal R, Schadde E, Hemmila M, Napolitano L, To K, Makupe A, Musowoya J, van der Naald N, Kumwenda D, Reece-Smith A, Otten K, Verbeek A, Prins M, Baquero Suarez AA, Balmaceda R, Deane C, Dijan E, Elfiky M, Koskenvuo L, Thollot A, Limoges B, Capito C, Alexandre C, Kotobi H, Leroux J, Pinnagoda K, Henric N, Azzis O, Rosello O, Francois P, Etienne S, Buisson P, Hmila S, Clegg-Lamptey JN, Imoro O, Abem OE, Papageorgiou D, Soulou V, Asturias S, Peña L, O'Connor DB, Luc AR, Russo AA, Ruzzenente A, Taddei A, Cona C, Bottini C, Pascale G, Rotunno G, Solaini L, Pascale MM, Notarnicola M, Corbellino M, Sacco M, Ubiali P, Cautiero R, Bocchetti T, Muzio E, Guglielmo V, Morandi E, Mao P, de Luca E, Ali FM, Žilinskas J, Strupas K, Kondrotas P, Baltrunas R, Kutkevicius J, Ignatavicius P, Tan CL, Siaw JY, Yam SY, Wilson L, Aziz MRA, Bondin J, Zorrilla CD, Majbar A, Sale D, Abdullahi L, Osagie O, Faboya O, Fatuga A, Taiwo A, Nwabuoku E, Bliksøen M, Khan ZA, Coronel J, Miranda C, Vasquez I, Helguero-Santin LM, Rickard J, Adedeji A, Alqahtani S, Rath M, Van Niekerk M, Koto MZ, Matos-Puig R, Israelsson L, Schuetz T, Yuksek MA, Mericliler M, Ulusahin M, Wolf B, Fairfield C, Yong GL, Whitehurst K, Redgrave N, Musyoka CK, Olivier J, Lee K, Cox M, Farhan-Alanie MMH, Callan R, Chibuye C, Ali THA, Rekhis S, Rommaneh M, Sam ZH, Pugliesi TB, Pardo G, Blanco R. Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study. Lancet Infect Dis 2018; 18:516-525. [PMID: 29452941 PMCID: PMC5910057 DOI: 10.1016/s1473-3099(18)30101-4] [Citation(s) in RCA: 236] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 12/06/2017] [Accepted: 12/15/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. METHODS This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. FINDINGS Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p<0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05-2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p<0·001). INTERPRETATION Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication. FUNDING DFID-MRC-Wellcome Trust Joint Global Health Trial Development Grant, National Institute of Health Research Global Health Research Unit Grant.
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Rayne S, Schnippel K, Fearnhead K, Grover S, Kruger D, Benn C, Firnhaber C. Unravelling the South African breast cancer story: The relationship of patients, delay to diagnosis and stage with tumour biology in an urban setting. Eur J Cancer 2018. [DOI: 10.1016/s0959-8049(18)30678-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Bhatia R, Rayne S, Rate W, Bakwenabatsile L, Monare B, Narasimhamurthy M, Dryden-Peterson S, Grover S. Factors Associated With Delays in Obtaining Cancer Care in Botswana. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.16000] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract 61 Purpose As life expectancy increases with widespread access to HIV treatment, cancer has become a leading cause of death in Botswana. Delays in the diagnosis and treatment of cancer can lead to the development of late-stage disease with poor survival. These delays represent a multifaceted problem that is attributable to patient, provider, and systemic factors. We aimed to quantify the delay intervals from symptom onset to treatment start among patients with cancer in Botswana as well as to understand knowledge, attitudes, and fears associated with these intervals. Methods From December 2015 to January 2017, we surveyed patients who were seen in an oncology clinic in Gaborone, Botswana. We calculated the proportions of patients who experienced delays in appraisal (between detecting symptoms and perceiving a reason to discuss with a provider, defined as > 1 month), getting help (between deciding to discuss and the first consultation with a provider, defined as > 1 month), diagnosis (between first consultation and receiving a diagnosis, defined as > 3 months), and treatment (between diagnosis and starting treatment, defined as > 2 months). We looked at the association of covariates, including beliefs and stigmas about cancer, with these delays. Results Among 214 patients with cancer who completed the survey, median age at diagnosis was 46 years, and the most common cancer was cervical (42.2%). Of patients, 81.3% were female, 60.7% were HIV infected, and 57.1% presented with advanced cancer (stage III and IV). Of patients, 25.7% experienced a delay in appraisal, 35.5% in getting help, 63.1% in diagnosis, and 76.85% in treatment. Patient income, education, and age were not associated with delays; however, patients who lived with larger families presented faster (odds ratio [OR], 0.89; P = .023). In multivariable analysis, males were more likely to experience an appraisal delay (OR, 2.31; P = .02). Patients with Kaposi’s sarcoma were more likely to have an appraisal delay (OR, 9.77; P < .001), whereas patients with breast cancer were more likely to have a treatment delay (OR, 9.12; P < .001). Patients who felt their symptoms were less serious were more likely to experience an appraisal delay (OR, 2.49; P = .02). Conclusion Nearly all patients who were surveyed experienced a delay in obtaining cancer care in Botswana. In a setting in which care is provided to patients without charge, cancer type and male sex were more important predictors of delays than socioeconomic factors. Improving cancer awareness by families, patients, and primary providers could reduce delays in cancer care. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.
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Affiliation(s)
- Rohini Bhatia
- Rohini Bhatia, University of Rochester School of Medicine and Dentistry; Sarah Rayne, University of the Witwatersrand; William Rate, Georgetown University; Lame Bakwenabatsile and Barati Monare, Botswana University of Pennsylvania Partnership; Mohan Narasimhamurthy, Department of Pathology, Faculty of Medicine, University of Botswana; Scott Dryden-Peterson, Brigham and Women's Hospital, Botswana Harvard AIDS Institute, and Harvard T.H. Chan School of Public Health; and Surbhi Grover, University of
| | - Sarah Rayne
- Rohini Bhatia, University of Rochester School of Medicine and Dentistry; Sarah Rayne, University of the Witwatersrand; William Rate, Georgetown University; Lame Bakwenabatsile and Barati Monare, Botswana University of Pennsylvania Partnership; Mohan Narasimhamurthy, Department of Pathology, Faculty of Medicine, University of Botswana; Scott Dryden-Peterson, Brigham and Women's Hospital, Botswana Harvard AIDS Institute, and Harvard T.H. Chan School of Public Health; and Surbhi Grover, University of
| | - William Rate
- Rohini Bhatia, University of Rochester School of Medicine and Dentistry; Sarah Rayne, University of the Witwatersrand; William Rate, Georgetown University; Lame Bakwenabatsile and Barati Monare, Botswana University of Pennsylvania Partnership; Mohan Narasimhamurthy, Department of Pathology, Faculty of Medicine, University of Botswana; Scott Dryden-Peterson, Brigham and Women's Hospital, Botswana Harvard AIDS Institute, and Harvard T.H. Chan School of Public Health; and Surbhi Grover, University of
| | - Lame Bakwenabatsile
- Rohini Bhatia, University of Rochester School of Medicine and Dentistry; Sarah Rayne, University of the Witwatersrand; William Rate, Georgetown University; Lame Bakwenabatsile and Barati Monare, Botswana University of Pennsylvania Partnership; Mohan Narasimhamurthy, Department of Pathology, Faculty of Medicine, University of Botswana; Scott Dryden-Peterson, Brigham and Women's Hospital, Botswana Harvard AIDS Institute, and Harvard T.H. Chan School of Public Health; and Surbhi Grover, University of
| | - Barati Monare
- Rohini Bhatia, University of Rochester School of Medicine and Dentistry; Sarah Rayne, University of the Witwatersrand; William Rate, Georgetown University; Lame Bakwenabatsile and Barati Monare, Botswana University of Pennsylvania Partnership; Mohan Narasimhamurthy, Department of Pathology, Faculty of Medicine, University of Botswana; Scott Dryden-Peterson, Brigham and Women's Hospital, Botswana Harvard AIDS Institute, and Harvard T.H. Chan School of Public Health; and Surbhi Grover, University of
| | - Mohan Narasimhamurthy
- Rohini Bhatia, University of Rochester School of Medicine and Dentistry; Sarah Rayne, University of the Witwatersrand; William Rate, Georgetown University; Lame Bakwenabatsile and Barati Monare, Botswana University of Pennsylvania Partnership; Mohan Narasimhamurthy, Department of Pathology, Faculty of Medicine, University of Botswana; Scott Dryden-Peterson, Brigham and Women's Hospital, Botswana Harvard AIDS Institute, and Harvard T.H. Chan School of Public Health; and Surbhi Grover, University of
| | - Scott Dryden-Peterson
- Rohini Bhatia, University of Rochester School of Medicine and Dentistry; Sarah Rayne, University of the Witwatersrand; William Rate, Georgetown University; Lame Bakwenabatsile and Barati Monare, Botswana University of Pennsylvania Partnership; Mohan Narasimhamurthy, Department of Pathology, Faculty of Medicine, University of Botswana; Scott Dryden-Peterson, Brigham and Women's Hospital, Botswana Harvard AIDS Institute, and Harvard T.H. Chan School of Public Health; and Surbhi Grover, University of
| | - Surbhi Grover
- Rohini Bhatia, University of Rochester School of Medicine and Dentistry; Sarah Rayne, University of the Witwatersrand; William Rate, Georgetown University; Lame Bakwenabatsile and Barati Monare, Botswana University of Pennsylvania Partnership; Mohan Narasimhamurthy, Department of Pathology, Faculty of Medicine, University of Botswana; Scott Dryden-Peterson, Brigham and Women's Hospital, Botswana Harvard AIDS Institute, and Harvard T.H. Chan School of Public Health; and Surbhi Grover, University of
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Szopinski JZ, Rayne S. Usefulness of Organ Electrodermal Diagnostics in Detection of Breast Pathology: A Multicenter, Randomized, Double-Blinded Clinical Study. Med Acupunct 2017; 29:390-396. [PMID: 29279734 DOI: 10.1089/acu.2017.1255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: Pathology of an internal organ/body part causes corresponding skin areas-organ projection areas/acupuncture points-to rectify applied electrical currents (a diode phenomenon) once the resistance "breakthrough effect" has been induced in these specific, and sometimes remote, skin zones. The aim of this study was to estimate the diagnostic accuracy-as well as the scope of utilization-for detection of breast pathology of organ electrodermal diagnostics (OED), which utilizes this electrophysiologic phenomenon. Materials and Methods: A multicenter randomized, double-blinded comparative study of OED results and clinical diagnoses, as the criteria standards, was done on 400 female volunteers, with a mean age of 39 (standard deviation: 9 years), at three academic breast clinics. Participants were divided into 7 groups: (1) a control group; (2) a cancer-survivor group; (3) a breast-fibroadenoma group; (4) a mastitis group; (5) a breast-abscess group; (6) a preinvasive breast-cancer group; and (7) an invasive breast-cancer group. Results: The OED overall detection rate was 88.8%, the sensitivity rate was 92.7%, and the specificity rate was 76.5%. The predictive value for positive OED results equaled 92.4% and, for negative OED results, equaled 77.3%. However, both sensitivity and specificity rates varied among specific groups. The highest sensitivity rates were shown by OED in groups with serious pathologies, such as invasive cancer (94.2%), preinvasive cancer (90.0%), breast abscess (94.4%), and mastitis (95.9%). The OED results correlated with the intensity of the pathologic process within breasts but were not affected by either the type or the etiology of the disease. Conclusions: OED appears to be a reliable method for detecting breast pathology; this method might also estimate the intensity of a breast pathologic process but cannot explain the cause of the disease directly.
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Affiliation(s)
- Jan Z Szopinski
- Pain Clinic, Mayo Medical Centre of South Africa, Johannesburg, Republic of South Africa
| | - Sarah Rayne
- Breast Care Clinic, Helen Joseph Academic Hospital and University of the Witwatersrand, Johannesburg, Republic of South Africa
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Lesetedi C, Rayne S, Kruger D, Benn CA. Indicators of breast cancer in patients undergoing microdochectomy for a pathological nipple discharge in a middle-income country. J Surg Res 2017; 220:336-340. [PMID: 29180200 DOI: 10.1016/j.jss.2017.06.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 05/26/2017] [Accepted: 06/16/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND The management of a pathological nipple discharge often involves surgery for the exclusion of a malignant etiology. This study aimed to determine the prevalence of cancer in patients who had microdochectomy for pathological nipple discharge in a population in South Africa and to evaluate patients' demographics and clinical characteristics as indicators of underlying cancer and make recommendations for their management in resource-limited settings. MATERIALS AND METHODS Clinical, radiological, and histological data from 153 patients who underwent a microdochectomy for a pathological nipple discharge at two South African breast clinics was collected. RESULTS Invasive or in situ cancer was found in 12 patients (7.84%), and in all patients, cancer was associated with a bloody nipple discharge. Bloody discharge had a sensitivity of 100% in indicating cancer, specificity of 55.32%, positive predictive value of 16%, and negative predictive value of 100%. Patients with breast cancer were also more likely to be aged 55 y or older (P = 0.04). Preoperative mammogram and ultrasound were poor in detecting cancer (0/12). CONCLUSIONS In our population, a bloody discharge in women aged 55 years or older should mandate a microdochectomy, with selective surgery for younger women and those with nonbloody discharges. Thorough clinical examination to determine the true color and nature of the discharge is vital in the initial assessment of these patients. Preoperative radiology is not helpful in determining the presence of cancer (in an isolated pathological nipple discharge), and microdochectomy still remains the gold standard in diagnosing cancer in these patients.
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Affiliation(s)
- Chiapo Lesetedi
- Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sarah Rayne
- Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Helen Joseph Breast Care Clinic, Helen Joseph Hospital, Johannesburg, South Africa.
| | - Deirdre Kruger
- Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Carol-Ann Benn
- Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Helen Joseph Breast Care Clinic, Helen Joseph Hospital, Johannesburg, South Africa; Netcare Breast Care Centre, Milpark Hospital, Johannesburg, South Africa
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Benn CA, Coetzee K, Rayne S. Breast hibernomas: Questioning the embryological origin? Breast J 2017; 24:199-202. [PMID: 28786166 DOI: 10.1111/tbj.12871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 09/28/2016] [Accepted: 09/28/2016] [Indexed: 11/28/2022]
Abstract
This paper aims to review the concept of hibernomas, with focus on their occurrence, in the breast. It will make reference to a specific case from the Helen Joseph Hospital's Breast Clinic situated in Johannesburg, South Africa. We describe the clinical, radiological and pathological findings in a patient as well as the final diagnosis and treatment (in the form of surgery). This report emphasizes the distinguishable features of hibernomas, and gives guidance as to the surgical approach in large hibernomas stressing the ease of achieving cosmesis without major oncoplastic techniques. More specifically, discussion as whether these rapidly growing, nonrecurring, usually encapsulated growths consisting of brown fat tissue similar to that found in hibernating animals arise from the breast or the underlying muscle is considered.
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Affiliation(s)
- Carol-Ann Benn
- Helen Joseph Hospital Breast Care Clinic, Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Faculty of Health Sciences, York Road University of the Witwatersrand, Johannesburg, South Africa
| | - Kirsten Coetzee
- Faculty of Health Sciences, York Road University of the Witwatersrand, Johannesburg, South Africa
| | - Sarah Rayne
- Helen Joseph Hospital Breast Care Clinic, Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Faculty of Health Sciences, York Road University of the Witwatersrand, Johannesburg, South Africa
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Rayne S, Burger S, Straten SV, Biccard B, Phaahla MJ, Smith M. Setting the research and implementation agenda for equitable access to surgical care in South Africa. BMJ Glob Health 2017; 2:e000170. [PMID: 29242749 PMCID: PMC5584486 DOI: 10.1136/bmjgh-2016-000170] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 02/06/2017] [Indexed: 01/09/2023] Open
Abstract
South Africa is an upper-middle-income country with widespread social and geographical inequality of surgical provision. The National Forum on Surgery and Anaesthesia in South Africa brought together various stakeholders, including government, societies, academic clinicians and the biomedical industry, to define the core strategy for a national surgical plan. During the forum, presentations and breakaway workshops explored and reported the challenges and opportunities these stakeholders may have in sustaining and improving surgical provision in South Africa. We present the recommendations of these reports with a literature review and other recent reports from organisations involved in healthcare systems in South Africa. We acknowledge the importance of access to safe and affordable surgery for all as a core component of healthcare provision for South Africa. The proposed core strategies for a South African National Surgical Plan to achieve these goals are the following. First, research will focus on high-quality interdisciplinary collaborative research and audit, which addresses the Global Surgery indices, adopts internationally consistent data points and focuses particularly on maternal mortality and the 'Bellwether procedures'. Second, workforce and training must be tailored to the country's specific surgical needs, based on a primary healthcare and district hospital model, which is supported by government and academic organisations. Third, the surgical infrastructure and service delivery needs to be strengthened by the district hospital. Finally, strong leadership with appropriate financial support by healthcare managers who partner with clinicians both locally and nationally is needed to achieve these objectives.
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Affiliation(s)
- Sarah Rayne
- Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sule Burger
- Department of Surgery, Tembisa Hospital, Johannesburg, South Africa
| | - Stephanie Van Straten
- Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Bruce Biccard
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Martin Smith
- Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Lince-Deroche N, Van Rensburg C, Firnhaber C, Benn C, Rubin G, Michelow P, Rayne S. Costs of Diagnosing Breast-Related Conditions at a Large, Public Hospital in a Middle-Income Country Without Population-Level Screening. J Glob Oncol 2017. [DOI: 10.1200/jgo.2017.009456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract 42 Background: Literature regarding the costs and cost-effectiveness of diagnosing breast disease globally, including cancer, has focused on mammographic screening in high-income settings. South Africa, a middle-income country, is currently crafting its first national breast cancer policy, and information on costs and best practices for national imaging services in low- and middle-income settings is required. We undertook this work to estimate the average cost per procedure and per patient for diagnosis of breast conditions by using a large, public outpatient clinic in Johannesburg as well as to explore potential cost savings through rationing mammography for diagnosis. Methods: Results of a retrospective clinical cohort study conducted at an outpatient clinic in 2013 and 2014 were used to establish a 12-month population of clinic patients and diagnostic service statistics. We used microcosting to estimate the average cost for each diagnostic procedure from the health service perspective. An Excel-based model and scenario analysis were used to explore changes in total and per patient costs when mammography use was incrementally reduced by shifting patients to ultrasound-based services. Results: We estimated that 3,867 individuals attended the clinic over 12 months. The average cost per patient for initial consultation and/or exam was $10.14 (2015 USD). Mammography was more costly than ultrasound at $59.96 and $21.11, respectively. Procedures for pathology were the most costly diagnostic (stereotactic core needle biopsy, $330.05; ultrasound-guided core needle biopsy, $279.42; fine needle aspiration, $101.00) because of substantial laboratory charges. The average cost per patient seen was $115.96. Hypothetically, replacing mammography with ultrasound resulted in minimal decreases in the average cost per patient as a result of the high cost of the mammogram machine. Cost savings at the facility level may be achieved when mammography use is eliminated entirely. Conclusion: Per patient mammography costs are largely dependent on economies of scale. Because ultrasound can be considered as an alternative for many women without compromising imaging in nonoccult disease, diagnostic mammography should be offered in centralized locations for maximum efficiency gains. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST Naomi Lince-Deroche No relationship to disclose Craig Van Rensburg No relationship to disclose Cindy Firnhaber Research Funding: Merck (Inst) Carol Benn No relationship to disclose Grace Rubin No relationship to disclose Pam Michelow No relationship to disclose Sarah Rayne Travel, Accommodations, Expenses: Novartis
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Affiliation(s)
- Naomi Lince-Deroche
- Naomi Lince-Deroche, Craig Van Rensburg, Cindy Firnhaber, Carol Benn, Grace Rubin, Pam Michelow, and Sarah Rayne, University of the Witwatersrand; Cindy Firnhaber, Right to Care; Carol Benn, Grace Rubin, and Sarah Rayne, Helen Joseph Hospital; and Pam Michelow, National Health Laboratory Service, Johannesburg, South Africa
| | - Craig Van Rensburg
- Naomi Lince-Deroche, Craig Van Rensburg, Cindy Firnhaber, Carol Benn, Grace Rubin, Pam Michelow, and Sarah Rayne, University of the Witwatersrand; Cindy Firnhaber, Right to Care; Carol Benn, Grace Rubin, and Sarah Rayne, Helen Joseph Hospital; and Pam Michelow, National Health Laboratory Service, Johannesburg, South Africa
| | - Cindy Firnhaber
- Naomi Lince-Deroche, Craig Van Rensburg, Cindy Firnhaber, Carol Benn, Grace Rubin, Pam Michelow, and Sarah Rayne, University of the Witwatersrand; Cindy Firnhaber, Right to Care; Carol Benn, Grace Rubin, and Sarah Rayne, Helen Joseph Hospital; and Pam Michelow, National Health Laboratory Service, Johannesburg, South Africa
| | - Carol Benn
- Naomi Lince-Deroche, Craig Van Rensburg, Cindy Firnhaber, Carol Benn, Grace Rubin, Pam Michelow, and Sarah Rayne, University of the Witwatersrand; Cindy Firnhaber, Right to Care; Carol Benn, Grace Rubin, and Sarah Rayne, Helen Joseph Hospital; and Pam Michelow, National Health Laboratory Service, Johannesburg, South Africa
| | - Grace Rubin
- Naomi Lince-Deroche, Craig Van Rensburg, Cindy Firnhaber, Carol Benn, Grace Rubin, Pam Michelow, and Sarah Rayne, University of the Witwatersrand; Cindy Firnhaber, Right to Care; Carol Benn, Grace Rubin, and Sarah Rayne, Helen Joseph Hospital; and Pam Michelow, National Health Laboratory Service, Johannesburg, South Africa
| | - Pam Michelow
- Naomi Lince-Deroche, Craig Van Rensburg, Cindy Firnhaber, Carol Benn, Grace Rubin, Pam Michelow, and Sarah Rayne, University of the Witwatersrand; Cindy Firnhaber, Right to Care; Carol Benn, Grace Rubin, and Sarah Rayne, Helen Joseph Hospital; and Pam Michelow, National Health Laboratory Service, Johannesburg, South Africa
| | - Sarah Rayne
- Naomi Lince-Deroche, Craig Van Rensburg, Cindy Firnhaber, Carol Benn, Grace Rubin, Pam Michelow, and Sarah Rayne, University of the Witwatersrand; Cindy Firnhaber, Right to Care; Carol Benn, Grace Rubin, and Sarah Rayne, Helen Joseph Hospital; and Pam Michelow, National Health Laboratory Service, Johannesburg, South Africa
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Rayne S, Schnippel K, Benn C, Kruger D, Wright K, Firnhaber C. Attitudes and beliefs of breast cancer patients toward their disease in urban South Africa: a cross-sectional descriptive study. Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30191-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Rayne S, Lince-Deroche N, Hendrickson C, Shearer K, Moyo F, Michelow P, Rubin G, Benn C, Firnhaber C. Characterizing breast conditions at an open-access breast clinic in South Africa: a model that is more than cancer care for a resource-limited setting. BMC Health Serv Res 2017; 17:63. [PMID: 28109290 PMCID: PMC5251303 DOI: 10.1186/s12913-016-1959-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 12/16/2016] [Indexed: 01/07/2023] Open
Abstract
Background While most breast-related research focuses on cancer, presentation of symptomatic persons in non-screened environments requires understanding the spectrum of breast diseases so as to plan services in resource-constrained settings. This study presents the variety of breast disease managed at a government, open-access breast clinic in South Africa. Methods We performed a retrospective file review using a systematic random sample of patients 18 years and above presenting for breast care over a 14-month period. We collected demographics, clinical characteristics, management and final diagnoses from the first visit and twelve subsequent months. Results The final sample contained 365 individuals (97 · 5% women). Most were black, unmarried and South African citizens with a median age of 43 years (IQR 31–55) . Of those reporting their status (24 · 1%) 38 · 6% were HIV-positive. A mass (57 · 0%) and/or pain (28 · 5%) were the most common symptoms. Imaging and breast biopsies were required in 78 and 25% of individuals, respectively. Nearly half of biopsies identified breast cancer (44 · 1% of women ≤40 and 57 · 3% for women >40). Benign conditions (47 · 7%) and no abnormality (18 · 2%) were common final classifications among women. There was no difference between the final classifications of patients who self-referred versus those who were formally referred from another health care provider. Nearly half of the participants (46 · 6%) travelled 20 km or more to attend the clinic. Conclusions Benign breast conditions far outweighed cancer diagnoses. As breast cancer awareness increases in resource-limited countries, facilities offering breast care require administrative and clinical preparation to manage a range of non-cancer related conditions.
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Affiliation(s)
- Sarah Rayne
- Helen Joseph Breast Care Clinic, Helen Joseph Hospital, Johannesburg, South Africa. .,Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Naomi Lince-Deroche
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Cheryl Hendrickson
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kate Shearer
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Faith Moyo
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Pam Michelow
- Cytology Unit, National Health Laboratory Service and Department of Anatomical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Grace Rubin
- Department of Radiology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Carol Benn
- Helen Joseph Breast Care Clinic, Helen Joseph Hospital, Johannesburg, South Africa.,Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Cynthia Firnhaber
- Clinical HIV Research Unit, Department of Internal Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.,Right to Care, Johannesburg, South Africa
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Grover S, Martei YM, Puri P, Prabhakar P, Mutebi M, Balogun OD, Price AJ, Freeman AH, Narasimhamurthy M, Rodin D, Rayne S, Zetola NM. Breast Cancer and HIV in Sub-Saharan Africa: A Complex Relationship. J Glob Oncol 2017; 4:1-11. [PMID: 30241185 PMCID: PMC6180795 DOI: 10.1200/jgo.2016.006585] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Introduction The number and lifespan of individuals living with HIV have increased
significantly with the scale-up of antiretroviral therapy. Furthermore, the
incidence of breast cancer in women with HIV is growing, especially in
sub-Saharan Africa (SSA). However, the association between HIV infection and
breast cancer is not well understood. Methods A literature search was performed to identify articles published in journals
pertaining to breast cancer and HIV, with an emphasis on SSA. Selected
US-based studies were also identified for comparison. Results Among the 56 studies reviewed, the largest study examined 314 patients with
breast cancer and HIV in the United States. There is no consensus on whether
HIV infection acts as a pro-oncogenic or antioncogenic factor in breast
cancer, and it may have no relation to breast cancer. A higher incidence of
breast cancer is reported in high-income countries than in SSA, although
breast cancer in SSA presents at a younger age and at a more advanced stage.
Some studies show that patients with breast cancer and HIV experience worse
chemotherapy toxicity than do patients without HIV. Data on treatment
outcomes are limited. The largest study showed worse treatment outcomes in
patients with HIV, compared with their counterparts without HIV. Conclusion HIV infection has not been associated with different clinical presentation of
breast cancer. However, some evidence suggests that concurrent diagnosis of
HIV with breast cancer is associated with increased therapy-related toxicity
and worse outcomes. Systematic prospective studies are needed to establish
whether there is a specific association between breast cancer and HIV.
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Affiliation(s)
- Surbhi Grover
- Surbhi Grover, Yehoda M. Martei, Priya Puri, and Nicola M. Zetola, University of Pennsylvania, Philadelphia, PA; Surbhi Grover, Mohan Narasimhamurthy, and Nicola M. Zetola, University of Botswana, Gaborone, Botswana; Pooja Prabhakar, University of Texas Southwestern Medical Center, Dallas, TX; Miriam Mutebi, Aga Khan University Hospital, Nairobi, Kenya; Onyinye D. Balogun, Weill Cornell Medicine, New York, NY; Aryeh J. Price, California Institute of Technology, Pasadena; Alexandra H. Freeman, Kaiser Permanente San Francisco, San Francisco, CA; Danielle Rodin, University of Toronto, Toronto, Canada; and Sarah Rayne, Helen Joseph Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Yehoda M Martei
- Surbhi Grover, Yehoda M. Martei, Priya Puri, and Nicola M. Zetola, University of Pennsylvania, Philadelphia, PA; Surbhi Grover, Mohan Narasimhamurthy, and Nicola M. Zetola, University of Botswana, Gaborone, Botswana; Pooja Prabhakar, University of Texas Southwestern Medical Center, Dallas, TX; Miriam Mutebi, Aga Khan University Hospital, Nairobi, Kenya; Onyinye D. Balogun, Weill Cornell Medicine, New York, NY; Aryeh J. Price, California Institute of Technology, Pasadena; Alexandra H. Freeman, Kaiser Permanente San Francisco, San Francisco, CA; Danielle Rodin, University of Toronto, Toronto, Canada; and Sarah Rayne, Helen Joseph Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Priya Puri
- Surbhi Grover, Yehoda M. Martei, Priya Puri, and Nicola M. Zetola, University of Pennsylvania, Philadelphia, PA; Surbhi Grover, Mohan Narasimhamurthy, and Nicola M. Zetola, University of Botswana, Gaborone, Botswana; Pooja Prabhakar, University of Texas Southwestern Medical Center, Dallas, TX; Miriam Mutebi, Aga Khan University Hospital, Nairobi, Kenya; Onyinye D. Balogun, Weill Cornell Medicine, New York, NY; Aryeh J. Price, California Institute of Technology, Pasadena; Alexandra H. Freeman, Kaiser Permanente San Francisco, San Francisco, CA; Danielle Rodin, University of Toronto, Toronto, Canada; and Sarah Rayne, Helen Joseph Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Pooja Prabhakar
- Surbhi Grover, Yehoda M. Martei, Priya Puri, and Nicola M. Zetola, University of Pennsylvania, Philadelphia, PA; Surbhi Grover, Mohan Narasimhamurthy, and Nicola M. Zetola, University of Botswana, Gaborone, Botswana; Pooja Prabhakar, University of Texas Southwestern Medical Center, Dallas, TX; Miriam Mutebi, Aga Khan University Hospital, Nairobi, Kenya; Onyinye D. Balogun, Weill Cornell Medicine, New York, NY; Aryeh J. Price, California Institute of Technology, Pasadena; Alexandra H. Freeman, Kaiser Permanente San Francisco, San Francisco, CA; Danielle Rodin, University of Toronto, Toronto, Canada; and Sarah Rayne, Helen Joseph Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Miriam Mutebi
- Surbhi Grover, Yehoda M. Martei, Priya Puri, and Nicola M. Zetola, University of Pennsylvania, Philadelphia, PA; Surbhi Grover, Mohan Narasimhamurthy, and Nicola M. Zetola, University of Botswana, Gaborone, Botswana; Pooja Prabhakar, University of Texas Southwestern Medical Center, Dallas, TX; Miriam Mutebi, Aga Khan University Hospital, Nairobi, Kenya; Onyinye D. Balogun, Weill Cornell Medicine, New York, NY; Aryeh J. Price, California Institute of Technology, Pasadena; Alexandra H. Freeman, Kaiser Permanente San Francisco, San Francisco, CA; Danielle Rodin, University of Toronto, Toronto, Canada; and Sarah Rayne, Helen Joseph Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Onyinye D Balogun
- Surbhi Grover, Yehoda M. Martei, Priya Puri, and Nicola M. Zetola, University of Pennsylvania, Philadelphia, PA; Surbhi Grover, Mohan Narasimhamurthy, and Nicola M. Zetola, University of Botswana, Gaborone, Botswana; Pooja Prabhakar, University of Texas Southwestern Medical Center, Dallas, TX; Miriam Mutebi, Aga Khan University Hospital, Nairobi, Kenya; Onyinye D. Balogun, Weill Cornell Medicine, New York, NY; Aryeh J. Price, California Institute of Technology, Pasadena; Alexandra H. Freeman, Kaiser Permanente San Francisco, San Francisco, CA; Danielle Rodin, University of Toronto, Toronto, Canada; and Sarah Rayne, Helen Joseph Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Aryeh J Price
- Surbhi Grover, Yehoda M. Martei, Priya Puri, and Nicola M. Zetola, University of Pennsylvania, Philadelphia, PA; Surbhi Grover, Mohan Narasimhamurthy, and Nicola M. Zetola, University of Botswana, Gaborone, Botswana; Pooja Prabhakar, University of Texas Southwestern Medical Center, Dallas, TX; Miriam Mutebi, Aga Khan University Hospital, Nairobi, Kenya; Onyinye D. Balogun, Weill Cornell Medicine, New York, NY; Aryeh J. Price, California Institute of Technology, Pasadena; Alexandra H. Freeman, Kaiser Permanente San Francisco, San Francisco, CA; Danielle Rodin, University of Toronto, Toronto, Canada; and Sarah Rayne, Helen Joseph Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Alexandra H Freeman
- Surbhi Grover, Yehoda M. Martei, Priya Puri, and Nicola M. Zetola, University of Pennsylvania, Philadelphia, PA; Surbhi Grover, Mohan Narasimhamurthy, and Nicola M. Zetola, University of Botswana, Gaborone, Botswana; Pooja Prabhakar, University of Texas Southwestern Medical Center, Dallas, TX; Miriam Mutebi, Aga Khan University Hospital, Nairobi, Kenya; Onyinye D. Balogun, Weill Cornell Medicine, New York, NY; Aryeh J. Price, California Institute of Technology, Pasadena; Alexandra H. Freeman, Kaiser Permanente San Francisco, San Francisco, CA; Danielle Rodin, University of Toronto, Toronto, Canada; and Sarah Rayne, Helen Joseph Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Mohan Narasimhamurthy
- Surbhi Grover, Yehoda M. Martei, Priya Puri, and Nicola M. Zetola, University of Pennsylvania, Philadelphia, PA; Surbhi Grover, Mohan Narasimhamurthy, and Nicola M. Zetola, University of Botswana, Gaborone, Botswana; Pooja Prabhakar, University of Texas Southwestern Medical Center, Dallas, TX; Miriam Mutebi, Aga Khan University Hospital, Nairobi, Kenya; Onyinye D. Balogun, Weill Cornell Medicine, New York, NY; Aryeh J. Price, California Institute of Technology, Pasadena; Alexandra H. Freeman, Kaiser Permanente San Francisco, San Francisco, CA; Danielle Rodin, University of Toronto, Toronto, Canada; and Sarah Rayne, Helen Joseph Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Danielle Rodin
- Surbhi Grover, Yehoda M. Martei, Priya Puri, and Nicola M. Zetola, University of Pennsylvania, Philadelphia, PA; Surbhi Grover, Mohan Narasimhamurthy, and Nicola M. Zetola, University of Botswana, Gaborone, Botswana; Pooja Prabhakar, University of Texas Southwestern Medical Center, Dallas, TX; Miriam Mutebi, Aga Khan University Hospital, Nairobi, Kenya; Onyinye D. Balogun, Weill Cornell Medicine, New York, NY; Aryeh J. Price, California Institute of Technology, Pasadena; Alexandra H. Freeman, Kaiser Permanente San Francisco, San Francisco, CA; Danielle Rodin, University of Toronto, Toronto, Canada; and Sarah Rayne, Helen Joseph Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Sarah Rayne
- Surbhi Grover, Yehoda M. Martei, Priya Puri, and Nicola M. Zetola, University of Pennsylvania, Philadelphia, PA; Surbhi Grover, Mohan Narasimhamurthy, and Nicola M. Zetola, University of Botswana, Gaborone, Botswana; Pooja Prabhakar, University of Texas Southwestern Medical Center, Dallas, TX; Miriam Mutebi, Aga Khan University Hospital, Nairobi, Kenya; Onyinye D. Balogun, Weill Cornell Medicine, New York, NY; Aryeh J. Price, California Institute of Technology, Pasadena; Alexandra H. Freeman, Kaiser Permanente San Francisco, San Francisco, CA; Danielle Rodin, University of Toronto, Toronto, Canada; and Sarah Rayne, Helen Joseph Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Nicola M Zetola
- Surbhi Grover, Yehoda M. Martei, Priya Puri, and Nicola M. Zetola, University of Pennsylvania, Philadelphia, PA; Surbhi Grover, Mohan Narasimhamurthy, and Nicola M. Zetola, University of Botswana, Gaborone, Botswana; Pooja Prabhakar, University of Texas Southwestern Medical Center, Dallas, TX; Miriam Mutebi, Aga Khan University Hospital, Nairobi, Kenya; Onyinye D. Balogun, Weill Cornell Medicine, New York, NY; Aryeh J. Price, California Institute of Technology, Pasadena; Alexandra H. Freeman, Kaiser Permanente San Francisco, San Francisco, CA; Danielle Rodin, University of Toronto, Toronto, Canada; and Sarah Rayne, Helen Joseph Hospital and University of the Witwatersrand, Johannesburg, South Africa
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Rayne S, Schnippel K, Thomson J, Reid J, Benn C. Male Breast Cancer Has Limited Effect on Survivor's Perceptions of Their Own Masculinity. Am J Mens Health 2016; 11:246-252. [PMID: 26864441 DOI: 10.1177/1557988316631512] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The purpose of the current study was to describe male breast cancer in Johannesburg, South Africa, and assess whether male breast cancer patients' perception of their own masculinity was affected by having a cancer commonly seen in women. A retrospective file review was carried out at two hospitals, one private and one government, of male breast cancer patients from 2007 to 2012 followed by a telephone survey of patients identified during review. Of approximately 3,000 breast cancer patients seen in the 5 years reviewed, 23 cases of male breast cancer were identified. Most were diagnosed with invasive ductal carcinoma ( n = 19, 83%). Stage at presentation was from stages 0 to 3 (Stage 0 [ n = 2, 9%], Stage 1 [ n = 3, 13%], Stage 2 [ n = 12, 52%], Stage 3 [ n = 6, 26%]) and no patients were metastatic at presentation. The telephonic survey was completed by 18 patients (78%). Nearly all ( n = 17/18) shared their diagnosis with family and close friends. Two thirds of patients delayed presentation and government hospital patients were more likely to present later than private sector hospital patients. Although most male breast cancer patients sampled did not perceive the breast cancer diagnosis as affecting their masculinity, Black men and those treated in government hospitals were less likely to be aware of male breast cancer, and were more likely to have their perception of their own masculinity affected.
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Affiliation(s)
- Sarah Rayne
- 1 Helen Joseph Hospital, Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - John Thomson
- 1 Helen Joseph Hospital, Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Joanna Reid
- 1 Helen Joseph Hospital, Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Carol Benn
- 1 Helen Joseph Hospital, Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Rayne S, Schnippel K, Firnhaber C, Wright K, Kruger D, Benn CA. Fear of Treatments Surpasses Demographic and Socioeconomic Factors in Affecting Patients With Breast Cancer in Urban South Africa. J Glob Oncol 2016; 3:125-134. [PMID: 28717750 PMCID: PMC5493272 DOI: 10.1200/jgo.2015.002691] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Breast cancer is the most common cause of cancer in women in South Africa, and often patients present late. There is little understanding of the psychosocial stresses affecting women with breast cancer in Africa. Methods A questionnaire was distributed to 263 patients with breast cancer at two sites (one government and one private facility) in Johannesburg. Self-reported levels of fear were recorded on summative scales and their relationship to demographic variables assessed through univariable and multivariable modified Poisson regression. Results Fears related to treatments and prognosis, particularly radiation, loss of hair, and loss of breast, were far stronger than those related to socioeconomic barriers. Relative risk (RR) of most fears was higher in women younger than age 40 years, including treatment affordability (RR, 1.80; 95% CI, 1.26 to 2.56), hair loss (RR, 1.48; 95% CI, 1.12 to 2.95), and surgery (RR, 1.31; 95% CI, 1.02 to 1.68). Difficulty taking time off work predicted fear of job loss (RR, 2.59; 95% CI, 1.59 to 4.21) and missing appointments because of transport (RR, 2.46; 95% CI, 1.52 to 3.96) or family commitments (RR, 2.46; 95% CI, 1.52 to 3.96). Women with dependents and black women were more afraid of dying (RR, 1.73; 95% CI, 1.03 to 2.90; and RR, 1.79; 95% CI, 1.33 to 2.24, respectively); however, socioeconomic status in this sample was a strong confounder of race and explained most of the racial differences in levels of fear. Conclusion The most significant fears around breast cancer were related to treatment modalities and adverse effects rather than transport, financial, or work concerns. Young age and job insecurity were predictive of increased fears. Education about treatments has a key role to play in improving access to breast cancer care in South Africa.
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Affiliation(s)
- Sarah Rayne
- All authors, University of the Witwatersrand; and Kathryn Schnippel and Cynthia Firnhaber, Right to Care, Johannesburg, South Africa
| | - Kathryn Schnippel
- All authors, University of the Witwatersrand; and Kathryn Schnippel and Cynthia Firnhaber, Right to Care, Johannesburg, South Africa
| | - Cynthia Firnhaber
- All authors, University of the Witwatersrand; and Kathryn Schnippel and Cynthia Firnhaber, Right to Care, Johannesburg, South Africa
| | - Kathryne Wright
- All authors, University of the Witwatersrand; and Kathryn Schnippel and Cynthia Firnhaber, Right to Care, Johannesburg, South Africa
| | - Deirdre Kruger
- All authors, University of the Witwatersrand; and Kathryn Schnippel and Cynthia Firnhaber, Right to Care, Johannesburg, South Africa
| | - Carol-Ann Benn
- All authors, University of the Witwatersrand; and Kathryn Schnippel and Cynthia Firnhaber, Right to Care, Johannesburg, South Africa
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Ann Benn C, Mapunda P, Rayne S. PO106 N2 LYMPH NODES POST-PRIMARY CHEMOTHERAPY MAY PREDICT RECURRENCE IN LOCALLY ADVANCED BREAST CANCER. Breast 2015. [DOI: 10.1016/s0960-9776(15)30118-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Serrurier L, Do Vale I, Benn C, Rayne S, Slabbert J. P322 Preserving areolar skin after mastectomy provides increased sensation in the reconstructed nipple. Breast 2015. [DOI: 10.1016/s0960-9776(15)70352-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Serrurier L, Benn C, Rayne S. P315 Direct to implant breast reconstruction without the use of an acellular–dermal matrix. Breast 2015. [DOI: 10.1016/s0960-9776(15)70345-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Rayne S, Cloete E, Benn C. PR25 Young age is not associated to adverse tumour biology in a South African population. Breast 2014. [DOI: 10.1016/s0960-9776(14)70035-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Rayne S, Mbatha B, Serrurier C, Slabbert J, Naylor S, Benn C. Reasonable doubt? Determining the rate of non-benign pathology in patients undergoing contralateral prophylactic mastectomy for breast cancer. Eur J Surg Oncol 2012. [DOI: 10.1016/j.ejso.2012.02.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Rayne S, Eggers NJ. A new conceptual approach to assigning biomass combustion-derived methoxyphenol structures by using a gas chromatographic retention index model. Anal Bioanal Chem 2007; 389:555-61. [PMID: 17653703 DOI: 10.1007/s00216-007-1442-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2007] [Revised: 06/03/2007] [Accepted: 06/18/2007] [Indexed: 11/28/2022]
Abstract
A new conceptual approach towards iteratively constructing chromatographic retention time/index models is presented. The approach is applicable where there is potential structural uncertainty in a number of members of the dataset used in constructing the model, and where limited spectroscopic information is available to guide the process. The model is demonstrated on a suite of biomass combustion-derived methoxyphenols for which gas chromatographic polydimethylsiloxane retention index data was available in the literature, but where there was ambiguity regarding the identity of several members of the dataset. The retention property model is populated by sequentially screening a series of candidate structures that meet basic mass spectrometric requirements by using a multiple linear regression model containing molecular and physicochemical properties that have been previously shown to yield reliable predictions of chromatographic behaviour within a compound class. The criteria for deciding on the likely structure(s) out of a suite of candidate structures is based upon the improved quality of fit the most probable structure gives the regression model relative to other candidate structures.
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Affiliation(s)
- S Rayne
- Chemistry, Earth and Environmental Sciences, Irving K. Barber School of Arts and Sciences, The University of British Columbia at Okanagan, 3333 University Way, Kelowna, British Columbia V1V 1V7, Canada.
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