Breast cancer pathology services in sub-Saharan Africa: a survey within population-based cancer registries

BMC Health Services Research

Christoph Thomssen¹  Cheick Traore²  Bakarou Kamate²  Godwin Ebughe³  Ima-Obong Ekanem³  Hannes-Viktor Ziegenhorn⁴  Kirstin Grosse Frie⁴  Eva Johanna Kantelhardt⁵  Claudia Wickenhauser⁶  Marcus Bauer⁶  Festus Igbinoba⁷  Biying Liu⁸  Donald Maxwell Parkin⁹  Olufemi Ogunbiyi^1,10  Charles Dzamalala^1,11 

[1] Department of Gynaecology, Martin-Luther-University Halle-Wittenberg, Halle, Germany;Department of Pathology, University of Bamako, Bamako Cancer Registry, Bamako, Mali;Department of Pathology, University of Calabar, Cancer Registry, Calabar, Nigeria;University of Calabar Teaching Hospital, Calabar, Nigeria;Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Magdeburgerstrasse 8, 06097, Halle, Germany;Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Magdeburgerstrasse 8, 06097, Halle, Germany;Department of Gynaecology, Martin-Luther-University Halle-Wittenberg, Halle, Germany;Institute of Pathology, Martin-Luther-University Halle-Wittenberg, Halle, Germany;National Hospital Abuja, Abuja, Nigeria;The African Cancer Registry Network, INCTR African Registry Program, Oxford, UK;Nuffield Department of Population Health, University of Oxford, Oxford, UK;The African Cancer Registry Network, INCTR African Registry Program, Oxford, UK;Nuffield Department of Population Health, University of Oxford, Oxford, UK;International Agency for Research on Cancer, Lyon, France;University of Ibadan, Cancer registry, Ibadan, Nigeria;University of Ibadan College of Medicine, Ibadan, Nigeria;University of Malawi College of Medicine, Cancer Registry, Blantyre, Malawi;

关键词: Pathology;    Sub-Saharan Africa;    Guidelines;    Immunohistochemistry;    Population-based cancer registry;   

DOI  :  10.1186/s12913-020-05752-y

来源: Springer

【 摘 要 】

BackgroundPathologists face major challenges in breast cancer diagnostics in sub-Saharan Africa (SSA). The major problems identified as impairing the quality of pathology reports are shortcomings of equipment, organization and insufficiently qualified personnel. In addition, in the context of breast cancer, immunohistochemistry (IHC) needs to be available for the evaluation of biomarkers. In the study presented, we aim to describe the current state of breast cancer pathology in order to highlight the unmet needs.MethodsWe obtained information on breast cancer pathology services within population-based cancer registries in SSA. A survey of 20 participating pathology centres was carried out. These centres represent large, rather well-equipped pathologies. The data obtained were related to the known population and breast cancer incidence of the registry areas.ResultsThe responding pathologists served populations of between 30,000 and 1.8 million and the centres surveyed dealt with 10–386 breast cancer cases per year. Time to fixation and formalin fixation time varied from overnight to more than 72 h. Only five centres processed core needle biopsies as a daily routine. Technical problems were common, with 14 centres reporting temporary power outages and 18 centres claiming to own faulty equipment with no access to technical support. Only half of the centres carried out IHC in their own laboratory. For three centres, IHC was only accessible outside of the country and one centre could not obtain any IHC results. A tumour board was established in 13 centres.ConclusionsWe conclude that breast cancer pathology services ensuring state-of-the-art therapy are only available in a small fraction of centres in SSA. To overcome these limitations, many of the centres require larger numbers of experienced pathologists and technical staff. Furthermore, equipment maintenance, standardization of processing guidelines and establishment of an IHC service are needed to comply with international standards of breast cancer pathology.

【 授权许可】

CC BY