The meeting welcomed oncologists and surgeons from Namibia, Zambia, Mozambique, Botswana and Zimbabwe. We discussed the challenges of the management of breast cancer in poorly resourced countries.
We don't have accurate statistics about the incidence and management of breast cancer from Southern Africa so in many cases our management decisions are based on small cohorts of patients or on descriptive statistics. With or without gaps, the data is important.
The afternoon session at BIGOSA was dedicated to the same topic. Excellent talks were given by Dr Ines Buccimazza, Prof Lynette Denny and Dr Pillay-Van Wyk.
When it comes to managing cancer in in low income countries, the problems are enormous. Although there were many points discussed, a few are presented here:
- We don't have disease registries. Although we are used to seeing tidy pie charts dividing up the causes of mortality into those due to infectious diseases, trauma and non communicable diseases, the overlap between them is enormous. To illustrate this, an estimated 40-60% of all cancers in Southern Africa are due to infectious diseases: HPV causing cervical cancer and HIV causing Karposi's sarcoma.
- South Africa has many more cancer centres (especially in the private sector) relative to neighbouring countries. (Zambia has one). There are few radiotherapy machines, limited imaging facilities and problems with spare parts and maintenance. Drug supplies are erratic. Access to medication is limited. The sparsity of resources and support systems mean women spend many months as inpatients in hospital. For example, in Mozambique, a woman undergoing routine treatment for breast cancer may occupy a hospital bed for 9 months. This would be unheard of in USA/UK.
- There are very few trained cancer specialists.
- For many women, just getting diagnosed with breast cancer and getting screened may take many months. (Figures presented from Botswana suggested delays of up to 1 year)
- The many social challenges within poorer communities are compounded by the devastating effects of civil unrest and war.
In her talk Ines asked whether drawing up guidelines for breast cancer care specifically for use in low middle income countries was condoning or perpetuating sub-standard care. She concluded that whilst guidelines alone are not enough to improve care, following the same protocols used in high income countries is simply not attainable.
If we are to achieve anything about the plight of the thousands of women developing breast cancer in poorer countries, we need to start putting cancer care high on the government's agenda and be creative in our approach.