47 research outputs found
Oncoplastic Breast Surgery: A Global Perspective on Practice, Availability, and Training
No full textBased on a BSI symposium, ISW 2007, Montreal, Canada.Oncoplastic surgery is the seamless joining of the extirpative and reconstructive aspects of breast surgery that is performed by a single surgeon. A symposium was held at ISW 2007 in Montreal with a prearranged aim to publish an article on the current and historical record of the developing specialty of oncoplastic breast surgery. The presenters and authors are well-known breast surgeons from Australia, Croatia, India, Sweden, and South Africa.Peter L. Malycha, Ian R. Gough, Marko Margaritoni, S. V. S. Deo, Kerstin Sandelin, Ines Buccimazza, Gaurav Agarwa
Implementing Sentinel Lymph Node Biopsy Programs in Developing Countries: Challenges and Opportunities
No full textEstablishing Requirements for Breast Centers in Low- and Middle-Income Countries: A South African Perspective
No full textPURPOSEIn South Africa, breast care lacks governance and standardization, necessitating urgent improvements in patient outcomes. Quality improvement initiatives are urgently needed in low- and middle-income countries (LMICs), but requirements for breast centers in lower resource settings remain undefined and must be tailored to local environments. This consensus document outlines the role and requirements of breast centers in LMICs and presents a step-by-step implementation plan.METHODSThe literature was systematically reviewed, and the primary review team tabulated international accreditation standards alongside the 2018 South African Clinical Guidelines for Breast Cancer Control and Management from the South African National Department of Health, along with proposed South African standards. The broader consensus panel consisted of 29 clinical experts and representatives from societies, advocacy, and funders.RESULTSWe categorized requirements into eight broader categories and achieved unanimous consensus on all requirement components, except for 1 abstention in the general specialist and expertise category. We were unable to reach consensus on the patient volume requirements for radiologists as well as for medical and clinical/radiation oncologists. Volume requirements for clinical and radiation oncologists were later provided by the South African Society of Clinical and Radiation Oncology (SASCRO), along with the volume requirements submitted by the participating radiologists. We also achieved unanimous consensus for the Breast Interest Group of Southern Africa (BIGOSA) to house the initial project implementation. This consensus document is endorsed by BIGOSA, SASCRO, and the Cancer Association of South Africa.CONCLUSIONWe emphasize the importance and necessity of breast centers in resource-constrained environments, outline the first set of requirements for breast centers tailored to LMICs in sub-Saharan Africa, and present a feasible and detailed plan for initial implementation
Human Immunodeficiency Virus in Southern and East Africa the Pandemic and Interface with Rehabilitation
No full textA retrospective analysis of ultrasound-guided large core needle biopsies of breast lesions at a regional public hospital in Durban, KwaZulu-Natal, South Africa
No full textBackground: Histological confirmation of a breast lesion is an important step to determine the aetiology and direct further management. Evidence supports ultrasound-guided large core needle biopsy (US-LCNB) (14 gauge) as the preferred diagnostic method over traditional open surgical biopsy.Objective: To assess the influence of technical variables on the diagnostic yield of breast specimens obtained by using US-LCNB, and the sensitivity of detecting malignancy during the study period.
Methods: A retrospective chart review was conducted of all patients who had US-LCNBs from March 2011 – September 2012 at Addington Hospital in Durban, KwaZulu-Natal. Histopathological findings were correlated to the size of the breast lesion, rank of the radiologist performing the procedure and the number of cores obtained. The sensitivity of the technique was determined.
Results: During the study period, 147 biopsies were performed. The majority of lesions were>5 mm (85.5%). The average number of cores was 4, and 79.5% of the biopsies were performed by the senior radiologist. Of the 147 biopsies, 132 specimens were eligible for inclusion in the study. Histopathology revealed 71 malignant lesions of which 60 were confirmed histologically at excision. In 11 patients, no excision was performed. Therefore, the sensitivity of detecting malignancy was 100%.
Conclusion: Although the study did not establish a statistically significant relationship between the above mentioned technical variables and the histological outcome, the overall diagnostic yield and the sensitivity of detecting malignancy using US-LCNB is comparable to other similar international studies. A prospective study with long-term follow-up of patients would be of value
Reply to Comments on: Improving Breast Cancer Surgery: A Classification and Quadrant per Quadrant Atlas for Oncoplastic Surgery
No full textThe challenges of managing breast cancer in the developing world – a perspective from sub-Saharan Africa
No full textCommunicable diseases are the major cause of mortality in lower-income countries. Consequently, local and international resources are channelled mainly into addressing the impact of these conditions. HIV, however, is being successfully treated, people are living longer, and disease patterns are changing. As populations age, the incidence of cancer inevitably increases. The World Health Organization has predicted a dramatic increase in global cancer cases during the next 15 years, the majority of which will occur in low- and middle-income countries. Cancer treatment is expensive and complex and in the developing world 5% of global cancer funds are spent on 70% of cancer cases. This paper reviews the challenges of managing breast cancer in the developing world, using sub-Saharan Africa as a model
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Abstract P1-01-03: The Impact of Comorbid HIV infection on Neoadjuvant and Adjuvant Chemotherapy Relative Dose Intensity in South African Breast Cancer Patients
No full textAbstract Introduction In the South African Breast Cancer and HIV Outcomes (SABCHO) study, early-stage breast cancer patients living with HIV, compared to their HIV-negative counterparts, demonstrated higher overall mortality and lower rates of pathologic complete response if treated with neoadjuvant chemotherapy. We aimed to determine if comorbid HIV also impacted receipt of timely and complete neoadjuvant and adjuvant chemotherapy. Methods We retrospectively identified Black, stage I-III SABCHO participants diagnosed with breast cancer from June 2015 to July 2019 and who received at least 2 doses of neoadjuvant or adjuvant chemotherapy at either Charlotte Maxeke Johannesburg Academic Hospital (Gauteng) or Grey’s Hospital (KwaZulu-Natal). Data on the originally prescribed chemotherapy regimen and the dose and timing of all received chemotherapy was extracted from patients’ medical records, as well as values from all complete blood counts and metabolic panels performed during treatment. Relative dose intensity (RDI) was calculated for each agent in the prescribed regimen with the mean RDI of all agents representing the RDI of the full regimen. We assessed for associations between full regimen RDI and HIV status using a multivariable linear regression model that included demographic and clinical covariates also shown to impact RDI. We also compared rates of myelosuppression, alkaline phosphatase elevation, and creatinine elevation using linear regression. Using previously collected survival data, we compared overall mortality based on overall RDI above or below 0.85. Results We analyzed data from 325 eligible subjects, 166 of whom were living with HIV. No differences based on HIV status were appreciated in the prescribed chemotherapy regimens. For women without HIV median RDI was 0.87 (interquartile range (IQR) 0.77-0.94) and, in those living with HIV, it was 0.89 (IQR 0.77-0.95). HIV status showed no significant association with RDI on multivariable analysis, and the only patient characteristics associated with RDI were estrogen/progesterone receptor (ER/PR) and HER2 status. Patients living with HIV experienced more CTCAE v5.0 grade 3+ anemia and leukopenia than those without HIV (anemia: 10.8% vs 1.9%, p=0.001; leukopenia: 8.4% vs 1.9%, p=0.008) and were more likely to receive at least one dose of filgrastim (24.7% vs 10.7%, p=0.001). Receipt of RDI greater or less than 0.85 did not predict overall mortality in the full cohort or HIV status subgroups. A trend towards improved survival with RDI greater than 0.85 was seen among the 69 participants with ER/PR negative disease (hazard ratio: 0.60, 95% confidence interval: 0.30-1.21, p = 0.15). Conclusions Neoadjuvant and adjuvant chemotherapy RDI did not differ by HIV status among women in the SABCHO study, although women living with HIV experienced more myelotoxicity during treatment. Efforts to reduce chemotherapy dose reduction and delays should target all South African breast cancer patients. Citation Format: Daniel S. O’Neil, Oluwatosin A Ayeni, Hayley A. Farrow Woolridge, Wenlong Carl Chen, Georgia Demetriou, Ines Buccimazza, Sharon Cacala, Maureen Joffe, Michael Antoni, Gilberto Lopes, Yoanna Pumpalova, Witness Mapanga, Judith S. Jacobson, Katherine D. Crew, Alfred I. Neugut, Paul Ruff, Herbert Cubasch. The Impact of Comorbid HIV infection on Neoadjuvant and Adjuvant Chemotherapy Relative Dose Intensity in South African Breast Cancer Patients [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-01-03
Mutations in BRCA-related breast and ovarian cancer in the South African Indian population: A descriptive study
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