Breast Cancer in Low - and Middle Income Countries: Persistent Challenges and Insights

Irfan Ali, Mariyah Anwer, Shabina Jaffar, Muhammad Naeem

Abstract

Objective

To determine the disease burden, patterns of referral, obstacles to surgical treatment and outcome of patients with breast cancer managed at a tertiary care hospital.

Study design

Cross sectional observational study.

Place & Duration of study

Department of General Surgery, Jinnah Postgraduate Medical Center (JPMC) Karachi, from January 2023 to December 2024.

Methods

Records of all the patients managed during the study period were analyzed. The data collected included demographics of the patients, the stage of the disease at diagnosis, referral pattern, comorbid conditions, types of surgery performed and postoperative outcomes. The descriptive statistics were employed to report for characteristics of patients. Chi-square test was used to find associations between categorical variables. The binary logistic regression was used to assess the independent predictors of surgical intervention. These were reported as odds ratios (OR) with 95% confidence intervals (CI).

Results

A total of 1500 breast cancer patients were registered at the cancer registry of the hospital. Out of this, 549 (36.6%) underwent surgical intervention. The most common surgical procedure undertaken was modified radical mastectomy (n=310 - 56.5%) followed by lumpectomy (n=120 - 21.9%) with breast-conserving (n=38 - 6.9%) and rarely oncoplasty (n=16 – 2.9%) was done. Important obstacles to surgical intervention were advanced stages III and IV of the disease (n=1065 – 71.0%), delays to referral (n=584 - 38.9%), financial barriers (n=504 - 33.6%) and comorbid conditions (n=395 - 26.3%). The predictive value of the disease being treated in its early stages (OR 2.34), the absence of a comorbid conditions (OR 1.58), direct arrival to outpatient services (OR 1.71) and age of less than 45-years (OR 1.43) were the antecedents of surgical treatment.

Conclusion

Late diagnosis and non-availability of the treatment were important factors observed in this study for adverse outcome. About a third of the patients had a surgical procedure done; most common which was modified radical mastectomy. Operative mortality was 2.5%, as fourteen women died in this series.

Key words

Breast cancer, Low- and middle-income countries (LMICs), Diagnosis, Health system, Healthcare. Modified radical mastectomy.