ecancermedicalscience

Special Issue

Building a breast cancer detection and treatment platform in the Democratic Republic of the Congo by integrating training, service and infrastructure development

13 May 2021
Kabongo Mukuta Mathieu, Tankoy Gombo YouYou, Michael L Hicks, Alex Mutombo, Mukanya Mpalata Anaclet, Mulumba Kapuku Sylvain, Leeya Pinder, Maya M Hicks, Louis Kanda, Mirielle Kanda, Groesbeck P Parham, Ronda Henry-Tillman

Background: Breast cancer is a leading cause of cancer-related morbidity and mortality in sub-Saharan Africa, a global region where opportunities for breast care of any type are extremely limited due to insufficient infrastructure, a paucity of clinical services and vast shortages of trained human resources.

Methods: A team of Zambian and US gynaecologic and breast oncology experts and nurse-specialists made multiple visits (each lasting 5 working days) to the Democratic Republic of the Congo (DRC), over a 2-year period. During each of five week-long site visits, hands-on training of local Congolese health providers was conducted during which time they were taught clinical breast exam (CBE), breast and axillary ultrasound, ultrasound-guided core needle biopsy/fine needle aspiration (FNA) and breast surgery. Simultaneous with the training exercises, a new breast care clinic was established and operationalised, and existing surgical theatres were upgraded. All activities were implemented in a private sector health care facility – Biamba Marie Mutombo Hospital – in the capital city of Kinshasa.

Results: From April 2017 to August 2020, a total of 5,211 women were identified as having breast abnormalities on CBE. Ages ranged from 26 to 86 years; median age: 42.0 (±14.1) years. Ultrasound abnormalities were noted in 1,420 (27%) clients, of which 516 (36%) met the criteria (indeterminate cystic lesion, solid or suspicious masses) for ultrasound-guided core needle biopsy or FNA. Pathology reports were available for 368 (71%) of the 516 clients who underwent biopsy, of which 164 were malignant and 204 benign. The majority (88%) of the cancers were advanced (TNM stages 3 and 4). Surgical procedures consisted of 183 lumpectomies, 58 modified radical mastectomies and 45 axillary lymph node dissections. Clinical competency for diagnostic and surgical procedures was reached early in the course of the training programme.

Conclusion: By integrating onsite training with simultaneous investments in clinical service and infrastructure development, the barriers to breast cancer diagnosis and treatment were disrupted and a modern breast care service platform was established in a private sector health care facility in the DRC.

Related Articles

Dario Alvaro Rueda, Cecilia Schweitzer, Di Nisio Lorena, María Laura Piccoletti, Nicolas Torressi, Víctor Acevedo, Silvia Ferrandini
João Felipe Lima Feldmann, João Henrique Lima Feldmann, Cassio Murilo Hidalgo-Filho, Amanda Acioli de Almeida Robatto, Breno Jeha Araújo, Publio Cesar Cavalcante Viana, Gilberto de Castro Junior
Rima Saad Rassam, Ryan R Lion, Siham Cherkaoui, Laila Hessissen, Ximena Garcia-Quintero, Lama Sayegh Najjar, Dolly Noun, Janane Hanna, Rana Yamout, Shahzadi Resham, Khaled Al Habaiba, Anwar Al-Nassan, Joe El-Khoury, Spandana Rayala, Qutaibah Alotaibi, Nahla Gafer, Giuseppe Troisi, Julia Downing, Suheir Rasul, Sima Jeha, Monnie Abraham, Michael J McNeil
Naciri Meryem, Aouzah Fatima Ezzahra, El Ghanmi Adil, Ghazi Bouchra Fichtali Karima Sqalli Houssaini Mohammed, Kouhen Fadila