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

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

doi:10.3332/ecancer.2021.1233

Abstract

BackgroundBreast 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.MethodsA 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.ResultsFrom 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.ConclusionBy 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.

Highlights

Two billion people live in areas plagued by violence and conflict, among whom are the majority of the global poor and a third of the world’s women [1, 2]
Cancer care services for women residing in these resources-constrained settings must address the following needs: (A) health promotion messages that consider the social, cultural and religious norms that impede the acceptance of allopathic cancer care; (B) clinical infrastructures for screening, early detection, diagnosis and treatment; (C) workforce development that includes oncology specialists, ancillary health professionals and technicians and (D) access to high-quality, low-cost cancer medicines and opioids
Stakeholders attending the Consensus Meeting listed the following as major barriers to the implementation of women’s cancer care services in the Democratic Republic of the Congo (DRC): (1) low levels of cancer awareness among health professionals and the general population; (2) lack of trained oncology human resources of all types, including ancillary personnel; (3) lack of financing and unreliable systems for the procurement, storage and dispersal of equipment and supplies; (4) poor access to affordable cancer medicines and (5) properly outfitted clinics and surgical theatres (Table 1)

Summary

Introduction

Two billion people live in areas plagued by violence and conflict, among whom are the majority of the global poor (income < $1.90/day) and a third of the world’s women [1, 2]. By destabilising the political institutions that help to ensure basic human rights and freedoms [4], war and conflict create the social conditions (extreme poverty, food shortages, lack of safety, overcrowded and unsanitary living arrangements) that result in disease and death within the countries in which they occur [5]. The majority of the world’s poorest women (income < $1.90/day) reside in fragile, conflict and violence (FCV)-affected countries, like the Democratic Republic of the Congo. Health services in these settings have traditionally focused on immediate relief efforts, communicable diseases and malnutrition.

Methods

Results

Discussion

Conclusion