Characterizing breast conditions at an open-access breast clinic in South Africa: a model that is more than cancer care for a resource-limited setting

Sarah Rayne,Faith Moyo,Cynthia Firnhaber,Naomi Lince-Deroche,Grace Rubin,Cheryl Hendrickson,Carol Benn,Kate Shearer,Pam Michelow

doi:10.1186/s12913-016-1959-4

Abstract

BackgroundWhile most breast-related research focuses on cancer, presentation of symptomatic persons in non-screened environments requires understanding the spectrum of breast diseases so as to plan services in resource-constrained settings. This study presents the variety of breast disease managed at a government, open-access breast clinic in South Africa.MethodsWe performed a retrospective file review using a systematic random sample of patients 18 years and above presenting for breast care over a 14-month period. We collected demographics, clinical characteristics, management and final diagnoses from the first visit and twelve subsequent months.ResultsThe final sample contained 365 individuals (97 · 5% women). Most were black, unmarried and South African citizens with a median age of 43 years (IQR 31–55) . Of those reporting their status (24 · 1%) 38 · 6% were HIV-positive. A mass (57 · 0%) and/or pain (28 · 5%) were the most common symptoms. Imaging and breast biopsies were required in 78 and 25% of individuals, respectively. Nearly half of biopsies identified breast cancer (44 · 1% of women ≤40 and 57 · 3% for women >40). Benign conditions (47 · 7%) and no abnormality (18 · 2%) were common final classifications among women. There was no difference between the final classifications of patients who self-referred versus those who were formally referred from another health care provider. Nearly half of the participants (46 · 6%) travelled 20 km or more to attend the clinic.ConclusionsBenign breast conditions far outweighed cancer diagnoses. As breast cancer awareness increases in resource-limited countries, facilities offering breast care require administrative and clinical preparation to manage a range of non-cancer related conditions.

Highlights

While most breast-related research focuses on cancer, presentation of symptomatic persons in non-screened environments requires understanding the spectrum of breast diseases so as to plan services in resource-constrained settings
More than 50% of these occurred in countries with a low or medium-level Human Development Index (HDI) [2], and for women the most common cancers diagnosed were of the breast and cervix [1]
We describe the primary complaints and diagnoses of a patient population attending a large, outpatient breast clinic operating within a government hospital in Johannesburg, South Africa

Summary

Introduction

While most breast-related research focuses on cancer, presentation of symptomatic persons in non-screened environments requires understanding the spectrum of breast diseases so as to plan services in resource-constrained settings. More than 50% of these occurred in countries with a low or medium-level Human Development Index (HDI) [2], and for women the most common cancers diagnosed were of the breast and cervix [1]. The significant cancer burden in low or medium-level HDI countries like South Africa impacts on families and communities as well as national-level productivity indicators [2, 6]. As the medical community and policy makers encourage women to become breast aware, examine their breasts regularly and consider populationlevel policies for screening for cancer, the health system should be prepared for the diagnosis and management of additional benign breast disease and previously undiagnosed breast problems

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Discussion

Conclusion