Abstract
BackgroundBreast cancer is the most common malignancy encountered during pregnancy. However, the burden of pregnancy-associated breast cancer (PABC) and subsequent care is understudied in sub-Saharan Africa (SSA). Here, we describe the characteristics, diagnostic delays and treatment of women with PABC seeking care at a rural cancer referral facility in Rwanda.MethodsData from female patients aged 18–50 years with pathologically confirmed breast cancer who presented for treatment between July 1, 2012 and February 28, 2014 were retrospectively reviewed. PABC was defined as breast cancer diagnosed in a woman who was pregnant or breastfeeding. Numbers and frequencies are reported for demographic and diagnostic delay variables and Wilcoxon rank sum and Fisher’s exact tests are used to compare characteristics of women with PABC to women with non-PABC at the alpha = 0.05 significance level. Treatment and outcomes are described for women with PABC only.ResultsOf the 117 women with breast cancer, 12 (10.3%) had PABC based on medical record review. The only significant demographic differences were that women with PABC were younger (p = 0.006) and more likely to be married (p = 0.035) compared to women with non-PABC. There were no significant differences in diagnostic delays or stage at diagnosis between women with PABC and women with non-PABC women. Eleven of the women with PABC received treatment, three had documented treatment delays or modifications due to their pregnancy or breastfeeding, and four stopped breastfeeding to initiate treatment. At the end of the study period, six patients were alive, three were deceased and three patients were lost to follow-up.ConclusionsPABC was relatively common in our cohort but may have been underreported. Although patients with PABC did not experience greater diagnostic delays, most had treatment modifications, emphasizing the potential value of PABC-specific treatment protocols in SSA. Larger prospective studies of PABC are needed to better understand particular challenges faced by these patients and inform policies and practices to optimize care for women with PABC in Rwanda and similar settings.
Highlights
Breast cancer is the most common malignancy encountered during pregnancy
Women with pregnancy-associated breast cancer (PABC) in sub-Saharan Africa (SSA) may face even longer delays to diagnosis and treatment than their counterparts with non-PABC because of low levels of breast cancer awareness, the possibility of breast cancers being misidentified as normal breast modifications that occur during pregnancy or lactation, providers delaying diagnostic workup until after pregnancy or lactation is complete, the competing priorities of pregnant women or new mothers, and the lack of alternatives to breastfeeding which make it difficult for a mother if she is advised to stop for treatment [9, 26,27,28,29,30,31]
We focus on women with PABC seeking care at Butaro Cancer Center of Excellence (BCCOE) to better understand their current demographic and clinical characteristics, diagnostic delays, how they are treated and their outcomes at the end of the study period to inform the provision of care for patients with PABC in low- and middle-income countries (LMICs)
Summary
The burden of pregnancy-associated breast cancer (PABC) and subsequent care is understudied in sub-Saharan Africa (SSA). Women with breast cancer in SSA are more likely to die of their disease than women with breast cancer in high-income regions in part because of delays in diagnosis leading to advanced stages at presentation [21]. Women with PABC in SSA may face even longer delays to diagnosis and treatment than their counterparts with non-PABC because of low levels of breast cancer awareness, the possibility of breast cancers being misidentified as normal breast modifications that occur during pregnancy or lactation, providers delaying diagnostic workup until after pregnancy or lactation is complete, the competing priorities of pregnant women or new mothers, and the lack of alternatives to breastfeeding which make it difficult for a mother if she is advised to stop for treatment [9, 26,27,28,29,30,31]. Despite the likely higher burden of PABC in SSA and the additional challenges women with PABC face, little is known about prevalence, presentation and management of PABC in the region [7, 8, 17, 24, 27]
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