Breast Cancer In Ghana Research Articles

Abstract C050: Breast cancer in Ghana: assessment of multidrug-resistant genes among breast cancer patients

Abstract Breast cancer (BC) is the most frequently diagnosed cancer among women globally and chemotherapy plays a crucial role in its management in sub-Saharan Africa. The long-term BC survival rate remains poor due to chemoresistance. Over 80% of currently used chemotherapy drugs are substrates of ABC transporter genes, ABCB1, ABCC1 and ABCG2. Possessing the wild-type genotype and alleles of these genes reduces intracellular drug accumulation and leads to poorer treatment outcomes due to the upregulation of efflux function. This study therefore determined the allelic and genotype frequencies of three variant alleles, rs1045642, rs28706727 and rs2231142 in these transporter genes, and assessed the association between the variant statuses and BC recurrence or metastasis in the Ghanaian BC population. A quantitative, observational, case-control study was conducted using a purposive and convenience sampling method. Sociodemographic and clinical data were collected from study participants using questionnaires and a review of medical records. Extracted blood DNA from participants was used to determine the gene variants in ABCB1, ABCC1 and ABCG2 genes using the TaqMan Allelic Discrimination assays. A significantly high frequency (p ≤ 0.001) of the homozygous wild-type genotypes and alleles (ABCB1 had 77.3%/88% for CC/C, ABCC1 had 95.3%/97.7% for GG/G and ABCG2 had 100%/100% for CC/C) was found in both case and control groups. The wild-type genotypes and alleles of ABCB1, ABCC1 and ABCG2 may contribute to poor BC treatment outcomes among Ghanaian BC patients receiving chemotherapy. Citation Format: Gloria Agyekum Boaitey, Rachel Martini, Nourddine Dean Djeddar, Brian Stonaker, Stevens M. Patino, Jason White, Ernest Osei Bonsu, Yaw Agyekum Boaitey, Christian Obirikorang, Melissa B. Davis, Linda Ahenkorah Fondjo. Breast cancer in Ghana: assessment of multidrug-resistant genes among breast cancer patients [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C050.

Incidence and severity of acute radiation induced toxicities among breast cancer patients treated with adjuvant radiotherapy at a major cancer treatment center in Ghana

BackgroundAdjuvant radiotherapy after mastectomy or breast conserving surgery (BCS) is the standard of care for majority of patients with breast cancer. This is however associated with mucosal and epidermal toxicity of organs at risk (OARs). Breast cancer patients are exposed to a plethora of wrong perceptions, misinformation and myths concerning the usefulness and adverse effects of radiotherapy. There is paucity of literature on the incidence and severity of radiation-induced acute toxicities experienced by patients with breast cancer in Ghana. AimTo assess the occurrence and severity of four main acute radiation-induced toxicities among female breast cancer patients treated with external beam radiotherapy at a major cancer treatment centre in Ghana. MethodsData on the occurrence of acute toxicities among patients was collected from patients' medical records, through a semi-structured questionnaire and via weekly clinical assessments. The Common Terminology Criteria for Adverse Events (CTCAE) grading scale (version 4.0) was used to grade the severity of these toxicities. Descriptive and inferential statistics using an independent two-sampled t-test (two-tailed), one-way analysis of variance (ANOVA), Pearson's Chi-square and Fisher's exact tests were performed. ResultsDermatitis, fatigue, pharyngitis, and breast (chest) pain were the radiation toxicities found among the breast cancer patients undergoing treatment on the two machines. The mean predominant radiation doses associated with the onset of dermatitis, fatigue, pharyngitis, and chest pain in the breast cancer patients were 22.32 Gy, 22.48 Gy, 13.59 Gy, and 19.27 Gy respectively for treatment with a statistically significant (p = 0.0173). Radiation dermatitis was the most dominant acute radiation toxicity recorded, and its incidence and severity. The range of Fisher's p-values (0.689–0.999) between the acute radiation toxicities with both machines revealed no statistical significance. ConclusionRadiation dermatitis was the dominant acute toxicity, both in incidence and severity for patients treated. There was no statistical significance in the incidence and severity of acute radiation side effects.

Utilisation of traditional medicine among women diagnosed with breast cancer in Ghana: a descriptive phenomenological study

BackgroundWomen living with breast cancer (BC) rely on traditional medicine (TM) in addition to orthodox medicine. There is a need to understand how and why women diagnosed with BC utilise TM. This study explored and described the lived experiences of women living with BC in terms of their utilisation of traditional medicine.MethodsA descriptive phenomenology design was used to purposively conduct 20 face-to-face in-depth interviews using a semi-structured interview guide. Data were analysed using NVivo-12 based on Collaizzi’s framework for thematic data analysis.ResultsOverall, five main themes emerged, namely: sources of knowledge on TM, motivations for using TM, treatment modalities, timing for the initiation of TM, the reasons for discontinuing use of TM, and the decision to seek orthodox medicine. Under the category of motivations for using TM, four themes emerged: financial difficulties and perceived cost effectiveness of TM, influence of social networks, including family and friends, assurance of non-invasive treatment, delays at the healthcare facility, and side effects of orthodox treatment. Non-invasive treatments included herbal concoctions, natural food consumption, and skin application treatments. Regarding the timing of initiation, TM was used in the initial stage of symptom recognition prior to the decision to seek orthodox medicine, and was also used complementarily or as an alternative after seeking orthodox medicine. However, patients eventually stopped using TM due to the persistence of symptoms and the progression of cancer to a more advanced stage, and disapproval by orthodox practitioners.ConclusionWomen living with BC in Ghana utilise traditional medicine (TM) for many reasons and report their family, friends and the media as a main source of information. A combination of herbal concoctions and skin application modalities is obtained from TM practitioners to treat their BC. However, they eventually discontinue TM when symptoms persist or when disapproval is expressed by their orthodox healthcare providers. We conclude that there is an opportunity to better integrate TM into the standard of oncological care for BC patients.

Covariate level stratification assessment of mortalities due to competing risks and breast cancer in Ghana

Ascertaining the extent of competing risk in survival data that has the capacity to set the basis for selecting appropriate models for analysing and predicting breast cancer mortality rates has been of interest. In this study, the estimates of two cumulative incidence functions were compared with the complement of the Kaplan-Meier to assess the presence of competing events. The results revealed that the complement of the product-limit estimator (1-KM) overestimated the survival probability at periods beyond the 32nd month of follow-up, an indication of competing risk. Older patients (>50 years) were found to be more likely to die from competing events (P<0.01,x2=52.26)than those in the age category of ≤50 years. Further analysis was conducted when the estimates of the Fine-Grey and Cox regression models were compared. The estimates were largely not identical, coupled with the overestimation of hazards in favour of the Cox model, a further sign of the presence of competing risk. Breast cancer deaths and deaths due to competing events were examined through stratification by each level of each covariate. The triple-negative (TRN) breast cancer molecular subtype was the most associated with the greatest absolute risk, which peaked at about 80 % by the 60th month. Patients who experienced a recurrence of BC and experienced competing events had about 35 % higher absolute risk by the 60th month. Again, BC patients who were hospitalized have about 25 % higher absolute risk than their counterparts who were not hospitalized. Poorly differentiated BC tumors (Grade 3) were associated with a 40 % increase in absolute risk in comparison with moderately differentiated tumors (Grade 2). Pre-menopausal patients experienced about 7 % increased absolute risk compared with post-menopausal patients. Older patients were solely the category that experienced the risk of dying from competing events, accounting for an absolute risk of 22 % by the 60th month. It is recommended for Ghanaian clinicians to integrate these findings into BC management in order to optimize treatment.

Geospatial availability of breast cancer treatment modalities and hypothetical access improvement in Ghana: A nationwide survey.

Breast cancer in Ghana is a growing public health problem with increasing incidence and poor outcomes. Lack of access to comprehensive treatment in Ghana may be a contributing factor to its high mortality. The purpose of this study was to evaluate the availability of treatments nationwide and systematically identify high yield areas for targeted expansion. We conducted a cross-sectional, nationwide hospital-based survey from November 2020-October 2021. Surveys were conducted in person with trained research assistants and described hospital availability of all breast cancer treatments and personnel. All individual treatment services were reported, and hospitals were further stratified into levels of multi-modal treatment modeled after the National Comprehensive Cancer Network (NCCN) Framework treatment recommendations for low-resource settings. Level 3 included Tamoxifen and surgery (mastectomy with axillary lymph node sampling); Level 2 included Level 3 plus radiation, aromatase inhibitors, lumpectomy, and sentinel lymph node biopsy; Level 1 included Level 2 plus Her2 therapy and breast reconstruction. Hospitals were identified that could expand to these service levels based on existing services, location and personnel. The distance of the total population from treatment services before and after hypothetical expansion was determined with a geospatial analysis. Of the 328 participating hospitals (95% response rate), 9 hospitals had Level 3 care, 0 had Level 2, and 2 had Level 1. Twelve hospitals could expand to Level 3, 1 could expand to Level 2, and 1 could expand to Level 1. With expansion, the population percentage within 75km of Level 1, 2 and 3 care would increase from 42% to 50%, 0 to 6% and 44% to 67%, respectively. Multi-modal breast cancer treatment is available in Ghana, but it is not accessible to most of the population. Leveraging the knowledge of current resources and population proximity provides an opportunity to identify high-yield areas for targeted expansion.

Socio-cultural and Economic Determinants of Delayed Reporting of Breast Cancer Among Ghanaian Women: A Qualitative Study

Delayed reporting of breast cancer continues to increase in African countries, including Ghana, which is attributable to socio-cultural and economic factors. However, there is a paucity of data on socio-cultural and economic determinants of delayed reporting of breast cancer in Ghana. This study aimed to explore the socio‐cultural and economic determinants of delayed reporting of breast cancer among Ghanaian women. The study adopted an exploratory descriptive qualitative design with purposive sampling to recruit 17 women with breast cancer from the Tamale Teaching Hospital, Ghana. Data were collected through in-depth interviews. Analysis: Data analysis was done using the thematic analysis approach. Delayed reporting was due to inaccurate information, the influence of social networks, cultural misconceptions, belief in alternative treatment, high cost of treatment, and extreme poverty. A combination of socio‐cultural and economic factors influences the delay in reporting breast cancer in Ghana. Culturally appropriate and adequate health information and education, integration of alternative treatment into the formal healthcare system in Ghana, and financial support from the government are needed to promote early reporting for treatment.

Abstract 10: Availability and Access to Hospital-Based Breast Cancer Early Detection and Diagnostic Services in Ghana

Abstract Purpose: Breast Cancer in Ghana is the leading type of cancer and second most common cause of cancer related death. Five-year survival in Ghana has been cited at 40-48% with most cases being stage 3 or 4 at diagnosis. Robust access to early detection and diagnostic services can lead to earlier stages of diagnosis and improved survival. The purpose of this study was to evaluate the early detection and diagnostic services available at hospital facilities nationwide in Ghana and to characterize geographic access. Methods: Trained research assistants administered a cross-sectional survey to all hospitals in Ghana from November 2020 to October 2021. Early detection and diagnostic services were characterized as having Basic, Core, or Enhanced services as per in the National Comprehensive Cancer Network (NCCN) framework for resource stratification. Availability of services were defined as available greater than 80% of the time, available less than 80%, or not at all. Results were analyzed for descriptive statistics in STATA. Results: 328 of 346 hospitals completed the survey. Of the 328 hospitals, 2 (1%) met NCCN Basic criteria alone, 11 (3%) of the hospitals met NCCN Core criteria, and none met NCCN Enhanced criteria. When including hospitals who offer services less than 80% of the year for varying circumstances, 3 (1%) met NCCN Basic criteria, 20 (6%) met NCCN Core criteria, and none met NCCN Enhanced criteria. Mammography was offered at 21 (6%) of the hospitals, 17 (5%) of which were available more than 80% of the year. Mapping and population data to estimate the percentage of population within various distances to hospital-based breast cancer early detection and diagnostic services will be done using Ghana 2021 census data in ArcGIS. Conclusion: Hospital based services for breast cancer early detection and diagnosis in Ghana are available but sparse. Many hospitals offer fragmented aspects of care outlined by the NCCN framework, but there are only a limited number of hospitals who offer the full spectrum of services. Understanding of current availability, and geographical distribution of services, provides a framework for potential targeted expansion or identification of alternative healthcare delivery models. Citation Format: Matthew Price, Anne Rositch, Florence Dedey, Mamadou Tounkara, Kirstyn Brownson, Raymond Price, Edward Kofi Sutherland. Availability and Access to Hospital-Based Breast Cancer Early Detection and Diagnostic Services in Ghana [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 10.

A Prospective Evaluation of the Quality of Life and Mental Health Implications of Mastectomy Alone on Women in sub-Saharan Africa.

Assess quality of life and mental health implications of mastectomy for breast cancer on sub-Saharan African women. Mortality rates amongst women diagnosed with breast cancer in sub-Saharan Africa (SSA) are high, with disparities in survival relative to women in high income countries partly attributed to advanced disease at presentation. Fears of the sequelae of mastectomy are a prominent reason for presentation delays. There is a critical need to better understand the effects of mastectomy on women in SSA to inform preoperative counseling and education for women with breast cancer. Women with breast cancer in Ghana and Ethiopia undergoing mastectomy were followed prospectively. Breast related quality-of-life and mental health measures were evaluated preoperatively, 3 and 6 months postoperatively, using BREAST-Q, PHQ-9, and GAD-7. Bivariate and logistic regression analyses evaluated changes in these measures for the total cohort and between sites. A total of 133 women from Ghana and Ethiopia were recruited. The majority of women presented with unilateral disease (99%) and underwent unilateral mastectomy (98%) with axillary lymph node dissection. Radiation was more common in Ghana ( P <0.001). Across most BREAST-Q subscales, women from both countries reported significantly decreased scores at 3 months postoperative. At 6 months, the combined cohort reported decreased scores for breast satisfaction (mean difference, -3.4). Women in both countries reported similar improvements in anxiety and depression scores postoperatively. Women from Ghana and Ethiopia who underwent mastectomy experienced a decline in breast-related body image while also experiencing decreased levels of depression and anxiety.

Clinicopathologic characteristics of early-onset breast cancer: a comparative analysis of cases from across Ghana

BackgroundBreast cancer is the commonest cancer diagnosed globally and the second leading cause of cancer-related mortality among women younger than 40 years. This study comparatively reviewed the demographic, pathologic and molecular features of Early-Onset Breast Cancer (EOBC) reported in Ghana in relation to Late Onset Breast Cancer (LOBC).MethodsA descriptive, cross-sectional design was used, with purposive sampling of retrospective histopathology data from 2019 to 2021. Reports of core or incision biopsy, Wide Local Excision or Mastectomy with or without axillary lymph node dissection specimen and matched immunohistochemistry reports were merged into a single file and analysed with SPSS v. 20.0. Descriptive statistics of frequencies and percentages were used to describe categorical variables. Cross-tabulation and chi-square test was done at a 95% confidence interval with significance established at p < 0.05.ResultsA total of 2418 cases were included in the study with 20.2% (488 cases) being EOBCs and 79.8% (1930 cases) being LOBCs. The median age at diagnosis was 34.66 (IQR: 5.55) in the EOBC group (< 40 years) and 54.29 (IQR: 16.86) in the LOBC group (≥ 40 years). Invasive carcinoma—No Special Type was the commonest tumour type with grade III tumours being the commonest in both categories of patients. Perineural invasion was the only statistically significant pathologic parameter with age. EOBC was associated with higher DCIS component (24.8% vs 21.6%), lower hormone-receptor-positive status (52.30% vs 55.70%), higher proliferation index (Ki-67 > 20: 82.40% vs 80.30%) and a higher number of involved lymph nodes (13.80% vs 9.00%). Triple-Negative Breast cancer (26.40% vs 24.30%) was the most predominant molecular subtype of EOBC.ConclusionEOBCs in our setting are generally more aggressive with poorer prognostic histopathological and molecular features when compared with LOBCs. A larger study is recommended to identify the association between relevant pathological features and early onset breast cancer in Ghana. Again, further molecular and genetic studies to understand the molecular genetic drivers of the general poorer pathological features of EOBCs and its relation to patient outcome in our setting is needed.

Breast cancer screening pathways in Ghana: applying an exploratory single case study methodology with cross-case analysis

BackgroundBreast cancer is steadily increasing in Ghana, with the majority of Ghanaians only seeking care in the advanced stage of the disease. Furthermore, structured breast cancer control strategies are mostly non-existent. This study aimed to examine breast cancer and breast screening pathways in a tertiary healthcare facility within the Kumasi metropolis. MethodWe used a single exploratory case-study design to purposefully select one healthcare facility as a case with embedded sub-units of analysis (patients, first-degree relatives of patients, and clinicians) to address the study's aim. In-depth interview was used to generate evidence from 35 participants. Applying Miles and Huberman's thematic strategy, a cross-case analysis was conducted using Morse's analytical framework. ResultsFive (5) main themes emerged from the data: description of breast cancer, breast health education in Ghana, breast screening practices among women, the state of breast screening and barriers to breast screening uptake and lastly, the way forward. Malignancy of the breast was described as common, especially among young women who commonly present with advanced disease with poor prognostic outcomes. There were reports of limited breast cancer awareness and knowledge among women. Comparatively, urban educated women were noted to be relatively knowledgeable and more proactive about breast cancer than the less-privileged women in rural communities. Self and clinical-breast examination practices were reported as unusual habits for Ghanaian women. Several provider-related factors, lack of screening facilities, and attitude of women were highlighted as barriers to breast screening practices. Education among health professionals and interventions to promote opportunistic and organized breast screening were cited as the way forward for breast cancer control and early detection in Ghana. ConclusionThis is a confirmatory result of a stark burden of breast cancer in Ghana, inferring a need to address the deficiencies around breast cancer and early detection practices.

Healthcare providers’ perspectives of the supportive care needs of women with advanced breast cancer in Ghana

BackgroundThe study sought to understand the supportive care needs of women with advanced breast cancer from the perspectives of healthcare professionals (HCPs) and key informants of charitable/non-governmental organisations (NGOs), that provide supportive care services to women with advanced breast cancer, in Ghana.MethodsA qualitative descriptive approach was employed via one-to-one semi-structured interviews with 13 HCPs and key informants of charitable/NGOs in Ghana that provide supportive care services to women with advanced breast cancer. The study was underpinned by Bradshaw’s taxonomy of social needs and Fitch’s supportive care framework. The data were analysed using a deductive content analysis approach.ResultsHealthcare providers and key informants perceived that women with advanced breast cancer in Ghana have numerous and complex supportive care needs in key areas that align with Fitch’s supportive care framework, including informational, psychological, emotional, physical, practical, social, sexuality and spiritual needs.ConclusionParticipants perceived that women who have advanced breast cancer in Ghana require ongoing information about their condition, treatments and related effects, as well as spiritual support and guidance particularly due to the fatalistic beliefs they often associate with the condition. Tailored supportive care interventions and services, which address the unique sociocultural circumstances for this cohort, are required. Additional research is needed to explore how multidisciplinary teams can work collaboratively to provide comprehensive support to women in addressing their needs.

The impact of a breast cancer educational intervention in Ghanaian high schools

IntroductionGlobally breast cancer is the leading cause of cancer with an estimated 2.3 million new cases and 685,000 deaths in 2020. Late presentation is the hallmark of breast cancer in Ghana for which ignorance and fear are the major reasons fuelled largely by myths and misconceptions. Breast cancer awareness and education needs to start early to bring about a change in knowledge, attitude and practices. However, Breast cancer awareness activities in Ghana have usually targeted adult women.This study assessed the impact of breast cancer education among adolescent high school girls in Ghana.MethodologyA pre- post-test quasi experimental study was conducted at two senior high schools. A self-administered pre-educational questionnaire was followed by an educational intervention consisting of a drama, PowerPoint lecture, question and answer session and distribution of breast cancer information leaflets. After 3 months the same questionnaire was administered as a post-education test to assess the impact of the educational intervention. The total score for each domain was categorised into adequate knowledge > 50% and inadequate knowledge < 50%.ResultsThe number of participants in the pre-test and post-test were 1043 and 1274; the median ages [IQR] were 16.0 [15.0–17.0] for both the pre and post-test students. General knowledge on breast cancer at pre-education (29.1%) improved to 72.5% (p < 0.001). Knowledge on signs and symptoms improved from 33.1 to 55% (p < 0.001); knowledge on risk factors improved from 55.3 to 79.2% (p < 0.001), and knowledge on breast self-examination and screening improved from 9.8 to 22.2% (p < 0.001). The overall performance of the students improved from 17.2 to 59.4% (p < 0.001).ConclusionThere is inadequate knowledge about breast cancer and self-examination among senior high school girls in Ghana. Our breast cancer educational intervention was effective in improving general knowledge of breast cancer, risk factors, signs and symptoms and breast self-examination. The overall knowledge base improved from 17.2 to 59.4% 3 months post intervention, accompanied by an increase in the reported practice of breast self-examination and a greater belief that breast cancer is curable. This study has demonstrated the need for a school breast cancer educational program and that breast cancer education in high schools is effective.

Overview of breast cancer external beam radiation therapy in Ghana: Towards the establishment of a national standardized treatment guidelines for improved patient care

Background and purposeThis paper reports on results from the foremost national survey on external beam radiation therapy (EBRT) treatment practice at the three radiotherapy (RT) facilities in Ghana. It is to survey the current EBRT treatment protocols and its resources available in the country for breast cancer treatment. Results are intended to form the foundation for future clinical research into developing standardized institutional and/or National breast cancer treatment planning guidelines. This will introduce uniformity into EBRT protocols across the three facilities in the country for their breast cancer patients. Materials and methodsThe survey was conducted with two online-based questionnaires; a general questionnaire that targeted radiation oncology professionals working in the three RT facilities in Ghana and a follow-up specifically for the radiation oncologists. The first survey was rolled out from 21st August 2020 to 31st December 2020. The second survey was conducted from 15th February 2021 to 31st March 2021 after the initial analysis of the responses from the first survey. The first questionnaire had 54 general EBRT breast cancer treatment questions. The second questionnaire had 14 questions focusing on dose fractionation regimens, definition of treatment targets and organs at risk (OAR) delineation. ResultsThe Google web-based questionnaires had in total 11 responses from the targeted radiation oncologists, medical physicists, and radiation therapists working in the three radiotherapy facilities in the country. The facility response rate was 100% for the survey as there were participation from all three RT facilities. CT-based breast planning was considered standard and used in all three facilities. Reference markers to aid patient positioning and target delineations were employed during simulations. Majority of the relevant OAR associated with breast EBRT were very well defined. 3 dimensional conformal radiotherapy (3DCRT) planning with forward-planning field-in-field (FP-FIF) technique has become the preferred planning of choice. From this survey, there were three medical linear accelerators (Linacs) and two Cobalt-60 (Co-60) treatment units used in treating an average of 750 breast cancer patients annually. ConclusionResults from the survey gave an in-depth overview of the current state of EBRT resources available in the treatment and management of breast cancer in Ghana. Minor protocol variations amongst the facilities were observed. However, there were strong consensus amongst the facilities regarding majority of their current existing protocols and possible future techniques/technology implementation.

Supportive care needs of women with advanced breast cancer in Ghana.

Most women with breast cancer in Ghana are initially diagnosed with advanced disease, however, there is limited research about Ghanaian women's experiences of living with advanced breast cancer. The study aimed to understand the perceived (felt) and expressed needs of women with advanced breast cancer. Using a cross-sectional design, this study assessed the supportive care and spiritual needs, as well as the supportive care service use, of women diagnosed with advanced breast cancer (n=176) with the Supportive Care Needs Survey-Long Form, the Spiritual Need Assessment for Patients and the modified Client Service Receipt Inventory. Most participants (96.6%) had financial needs and needs in relation to having access to professional counselling. The most prevalent supportive care needs reported were related to health system issues and information needs (90.3%-96.6%). Compared to older women (51.7%), younger women (48.3%) reported greater psychological (p=0.002) and sexuality needs (p<0.001) and less religious needs (p=0.048). Most participants (92.1%) had at least one spiritual need. Many of the available outpatient services were not accessed by the majority of participants (>63%). The study participants reported high supportive care needs even so, most did not access available relevant services. Study findings indicate that most of the participants were unaware of the health and supportive care services that were available to them or that these services were not easily accessible due to their financial status or geographical location. Targeted interventions are needed to assist the women to address their supportive care, spiritual and service needs.

The cultural and structural influences that \u2018hide\u2019 information from women diagnosed with breast cancer in Ghana: an ethnography

BackgroundSocio-cultural factors may influence the uptake of breast cancer treatments. This study aimed to explore these socio-cultural influences on treatment decision-making for women in Ghana.MethodAn ethnographic approach was adopted. Observation was conducted of women newly diagnosed with breast cancer, nominated relatives, nurses and doctors at a breast clinic in Ghana. Semi-structured interviews followed participant observation. Thematic analysis was employed.FindingsOver 16 weeks (July 2017–November 2017), 31 participants were observed and 29 took part in semi-structured interviews. Three overarching themes were identified: (1) unequal power relationships; (2) Language barriers and (3) structural constraints. Following a breast cancer diagnosis, essential information necessary for treatment decision making is ‘hidden’ from women due to an unequal patient-provider relationship. Patients acknowledged cultural behaviours of deference to experts. Doctors deliberately misrepresented treatment information to women to encourage them to undergo surgical treatment. Structural issues such as the lack of privacy during consultations hindered quality patient engagement with decision-making. High treatment costs and the lack of resources to assist women with fertility after treatment impeded open discussions around these issues. Language barriers included a lack of terms in the local Twi language to explain cancer and its treatment. There was also an absence of appropriate information materials.ConclusionFindings highlight the need for health professionals to be aware of the socio-cultural factors that limit access to quality information which is needed for informed treatment decision making. Policies that aim to provide adequate logistics; increase staffing levels; improve staff cultural awareness training and remove financial barriers are recommended.

Lived Experiences of Women Receiving Medical Treatments for Breast Cancer in Ghana: A Qualitative Study

Breast cancer diagnosis and its treatment present women with significant challenges which require adjustment in several domains to ensure good health outcomes. Any psychosocial interventions to address the challenges need to be informed by empirical evidence. However, there is dearth of empirical literature in this regard in the Ghanaian context. To address some of these gaps, we explored the lived experiences of women living with breast in Ghana to inform healthcare practice and breast cancer research. In-depth individual interviews were conducted among 11 breast cancer patients receiving medical treatment for breast cancer. The interpretative phenomenological approach was used in the data analysis. Findings from the study showed that participants’ lived experiences cluster around three major themes; burdens of breast cancer treatments, alternative/herbal medicine use, and breast cancer stigma. These findings underscore the need for a multidisciplinary treatment approach to achieve optimum health outcomes among these groups of women.

The Analysis of bcl-2 in Association with p53 and Ki-67 in Triple Negative Breast Cancer and Other Molecular Subtypes in Ghana.

Background Little is known about the role of apoptosis in the tumorigenesis and prognosis of breast cancer in Ghana. Chemotherapeutic drug efficacy partially relates to apoptosis induction, rendering it a vital target in cancer therapy with unique biomarker opportunities that have not been exploited. Aberrations in this pathway are central to tumorigenesis, tumor progression, overall tumor growth, and regression during treatment therapies. Antiapoptotic bcl-2 (gene) and p53 are known to play roles in apoptosis while Ki-67 is a proliferative marker. The aim of our study is to determine the association of bcl-2 (protein) with p53 and Ki-67 in 203 consecutive breast cancer cases over a 10-year period. Method A retrospective cross-sectional study on archival FFPE tissue blocks over a 9-year period with abstraction of clinicopathologic data. Two hundred and three consecutive and suitable FFPE blocks were selected for tissue microarray (TMA) construction, and IHC (bcl-2 (protein), Ki-67, p53, cyclin D, pan cytokeratins A and E, ER, PR, and HER2/neu) was done. Expressions of bcl-2 (protein), p53, and Ki-67 were related to histological grade, lymphovascular invasion, and molecular subtypes. SPSS version 23 was used to analyze results. Results Most of our cases were in the fifth decade of life (31%); invasive carcinoma of no special type (NST) was predominant (87%); histological grade III (38%) was the highest; and Luminal A (19.8%), Luminal B (9.9%), HER2 (16%), and TNBC (54.3%) constituted the molecular classes. bcl-2 expression was found in 38% of the cases. Our cases also showed mutation in p53 (36.7%) and ki-67 expression (62.5%). bcl-2 (protein) and p53 significantly correlated with Luminal B and TNBC (p < 0.01). Ki-67 also correlated significantly with Luminal A and B and HER2 overexpression (p < 0.01). Premenopausal age (40–49) and histological grade inversely correlated with bcl-2 (protein) expression. p53 statistically correlated with Ki-67 (p < 0.05). Conclusion Our results show high expression of bcl-2 (protein) suggesting an important role of apoptosis in Ghanaian breast cancer cases. bcl-2 (protein), p53, and Ki-67 expressions emerged interdependently from this research and can thus be manipulated in prediction and prognosis of breast cancers in our setting.

Developing a Breast Reconstruction Program in a Resource-Constrained Ghanaian Teaching Hospital: Needs Assessment and Implementation.

As the detection of breast cancer in Ghana improves, the incidence of mastectomy has increased and the outcomes have improved. As a secondary result, the need for breast reconstruction is increasing. The cultural hesitation to undergo a mastectomy and live without a breast can be decreased by making breast reconstruction available, cost-effective, and acceptable. Cultural, economic, and technical factors were considered in choosing the best method of breast reconstruction. Discussions, lectures, and cadaver dissections investigated the various reconstructive options. Operative cases were performed using a latissimus musculocutaneous flap, a lower abdominal transverse rectus abdominis myocutaneous (TRAM) flap, and a midabdominal TRAM flap. The midabdominal TRAM was found to be the best choice at Komfo Anokye Teaching Hospital. It is a reliable, robust, well-perfused, single-stage flap that produced excellent patient satisfaction.

Information needs of breast cancer patients and how educational status influence their information needs in Ghana

Health information literacy plays a critical role in self-management practices among patients living with chronic health conditions. However, there are limited studies on information needs among breast cancer patients in Ghana. This paper therefore investigated the information needs of women living with breast cancer in Ghana and how educational status influenced their information needs. The study was conducted in two health facilities in Accra, Ghana (37 Military Hospital and Sweden Ghana Medical Centre). A total of 75 breast cancer patients were conveniently selected from the two health facilities for the study. The instrument used to elicit relevant data for this study was a questionnaire using the survey design. Data was analysed descriptively. The findings of the study revealed that the information needs of the breast cancer patients investigated were centred mainly around treatment and management information and less around preventive information. The patients also ranked diagnostic information as their highest need, followed by physical care information, treatment information, psychosocial information and disease-specific information in that order. Patients with higher education reported higher information need on all the five domains compared to those with lower education. The study therefore recommended that management of health facilities make health information literacy an integral component of their treatment and management of breast cancer.

Abstract PR01: Breast cancer in Ghana: A study of the characteristics of breast cancers reported nationally from 2018 to 2020

Abstract Introduction According to GLOBOCAN 2018 data, breast cancer (BC) is the leading cancer in women and the second cause of cancer mortality. Most BC studies in Ghana and other nations in the Sub-Saharan African regions have revealed that these BC are very aggressive and have poor prognostic features. However, previous studies on the clinical and pathological characteristics have been limited to data from single institutions and have used smaller sample sizes. Here we are reporting on the data from a pathology lab (Pathologists Without Borders) that serves patients from each of 16 regions of Ghana that are representative of more than 50% of the BC patients seen over the span of two years; this is due to the unique ability to sustain immunohistochemistry services for an entire year. Objectives The objective of this study is to more accurately report the clinical and histological characteristics of BC across the country to determine the distribution by age and subtype to better understand the relationship between West sub-Saharan African ancestry and aggressive triple negative BC. Methods With ethical approval, demographic, clinical and pathology data on patients with histological diagnosis of BC between 5/1/18 and 5/14/20 at participating healthcare facilities in Ghana were entered into a database. Immunohistochemistry for the estrogen receptor, progesterone receptor, and human epidermal growth factor (HER2) is based on the bio-SB semi-automated platform. A descriptive analysis on variables such as age, clinical diagnosis, tumor size, number of lymph nodes, tumor grade, and BC subtypes was performed. A comparative analysis of the various variables was done using IBM Statistical Package for Social Sciences (SPSS) for windows, version 26.0 at 5% confidence interval. Results A total of 1741 BC cases with a mean age of diagnosis, 51.70 ± 16.68 were included in the study. BC was diagnosed most frequently in patients ≥50 years (41.5%) and occurred more frequently on the left side (45.7%). The majority of BC were &amp;lt;1000g (61.7%), &amp;gt;5cm in size (67.8%) had no lymph nodes involvement (35.8%) and were grade II (49.7%). 32.0% of the patients were triple negative. Triple Negative Breast Cancers (TNBCs) were more frequently diagnosed in patients &amp;lt;40 years old (41.2%) who had T3 tumors (30.6%) that was &amp;lt;1000g (37.9%), &amp;gt;5cm in size, grade III (49.5%), and had &amp;gt;10 lymph nodes involved N3 (33.3%). Conclusion TNBCs and HER2+ tumors are the most frequently diagnosed BC in Ghana. The majority of the tumors present with aggressive features such as premenopausal diagnosis, large size, high grade, and have more lymph node involvement. This data is more representative of the characteristics of BC across the country. Here we demonstrate the importance of a standardized pathology reporting system across the country. Research should be carried into the molecular pathology of Ghanaian BC to ascertain reasons for high number of aggressive forms. Citation Format: Kafui Akakpo, Livingstone Aduse-Poku, Kurt Fernando, Lawrence Edusai, Simon Naporo, Sabrina I. Fossi, Sylvester Antwi, Evelyn M. Jiagge. Breast cancer in Ghana: A study of the characteristics of breast cancers reported nationally from 2018 to 2020 [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PR01.