Breast cancer care in Uganda: A multicenter study on the frequency of breast cancer surgery in relation to the incidence of breast cancer

• Published in: PloS one Vol. 14; no. 7; p. e0219601
• Main Authors: Ekdahl Hjelm, Tove, Matovu, Alphonsus, Mugisha, Noleb, Löfgren, Jenny
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 11.07.2019; Public Library of Science (PLoS)
• Subjects: Adult; Breast - pathology; Breast - surgery; Breast cancer; Breast Neoplasms - epidemiology; Breast Neoplasms - pathology; Breast Neoplasms - surgery; Cancer och onkologi; Cancer research; Cancer surgery; Care and treatment; Delivery of Health Care; Disease; Female; Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi; Health care; Health care services accessibility; Hospitals; Humans; Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi; Hälsovetenskap; Incidence; Income; Klinisk medicin; Low income groups; Mastectomy; Medical diagnosis; Medical personnel; Medical research; Medicin och hälsovetenskap; Medicine and Health Sciences; Mens health; Middle Aged; Missing data; Mortality; Oncology; Patients; People and Places; Physicians; Poverty; Public Health; Statistics; Studies; Supply and demand; Surgery; Systematic review; Uganda - epidemiology; Women; Womens health; Young women; Uganda; Sweden; Africa
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0219601

Breast cancer is the most common cancer in women worldwide. Considerable funding and efforts are invested in breast cancer research and healthcare, but only a fraction of this reaches women and healthcare systems in low income countries. Surgical treatment is an essential part of breast cancer care, but access to surgery is in general very limited in low income countries such as Uganda. In this study, the previously unknown nationwide rate of breast cancer surgery was investigated. This was a multicenter, retrospective study, investigating breast cancer surgery in the public healthcare system in Uganda. Data were collected from operating theater registries at primary, secondary and tertiary level healthcare centres throught the country, including 14 general hospitals, the 14 regional referral hospitals and the national referral hospital. Patients who underwent major surgery for breast cancer at these hospitals during 2013 and 2014 were included. The number of breast cancer procedures performed, geographical variation, level of healthcare staff performing surgery and patient characteristics were investigated. After correction for missing data, a total of 137 breast cancer procedures were performed each year within the public healthcare system, corresponding to 5.7% of the breast cancer incidence in the country at that time. Most procedures (n = 161, 59.0%) were performed at the national referral hospital by qualified surgeons. Many of the patients were young; 30.1% being less than 40 years old. The proportion of male breast cancers in the study was large (6.2%). The rate of breast cancer surgery in Uganda is minimal and in several parts of the country breast cancer surgery is not performed at all. More resources must be directed towards breast cancer in low income countries such as Uganda. The fact that the patients were young calls for further research, prevention and treatment specifically targeting young women in the study setting.