breast cancer surgery in sub saharian africa · breast cancer surgery in sub saharian africa ......

BREAST CANCER SURGERY IN

SUB SAHARIAN AFRICA

Dr DILLE Issimouha Oncologic surgeon SOS CANCER NIGER

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BREAST CANCER IN THE WORD

CIRC 2012 • NEW CASES: 1,67 MILLION • LESS DEV COUNTRIES 883 000 (53%) • DEATH: 522000 with 324000 less developing

countries

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LOWER INCIDENCE

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HIGHEST MORTALITY

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WHY?

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LACK SCREENING

WEAKNESS OF TECHNICAL EQUIPMENT • Availability of diagnosis material:

o Lack of suitable imaging techniques • mammography:

• 0 • 1 per country

• MRI ??? • SELF EXAMINATION +++ • Lack of qualified personnel in oncology

• ADVANCED STAGES ONLY

POOR PRONOGSIS 6

DIAGNOSIS PROBLEM • Inadequal diagnosis approaches

o human Ressources non competent

• Inadequal technical equipment o Lack laboratory for diagnosis or o without adequal equipment (No IHC) o 0 -1 pathology laboratory per country

• Xray • US

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AVALIBILITY OF ADJUVANT TREATEMENT

• CHEMOTHERAPY o Frequently not available (only big town) o sparse availability of medical care dedicate for chemo o inadequate chemotherapy IHC … very rare o VERY EXPENSIVE o Artisanal way

• Metastasis +++

• ENDOCRINE THERAPY:

o NOT POSSIBLE OR PROBABILISTIC (IHC…)

• TARGET THERAPY: DREAM ... • PALLIATIVE CARE (UGANDA)

CONSEQUENCES

Advanced stages need radiotherapy +++

NO RADIOTHERAPY

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2015

Local recurences +++ Due to rare adjuvant treatment

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ONCOLOGIC BREAST SURGERY

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ONCOLOGIC BREAST SURGERY Developping countries

• SCREENING: early stages +++

- Adequal diagnosis - Adequal treatment - RCP (multidisciplinarity) - Conservative breast surgery • Zonectomie • Lumpectomy • Stereotaxic surgery • Oncoplasty • Sentinel nods • Reconstructive surgery

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o is this surgery possible ???

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ONCOLOGIC BREAST SURGERY in

African sub saharian countries

90% Advanced Stages

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NO

• Holistic approach; generalist surgeon ALONE

• NO MULTIDISCIPLINARY APROACH • Few oncologic surgeon • Few experimented surgeon on oncology • Few health worker on oncology

• Oncologic surgery : not promoting

o Even 5% patient early detection seen by inexperimented surgeon

‘’nodulectomie’’

SURVIVAL Europe or USA 80% after 5 years Africa 10-15% after 1 year

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ONCOLOGIC BREAST SURGERY IN SUB

SAHARIAN COUNTRIES

Surgery • Radical mastectomy including toilet mastectomy

o Rate similar in most studies: More than 80%

Most of the time Inadequal surgical approaches

• Lumpectomy o Less than 5%

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RARE LUMPHECTOMY

• breast conservation surgery is often not an option and patients experience higher mortality rates

• While the mastectomy rate is 30% in Europe, it is greater than 85% in some regions of Africa

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AGRESSIVE SURGERY

COMPLICATIONS

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Breast cancer in LMCs: Health-care systems and public policy

• Lack core infrastructure elements required to sustain

a breast care program • The three areas

o early detection, o diagnosis, and o Treatment facilities are inextricably linked. need to be developed

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CONCLUSION • ONCOLOGIC BREAST SURGERY IN SUB SAHARIAN AFRICA

o Desaster surgery o Non qualified health staff o Inadequal approaches

• diagnosis • treatment

• CHALLENGES

o UPDATE DATA o TRAINING o SENSITIZATION o SCREENING o INCREASE THE QUALITY OF INFRASTRUCTURES

o LEADERSHIP o ADVOCACY

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HOPE

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