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