What you need to know: Dr Junker recommends aligning interventions with World Health Organisation’s three pillars: early detect...
What you need to know:
- Dr Junker recommends aligning interventions with World Health Organisation’s three pillars: early detection, timely diagnosis, and comprehensive management to improve survival from breast cancer and protect future generations.
Breast cancer patients in Busoga Sub-region have a low survival rate, according to a new study, whose results have been described by oncological experts as “very serious”.
The study was conducted at the beginning of the year by Rays of Hope Hospice Jinja (RHHJ), the only specialised palliative care provider in Busoga Sub-region and parts of Buganda, and Aarhus University, Denmark.
However, the results were made available on August 19 by BJC Reports, a partner journal to the British Journal of Cancer.
The researchers included Rasmus Kallestrup, Katinka Bolette, and Lorentzen Per Kallestrup from the department of Public Health at Aarhus University, Denmark; Mr John Mwayi and Ms Joanita Mbabazi from RHHJ.
The study sampled 256 breast cancer patients between the age of 19 and 88 years, with majority of them being between the age of 30 and 49 years, with over half (54.3%) of them having at least one dependent.
Findings
Among the key findings were that 1-, 3-, and 5-year survival rates were 57.7%, 19.1%, and 16.3%, markedly lower than other Sub-Saharan Africa studies (typically 78–91% at 1 year, 50–72% at 3 years, 24–61% at 5 years), and that those aged 50 years and above with a higher level of education were linked to better survival.
“Advanced disease presentation (lymphadenopathy and/or ulcerating/infiltrative tumours) was linked to higher mortality. HIV status showed no association with survival.
“Majority (65.6%) presented with advanced-stage disease at enrolment, and 64.5% reported symptoms for more than a year before joining the programme,” the study reveals.
It adds that while 68.8% of the patients were referred to treatment, nearly a third (31.3%) were never referred, 49.6% ultimately received cancer-directed treatment, mainly at the Uganda Cancer Institute (UCI), representing 72.2% of those referred.
The study further revealed that treatment delays were common, and that 22% began within a month of enrolment, 61% within 1 and 6 months, and 12% after more than 6 months.
“Of the 256 patients, 172 died, 8 went into remission, 41 were lost to follow-up (LTFU), and 35 were alive with active disease at the end of observation.
“Seventy-eight (78) had a documented biopsy, 48 had a biopsy without a known date, 49 were clinically diagnosed elsewhere, and the remainder were diagnosed at enrolment.”
Interpretation
The explanation is that “poorer survival compared to Sub-Saharan Africa averages may reflect the high proportion of clinical diagnoses and rural-urban inequalities in healthcare access”.
It is a gap researchers aim to bridge by investigating breast cancer survival among the rural population of the Busoga Sub-region by leveraging data from patient registers of RHHJ.
Dr Margrethe Juncker from RHHJ, while explaining the findings on September 21, said: “These are very serious results when you compare with the United States and Europe, which has a five-year survival rate of 95%.”
She adds that the 57.7% one-year survival rate means that percentage of women diagnosed with breast cancer were still alive after one year; 19.1% were alive after three years, and only 16.3% were alive after five years.
Dr Junker described the task ahead as “enormous”, adding: “The treatment for Breast Cancer is totally available in Uganda at UCI, but the big problem is access to the treatment.”
According to her, there are delays at all levels, including going to the health centre for examination, correct diagnosis at the health centres, while getting the requisite diagnostic tests and traveling to the UCI is long and expensive.
Founded in 2005, RHHJ provides holistic relief from symptoms and stress of serious life-threatening illnesses, aiming to enhance the quality of life for both the patients and their families. It begins at diagnosis and continues throughout the illness.
Such palliative care services encompass home visits along with outreaches, roadside clinics, and hospice field offices, thus reaching rural populations that do not have health facilities in their vicinity.
Solution
Dr Junker recommends aligning interventions with World Health Organisation’s three pillars: early detection, timely diagnosis, and comprehensive management to improve survival from breast cancer and protect future generations.
“RHHJ has already adopted this strategy, but we seriously have to do a lot more to bring the survival rate of 1-year of 57.7% a 3-year SR of 19.1% and a 5-year SR of 16.3% up and help our mothers live.
“Education helps women survive because it encourages them to seek care earlier, while training of health workers will help to get the correct diagnosis and referral earlier; plus, solutions should follow the WHO Global Breast Cancer Initiative (GBCI).”
These include teaching people about early warning signs, making sure diagnosis happens quickly, providing full and proper treatment, and reducing delays in care to saving lives. “We have the full treatment available at UCI, but the rural women don't get there in time.”
Asked why the study concentrated on Busoga Sub-region, Dr Junker says: “It is a retrospective study on RHHJ breast cancer patients, and we only operate in Busoga and neighbouring parts of Buganda; however, it is highly possible that the situation is similar in other rural regions.”
Busoga Sub-region comprises of Jinja City, the districts of Kamuli, Iganga, Luuka, Buyende, Kaliro, Namutumba, Bugiri, Namayingo, Mayuge, Bugweri, and parts of Buikwe.
In addition to delivering palliative care, RHHJ provides comprehensive treatment guidance, including referrals, post-treatment follow-ups, and financial assistance to poverty-stricken patients.
According to Dr Junker, fewer women survive breast cancer in Sub-Saharan Africa compared to “richer countries”, adding that the situation is even worse in rural Uganda.
“Many women only go to the hospital when the cancer is already advanced, showing that delays in seeking care are a big problem, many health workers are not familiar with the early signs and symptoms or refer to tests that the women cannot afford, which causes further delay in getting proper treatment started.
In a bid to raise awareness, RHHJ last October, for the sixth year in the row, launched the “Fight Women’s Cancer Event” under the theme: Detect. Treat. Defeat. Throughout the month, information about breast cancer was disseminated, climaxing with a run, walk, and ride which gathered over 1,000 participants.
Ms Sylvia Nakami, the Executive Director RHHJ, earlier said they discovered that 60% of the cancers they were dealing with were breast and cervical, that is why they launched the “Fight Women’s Cancer Event”.
Background
Breast cancer is one of the most prevalent and deadly cancers globally, affecting millions of women each year.
With over 2.31 million new cases annually, it is the second-most common cancer and the most-common of all female cancer diagnoses, making it a substantial health challenge worldwide, according to an International Research on Cancer document released by WHO in 2024.
The 2024 Global Cancer Observatory, suggests that in 2022, Africa accounted for 8.6% of global breast cancer incidences, with 13.7% of global breast cancer mortality. This disparity indicates higher mortality rates from the disease in Africa compared to the global average.
The same observatory suggests that in Uganda, breast cancer constitutes a significant health burden, ranking as the third-most common cancer and the second-most common cancer in women.
Design
The study based on patient care sheets and home-visit notes from RHHJ archives of those enrolled between January 1, 2016 and December 31, 2022.
The patient care sheets were updated and systematised at the beginning of 2016 because data was collected in February and March 2024, securing a minimum of one year follow-up time for all patients included.
The included patient care sheets were examined by the investigators; however, patients were excluded if a breast cancer diagnosis was later disproven.
Setting
A significant majority of cancer patients referred to RHHJ present with advanced stage disease. RHHJ’s patient care sheets contain extensive socio-demographic data alongside details concerning symptoms, clinical presentation, diagnosis, and treatment history of the patient’s disease.
Around half of the enrolled patients are referred via community volunteers designated by RHHJ to identify local individuals residing in rural areas in need of healthcare. The rest are referred by healthcare professionals via radio, other patients, friends, or relatives, contributing to a diverse referral network.
Quantitative information was drawn directly from the patient care sheets, while qualitative information was transcribed into the note section of the data collection tool. Information concerning ‘history of illness often required interpretation or local knowledge, which was provided by the RHHJ clinical officers or other staff.
The patient care sheet also contained important information on the onset and development of breast Cancer symptoms and potential diagnosis and or treatment before enrolment.
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