Down-staging and improving survival of breast cancer in SA – Dr Herbert Cubasch
Dr Herbert Cubasch
- Dept of Surgery and Batho Pele Breast Clinic Division, University of Witwatersrand, Wits Health Consortium of University Witwatersrand and Chris Hani Baragwanath Academic Hospital
Title of the project
Down-staging and improving survival of breast cancer in South Africa.
The overall purpose of this project was to identify the major drivers of breast cancer stage (early or late) at diagnosis and of survival that can be targeted in South African disadvantaged communities to save lives. In South Africa, breast cancer (BC) is the most common cancer in women. Although incidence rates (number of newly diagnosed cases per year) are half of those in Western countries, death rates are as high as in high-incidence countries. Incidence rates are expected to increase markedly owing to westernization of lifestyles, changing fertility patterns (less and later pregnancies) and increasing cancer risk factor profiles (e.g. obesity and physical inactivity). BC is an excellent-prognosis cancer if diagnosed at an early stage, thus down-staging (earlier stage of BC at patient presentation) is an imperative to improving survival.
This grant enabled collection of baseline 5 year survival data for patients from South African disadvantaged communities newly diagnosed with breast cancer, and significant barriers patients face in accessing and utilising breast cancer diagnostic and treatment services in the Johannesburg public health services. This is the first study undertaken in sub-Saharan Africa to assess the impact of HIV on treatment access challenges, response to treatment and longer-term survival analysis for comparative analysis with other middle income countries. The study has also enabled the researchers to embark on a larger study in 5 breast cancer centres located in Johannesburg and Kwazulu Natal.
Once data analysis is complete the researchers will be submitting grants for i) health system and community intervention projects to upskill surgical oncology nurses in the primary health sector to recognise and timeously refer patients with suspicious breast conditions to tertiary breast treatment centres and ii) for community education and outreach programmes aimed at earlier access and utilisation of existing primary and tertiary breast cancer treatment services. To this end the researchers have already initiated a community outreach project. An outreach manager plus 5 fieldworkers are regularly visiting primary women’s health clinics in the referral network informing women of the signs and symptoms of breast cancer. They also facilitate the referral process to cut through red tape and ensure women with breast symptoms get to the breast clinic timeously. Since initiating this outreach programme in April 2016 the number of women attending the weekly breast clinic has risen by 20%.