Challenges in the management of breast cancer in Kinshasa, the Democratic Republic of the Congo.
Authors: Mutombo Baleka Alex , Tasoulis Marios Konstantinos , Kilumbu Benedicte Ndembo , Mbala Leon Nlandu , Kalenga Baron Kashala , Tozin Rahma Rashid , Van Geertruyden Jean-Pierre , Ramael Marc , Jacquemyn Yves 
Published: June 2022

e12503

Background: Breast cancer mortality has decreased by almost 40% since the 1980s in high-income countries. However, this trend is not paralleled in low-income countries, where poor outcomes are consistently reported, thus making it a significant public health consideration. Moreover, the lack of cancer registries in these countries makes it difficult to assess the true burden of disease. The aim of the present study was to provide data on breast cancer management and the faced challenges in the Democratic Republic of the Congo. Methods: Retrospective cohort study of women admitted for breast cancer care from January 2010 to December 2020 at 3 institutions (Cliniques Universitaires de Kinshasa, Centre Hospitalier Nganda, Hôpital Saint-Joseph) in Kinshasa, DRC. Patient demographics, diagnostic procedures and treatments received were collected from the patients’ files database. The study was approved by each institution’s ethics committee. Results: A total of 349 patients were included in the cohort. The median age at diagnosis was 46 years (IQR 40-56 years). Only 12 women were nulliparous and approximately 50% (119/234 with available data) were post-menopausal. 60.2% presented with clinically involved axillary lymph nodes while in 88.2% of cases breast cancer was diagnosed at advanced stages (TNM III-IV). Distant metastases were present at diagnosis in 91 patients (26.1%) with the most common site being the lungs. Invasive ductal carcinoma was the most commontype (128/178 whose biopsy results were available, 91.4%) with a grade 2 morphology in 54.3% of cases. Immunohistochemistry was performed in only 10.3% of patients (n=36) with the findings showing HR+/HER2−ve: 6.0%; HR+/HER2+: 2.6%; HR−/HER2−: 1.7%. Surgery was performed in 53 patients (15.2%), among whom 40, 11 and 2 underwent modified radical mastectomy, simple mastectomy and breast-conserving surgery, respectively. The median time to surgery after diagnosis was 30 days (IQR: 13.25-64.75). Chemotherapy was administered to 81 (23.2%) patients; 50% of cases this consisted of an anthracycline-based regimen but only 19 patients completed 6 cycles. Among this cohort 57 (16,3%) patients received endocrine therapy with Tamoxifen being the most prescribed drug (44/57 patients). No patient received radiotherapy as there was no capacity. The median follow-up was 13 days (IQR: 0-45.5) limiting assessment of oncological outcomes. Conclusions: Patients with breast cancer in Kinshasa tend to present with advanced stage disease. Lack of organized screening, limited treatment resources and lack of robust follow-up pose significant challenges in breast cancer management and may be associated with adverse oncological outcomes. Multiple efforts are warranted to enhance early diagnosis, improve access to histopathologic evaluation to guide treatment as well as access to systemic therapies to allow implementation of evidence-based best practices.