Barriers to timely surgery and early surgical outcomes for breast cancer patients in a setting with limited resources

BACKGROUND: Breast cancer patients in Rwanda are young, premenopausal and presenting with advanced stages. Surgery is often the primary line of treatment and its timing may impact adjuvant medical and/or radiation therapies, influencing negative outcomes. The objective of this study was to identify barriers to timely surgery and describe early surgical outcomes for patients who underwent surgery for breast cancer at two tertiary hospitals in Rwanda.

METHODS: A cross-sectional study was conducted at the University Teaching Hospital of Kigali and Rwanda Military Hospital over 12 a month period from May 2016 to May 2017.

RESULTS: 69 patients met inclusion criteria. Median age was 48 years. 74.16% of patients ≤ 60 years, 58% were premenopausal. 69.5% presented with locally advanced stages. Mean duration of symptoms was 10.9 months before initial consultation. Patients had to wait 91 days (3 months) before surgery. Mean hospital stay was 5 days after surgery and 98.9% underwent modified radical mastectomy. No major complications reported. Socio-economic status(p=0.0002), level of education (p=0.000), traditional healer’s consultation (p=0.0001) influenced the timing of the initial consultation. Level of first heath facility consulted (P=0.00045), number of breast surgeon (p=0.0000), pathology report availability, (p=0.0004) and imaging availability (p=:0.0006) influenced timing of surgery.

CONCLUSION: Delays to surgery are both patient and system-related. Increased awareness, surgical outreaches and task sharing with a non-breast surgical specialist may decrease delays to surgery and increase timely access to subsequent adjuvant therapies. Even if early surgical outcomes are good, long term follow up study is necessary to assess oncological outcomes.