Assessment of quality of operable breast cancer care in a tertiary care hospital in northwestern Tanzania: a single institution experience

Background: Breast cancer and its treatment constitute a great challenge in resource limited countries as found in Africa. This study was conducted to assess the quality of operable breast cancer in our setting and compare with the international standards.
Methods: This was a retrospective study of histologically confirmed breast cancer patients seen at the department of Surgery of Bugando Medical Centre from January 2004 to December 2013. The details of patients were obtained using data derived prospectively from and also from patients’ files kept in the Medical Record Department, the surgical wards, operating theatre and histopathology laboratory. The study variables included demographic data, menopausal status, duration of illness, preoperative diagnosis, tumor size, pathological nodal status, clinical stage, histopathological type and grade, and treatment modalities. This information was collected using a pre-formed questionnaire.
Results: A total of 374 patients were studied. The median age at diagnosis was 48 years (range 18- 84 years). Pre-operative bilateral mammography was performed in 56 (14.9%) and fine needle aspiration cytology in 221 (59.0%) patients. Triple assessment before definitive surgery was performed in only 42 (11.2%) patients. Excisional biopsy was performed in 214 (57.2%) patients. Complete pre-operative staging according to AJCC was performed in 289 (77.3%) patients. Definitive surgical procedure was performed in 372 (99.5%) patients, of which 366 (98.4%) patients had mastectomy. Axillary dissection was performed in 224 (65.5%) patients. None of our patients had sentinel node biopsy performed. The tumor size, histopathological grade, margins of excision, and the total number of nodes removed were recorded in 158 (42.5%), 308 (82.4%), 69(18.5%) and 198 (53.2%) patients respectively. Histopathological type was reported in all patients (100%). Estrogen receptor and progesterone receptor status was not reported in all patients. Adjuvant chemotherapy and hormonal therapy were given in 59 (42.8%) and 208 (55.6%) patients respectively.
Conclusion: This study demonstrated that the quality of breast cancer care in this institution was below the accepted international standards. This study may be used to make interventions for improvement of quality of breast cancer care in this part of Tanzania and in similar institutions in resource limited countries.

Keywords
assessment of care; breast cancer; health care quality; quality assessment; Tanzania