Purpose: To understand the current state of breast cancer management in sub-Saharan Africa.Methods: We conducted an anonymous online survey of breast cancer management among African Organization for Research and Treatment in Cancer (AORTIC) members by using a 42-question structured questionnaire in both English and French in 2013.Results: Twenty members from 19 facilities in 14 countries responded to the survey.Twelve members (60%) belonged to a multidisciplinary breast cancer team.Radiotherapy equipment was available in seven facilities (36%), but equipment had down time at least once a week in four facilities.
Available chemotherapy drugs included methotrexate, cyclophosphamide, fluorouracil, anthracyclines, and vincristine, whereas trastuzumab, Neoprene Jackets taxanes, vinorelbine, and gemcitabine were available in few facilities.Core-needle biopsy was available in 16 facilities (84%); mammogram, in 17 facilities (89%); computed tomography scan, in 15 facilities (79%); magnetic resonance imaging, in 11 facilities (58%); and bone scans, in nine facilities (47%).It took an average of 1 to 3 weeks to report histopathology.Immunohistochemistry was available locally in eight facilities (42%), outside hospitals but within the SELENIUM PLUS country in seven facilities (37%), and outside the country in four facilities (21%).Thirteen facilities (68%) performed axillary node dissections as part of a breast protocol.
Neoadjuvant chemotherapy was the most common therapy for locally advanced breast cancer in 13 facilities (68%).In three facilities (16%), receptor status did not influence the prescription of hormone treatment.Conclusion: This pilot survey suggests that AORTIC members in sub-Saharan Africa continue to make gains in the provision of access to multidisciplinary breast cancer care, but the lack of adequate pathology and radiotherapy services is a barrier.Focused attention on in-country and regional training needs and improvement of health systems deliverables is urgently needed.