Partners In Health/Inshuti Mu Buzima, P.O.Box 3432, Kigali, Rwanda.
Ministry of Health, Butaro District Hospital, Butaro, Rwanda.
BMC Cancer. 2018 Jun 5;18(1):634. doi: 10.1186/s12885-018-4535-y.
Breast cancer is the most common malignancy encountered during pregnancy. However, the burden of pregnancy-associated breast cancer (PABC) and subsequent care is understudied in sub-Saharan Africa (SSA). Here, we describe the characteristics, diagnostic delays and treatment of women with PABC seeking care at a rural cancer referral facility in Rwanda.
Data from female patients aged 18-50 years with pathologically confirmed breast cancer who presented for treatment between July 1, 2012 and February 28, 2014 were retrospectively reviewed. PABC was defined as breast cancer diagnosed in a woman who was pregnant or breastfeeding. Numbers and frequencies are reported for demographic and diagnostic delay variables and Wilcoxon rank sum and Fisher's exact tests are used to compare characteristics of women with PABC to women with non-PABC at the alpha = 0.05 significance level. Treatment and outcomes are described for women with PABC only.
Of the 117 women with breast cancer, 12 (10.3%) had PABC based on medical record review. The only significant demographic differences were that women with PABC were younger (p = 0.006) and more likely to be married (p = 0.035) compared to women with non-PABC. There were no significant differences in diagnostic delays or stage at diagnosis between women with PABC and women with non-PABC women. Eleven of the women with PABC received treatment, three had documented treatment delays or modifications due to their pregnancy or breastfeeding, and four stopped breastfeeding to initiate treatment. At the end of the study period, six patients were alive, three were deceased and three patients were lost to follow-up.
PABC was relatively common in our cohort but may have been underreported. Although patients with PABC did not experience greater diagnostic delays, most had treatment modifications, emphasizing the potential value of PABC-specific treatment protocols in SSA. Larger prospective studies of PABC are needed to better understand particular challenges faced by these patients and inform policies and practices to optimize care for women with PABC in Rwanda and similar settings.
乳腺癌是怀孕期间最常见的恶性肿瘤。然而，在撒哈拉以南非洲（SSA），妊娠相关性乳腺癌（PABC）及其后续护理的负担研究不足。在这里，我们描述了在卢旺达农村癌症转诊机构寻求治疗的 PABC 女性的特征、诊断延迟和治疗情况。
回顾性分析了 2012 年 7 月 1 日至 2014 年 2 月 28 日期间因病理证实的乳腺癌就诊的 18-50 岁女性患者的数据。将 PABC 定义为在妊娠或哺乳期诊断为乳腺癌的女性。报告了人口统计学和诊断延迟变量的数量和频率，并使用 Wilcoxon 秩和检验和 Fisher 精确检验在 alpha = 0.05 显著性水平上比较 PABC 女性与非 PABC 女性的特征。仅描述了 PABC 女性的治疗和结局。
在 117 名患有乳腺癌的女性中，根据病历回顾，有 12 名（10.3%）患有 PABC。唯一具有显著人口统计学差异的是，PABC 女性更年轻（p = 0.006）且更有可能已婚（p = 0.035），与非 PABC 女性相比。PABC 女性与非 PABC 女性在诊断延迟或诊断时的分期方面没有显著差异。11 名 PABC 女性接受了治疗，3 名因怀孕或哺乳期而有记录的治疗延迟或修改，4 名停止母乳喂养以开始治疗。在研究结束时，6 名患者存活，3 名患者死亡，3 名患者失访。
在我们的队列中，PABC 相对常见，但可能报告不足。尽管 PABC 患者的诊断延迟没有增加，但大多数患者的治疗都进行了修改，这强调了在 SSA 制定 PABC 特定治疗方案的潜在价值。需要进行更大规模的前瞻性 PABC 研究，以更好地了解这些患者面临的特殊挑战，并为卢旺达和类似环境中 PABC 女性的护理提供政策和实践信息。
