Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Magdeburgerstrasse 8, 06097, Halle, Germany.
Department of Pathology, University of Calabar, Cancer Registry, Calabar, Nigeria.
BMC Health Serv Res. 2020 Oct 2;20(1):912. doi: 10.1186/s12913-020-05752-y.
Pathologists face major challenges in breast cancer diagnostics in sub-Saharan Africa (SSA). The major problems identified as impairing the quality of pathology reports are shortcomings of equipment, organization and insufficiently qualified personnel. In addition, in the context of breast cancer, immunohistochemistry (IHC) needs to be available for the evaluation of biomarkers. In the study presented, we aim to describe the current state of breast cancer pathology in order to highlight the unmet needs.
We obtained information on breast cancer pathology services within population-based cancer registries in SSA. A survey of 20 participating pathology centres was carried out. These centres represent large, rather well-equipped pathologies. The data obtained were related to the known population and breast cancer incidence of the registry areas.
The responding pathologists served populations of between 30,000 and 1.8 million and the centres surveyed dealt with 10-386 breast cancer cases per year. Time to fixation and formalin fixation time varied from overnight to more than 72 h. Only five centres processed core needle biopsies as a daily routine. Technical problems were common, with 14 centres reporting temporary power outages and 18 centres claiming to own faulty equipment with no access to technical support. Only half of the centres carried out IHC in their own laboratory. For three centres, IHC was only accessible outside of the country and one centre could not obtain any IHC results. A tumour board was established in 13 centres.
We conclude that breast cancer pathology services ensuring state-of-the-art therapy are only available in a small fraction of centres in SSA. To overcome these limitations, many of the centres require larger numbers of experienced pathologists and technical staff. Furthermore, equipment maintenance, standardization of processing guidelines and establishment of an IHC service are needed to comply with international standards of breast cancer pathology.
在撒哈拉以南非洲（SSA），病理学家在乳腺癌诊断方面面临重大挑战。被确定为影响病理报告质量的主要问题是设备、组织和人员素质不足。此外，在乳腺癌的背景下，免疫组织化学（IHC）需要用于评估生物标志物。在本研究中，我们旨在描述乳腺癌病理学的现状，以突出未满足的需求。
我们从 SSA 人群癌症登记处获取了乳腺癌病理学服务的信息。对 20 个参与的病理中心进行了调查。这些中心代表了大型、设备较好的病理科。获得的数据与登记处地区的已知人口和乳腺癌发病率有关。
有回应的病理学家服务的人群数量在 3 万至 180 万之间，接受调查的中心每年处理 10-386 例乳腺癌病例。固定时间和福尔马林固定时间从过夜到超过 72 小时不等。只有五个中心将核心针活检作为日常常规处理。技术问题很常见，14 个中心报告临时停电，18 个中心声称拥有有故障的设备，无法获得技术支持。只有一半的中心在自己的实验室进行 IHC。对于三个中心，IHC 只能在国外获得，一个中心无法获得任何 IHC 结果。13 个中心建立了肿瘤委员会。
我们的结论是，只有在 SSA 的一小部分中心提供确保最先进治疗的乳腺癌病理学服务。为了克服这些限制，许多中心需要更多经验丰富的病理学家和技术人员。此外，需要设备维护、处理指南的标准化以及建立 IHC 服务，以符合乳腺癌病理学的国际标准。
