One-stop multi-disciplinary breast cancer clinic needed to provide holistic approach

Prof. Mansoor Saleh, Chair of the Haematology-Oncology department, Aga Khan University Hospital, Nairobi

By Prof Mansoor Saleh

Breast cancer is rising in Africa and not a day passes that we do not hear about a friend, family member, colleague, or acquaintance who has been diagnosed with breast cancer. It is a scary time in the life of any woman.

According to the World Health Organisation, breast cancer is the most frequent cancer among women, impacting 2.1 million women each year, and also causes the greatest number of cancer-related deaths among women. In 2018, it is estimated that 627,000 women died from breast cancer – that is approximately 15 per cent of all cancer deaths among women. While breast cancer rates are higher among women in more developed regions, rates are increasing in nearly every region globally. GLOBOCAN statistics show that Africa recorded 168,690 new breast cancer cases in 2018, out of the slightly over 2 million new cases globally. GLOBOCAN 2018 is an online database providing estimates of incidence and mortality in 185 countries for 36 types of cancer, and for all cancer sites combined.

If breast cancer is detected early, there are more treatment options and a better chance for survival. It is therefore important to ensure timely and accurate diagnosis.

A Multi-disciplinary diagnosis process

The diagnosis of breast cancer is a multi-disciplinary endeavor and involves experts in the fields of radiology and pathology.  It requires the involvement of trained breast radiologist, who performs the mammogram, followed up with an ultrasound, or MRI and then perform the image guided biopsy of the suspicious lesion. That biopsy is then reviewed by a trained breast pathologist to determine the diagnosis and the pathologic characteristic of the tumor.

Multi-disciplinary approach to treatment

The treatment of confirmed breast cancer also involves a number of expert consultants. It requires the input of an experienced breast surgeon, the medical oncologist who will administer systemic therapy, and the radiation therapist who may ultimately need to administer radiation. 

A multi-disciplinary approach involving all three specialists seeing the patient and reviewing the case at the same time has been shown to provide optimal management of breast cancer.  This is critical since many patients may qualify for breast conserving surgery if their tumors could be shrunk by giving chemotherapy before surgery (neo-adjuvant chemotherapy). 

The concept of a multi-disciplinary approach is new to Kenya but has become standard practice at most major cancer centers in Europe and North America.  It is imperative that women are given options and choices in advance of having to make a critical decision in the management of their breast cancer.

The Aga Khan University Hospital, Nairobi embarked on this best practice by launching the Multi-Disciplinary Breast Cancer Clinic (MBC) this July.  Held once a week, the clinic is for those women diagnosed with breast cancer and awaiting a treatment plan for the optimal management of their condition.  On July 9th 2020, AKUHN launched its MBC program with three patients, all of whom were recently diagnosed with breast cancer and were able to be seen by a breast surgeon, medical oncologist and radiation therapist in one sitting. The weekly multi-disciplinary clinic provides an environment where the patient will receive all rounded consultation and care ensuring that they access the best care available, for diagnosis and treatment.

By Prof Mansoor Saleh is Chair of the Haematology-Oncology department, Aga Khan University Hospital, Nairobi. 

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