TY - JOUR
T1 - Characterizing breast conditions at an open-access breast clinic in South Africa
T2 - A model that is more than cancer care for a resource-limited setting
AU - Rayne, Sarah
AU - Lince-Deroche, Naomi
AU - Hendrickson, Cheryl
AU - Shearer, Kate
AU - Moyo, Faith
AU - Michelow, Pam
AU - Rubin, Grace
AU - Benn, Carol
AU - Firnhaber, Cynthia
N1 - Funding Information:
SR, PM, GR, and CB were unsupported. This study (and support for NLD, CH, KS, FM, and CF) was made possible by the generous support of the American people through the United States Agency for International Development (USAID), award number AID-674-A-12-00029. The contents of the article are the responsibility of the authors and do not necessarily reflect the views of USAID or the US government. The funders had no role in the study design, collection, analysis and interpretation of the data, in manuscript preparation or the decision to publish.
Publisher Copyright:
© 2017 The Author(s).
PY - 2017/1/21
Y1 - 2017/1/21
N2 - Background: While most breast-related research focuses on cancer, presentation of symptomatic persons in non-screened environments requires understanding the spectrum of breast diseases so as to plan services in resource-constrained settings. This study presents the variety of breast disease managed at a government, open-access breast clinic in South Africa. Methods: We performed a retrospective file review using a systematic random sample of patients 18 years and above presenting for breast care over a 14-month period. We collected demographics, clinical characteristics, management and final diagnoses from the first visit and twelve subsequent months. Results: The final sample contained 365 individuals (97 · 5% women). Most were black, unmarried and South African citizens with a median age of 43 years (IQR 31-55). Of those reporting their status (24 · 1%) 38 · 6% were HIV-positive. A mass (57 · 0%) and/or pain (28 · 5%) were the most common symptoms. Imaging and breast biopsies were required in 78 and 25% of individuals, respectively. Nearly half of biopsies identified breast cancer (44 · 1% of women ≤40 and 57 · 3% for women >40). Benign conditions (47 · 7%) and no abnormality (18 · 2%) were common final classifications among women. There was no difference between the final classifications of patients who self-referred versus those who were formally referred from another health care provider. Nearly half of the participants (46 · 6%) travelled 20 km or more to attend the clinic. Conclusions: Benign breast conditions far outweighed cancer diagnoses. As breast cancer awareness increases in resource-limited countries, facilities offering breast care require administrative and clinical preparation to manage a range of non-cancer related conditions.
AB - Background: While most breast-related research focuses on cancer, presentation of symptomatic persons in non-screened environments requires understanding the spectrum of breast diseases so as to plan services in resource-constrained settings. This study presents the variety of breast disease managed at a government, open-access breast clinic in South Africa. Methods: We performed a retrospective file review using a systematic random sample of patients 18 years and above presenting for breast care over a 14-month period. We collected demographics, clinical characteristics, management and final diagnoses from the first visit and twelve subsequent months. Results: The final sample contained 365 individuals (97 · 5% women). Most were black, unmarried and South African citizens with a median age of 43 years (IQR 31-55). Of those reporting their status (24 · 1%) 38 · 6% were HIV-positive. A mass (57 · 0%) and/or pain (28 · 5%) were the most common symptoms. Imaging and breast biopsies were required in 78 and 25% of individuals, respectively. Nearly half of biopsies identified breast cancer (44 · 1% of women ≤40 and 57 · 3% for women >40). Benign conditions (47 · 7%) and no abnormality (18 · 2%) were common final classifications among women. There was no difference between the final classifications of patients who self-referred versus those who were formally referred from another health care provider. Nearly half of the participants (46 · 6%) travelled 20 km or more to attend the clinic. Conclusions: Benign breast conditions far outweighed cancer diagnoses. As breast cancer awareness increases in resource-limited countries, facilities offering breast care require administrative and clinical preparation to manage a range of non-cancer related conditions.
KW - Benign breast disease
KW - Breast cancer
KW - Diagnosis
KW - Global health
KW - Open access
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U2 - 10.1186/s12913-016-1959-4
DO - 10.1186/s12913-016-1959-4
M3 - Review article
C2 - 28109290
AN - SCOPUS:85009997078
SN - 1472-6963
VL - 17
JO - BMC health services research
JF - BMC health services research
IS - 1
M1 - 63
ER -