Assessment of quality of operable breast cancer care in a tertiary care hospital in northwestern Tanzania: a single institution experience

Abstract

Breast cancer and its treatment constitute a great challenge in resource limited countries as found in Africa. A retrospective analysis of all breast cancer patients seen in our institution was conducted to assess the quality of operable breast cancer care in our setting and compare with the international standards. Data collected were compared with the internationally accepted quality care indictors throughout the continuum of care. A total of 374 patients were studied. The median age at diagnosis was 48 years (range 18- 84 years). Pre-operative bilateral mammography was performed in 56 (14.9%) and fine needle aspiration cytology in 221 (59.0%) patients. Triple assessment before definitive surgery was performed in only 42 (11.2%) patients. Excisional biopsy was performed in 214 (57.2%) patients. Complete pre-operative staging according to AJCC was performed in 289 (77.3%) patients. Definitive surgical procedure was performed in 372 (99.5%) patients, of which 366 (98.4%) patients had mastectomy. Axillary dissection was performed in 224 (65.5%) patients. None of our patients had sentinel node biopsy performed. The tumor size, histopathological grade, margins of excision, and the total number of nodes removed were recorded in 158 (42.5%), 308 (82.4%), 69(18.5%) and 198 (53.2%) patients respectively. Histopathological type was reported in all patients (100%). Estrogen receptor and progesterone receptor status was not reported in all patients. Adjuvant chemotherapy and hormonal therapy were given in 59 (42.8%) patients and 208 (55.6%) patients respectively. Our study demonstrated that the quality of breast cancer care in this institution was below the accepted international standards. This study may be used to make interventions for improvement of quality of breast cancer care in our setting and in similar institutions in resource limited countries.