Carcinoma of the Breast in Low Resource Setting: A Surgical Case Series from Rural India
The burden of breast cancer has been on the rise world over and has become the most common cancer among women in urban India and the second most common cancer in rural women after carcinoma cervix. There is a considerable delay in presentation associated with a lack of access to adequate and timely surgical intervention. Consequently, most patients present to tertiary care centers in advanced or inoperable stages. Many subsets of these patients can be managed adequately in resource-limited rural surgical centers. In this series of patients diagnosed with carcinoma breast, we have outlined comprehensive management that is possible in resource-constrained settings. The challenges in adhering to the standard of care and strategies to overcome these limitations have been discussed with a relevant review of the literature.
Sullivan R, Alatise OI, Anderson BO, Audisio R, Autier P, Aggarwal A, et al. Global cancer surgery: delivering safe, affordable, and timely cancer surgery. Lancet Oncol. 2015 Sep;16(11):1193–224. https://doi.org/10.1016/S1470-2045(15)00223-5
ICMR issues consensus document for management of breast cancers [Internet]. [cited 2021 Jan 15]. Available from: http://www.pharmabiz.com/NewsDetails.aspx?aid=97342&sid=1
Malvia S, Bagadi SA, Dubey US, Saxena S. Epidemiology of breast cancer in Indian women. Asia Pac J Clin Oncol. 2017;13(4):289–95. https://doi.org/10.1111/ajco.12661
Agarwal G, Ramakant P. Breast cancer care in India: the current scenario and the challenges for the future. Breast Care. 2008 Mar;3(1):21–7. https://doi.org/10.1159/000115288
Chopra R. The Indian scene. J Clin Oncol Off J Am Soc Clin Oncol. 2001 Sep 15;19(18 Suppl):106S-111S.
Agarwal G, Pradeep PV, Aggarwal V, Yip C-H, Cheung PSY. Spectrum of breast cancer in Asian women. World J Surg. 2007 May;31(5):1031–40. https://doi.org/10.1007/s00268-005-0585-9
Aggarwal V, Agarwal G, Lal P, Krishnani N, Mishra A, Verma AK, et al. Feasibility study of safe breast conservation in large and locally advanced cancers with use of radiopaque markers to mark pre-neoadjuvant chemotherapy tumor margins. World J Surg. 2008 Dec;32(12):2562–9. https://doi.org/10.1007/s00268-007-9289-7
Nagrani RT, Budukh A, Koyande S, Panse NS, Mhatre SS, Badwe R. Rural urban differences in breast cancer in India. Indian J Cancer. 2014 Jul 1;51(3):277. https://doi.org/10.4103/0019-509X.146793
Bhat D, Heiman AJ, Talwar AA, Dunne M, Amanjee K, Ricci JA. Access to breast cancer treatment and reconstruction in rural populations: do women have a choice? J Surg Res. 2020 Oct 1;254:223–31. https://doi.org/10.1016/j.jss.2020.04.035
Vijaykumar DK, Arun S, Abraham AG, Hopman W, Robinson AG, Booth CM. Breast cancer care in South India: is practice concordant with national guidelines [Internet]? J Glob Oncol. 2019 Jul 1 [cited 2020 Oct 30];5. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6613671/
Shrime MG, Bickler SW, Alkire BC, Mock C. Global burden of surgical disease: an estimation from the provider perspective. Lancet Glob Health. 2015 Apr;3:S8–9. https://doi.org/10.1016/S2214-109X(14)70384-5
George M, Ngo P, Prawira A. Rural oncology: overcoming the tyranny of distance for improved cancer care. J Oncol Pract. 2014 Mar 25;10(3):e146–9. https://doi.org/10.1200/JOP.2013.001228
Ravi C, Rodrigues G. Accuracy of clinical examination of breast lumps in detecting malignancy: a retrospective study. Indian J Surg Oncol. 2012 Jun;3(2):154-7. https://doi.org/10.1007/s13193-012-0151-5
Kharkwal S, Sameer, Mukherjee A. Triple test in carcinoma breast. J Clin Diagn Res JCDR. 2014 Oct;8(10):NC09-NC11. https://doi.org/10.7860/JCDR/2014/9237.4971
Rozycki GS. Surgeon-performed ultrasound: its use in clinical practice [Internet]. 1998 Jul [cited 2020 Oct 29];228(1):16-28. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1191423/
Ahmed M, Abdullah N, Cawthorn S, Usiskin SI, Douek M. Why should breast surgeons use ultrasound [Internet]? Breast Cancer Res Treat. 2014 May [cited 2020 Oct 29];145(1):1-4. http://doi.org/10.1007/s10549-014-2926-6 [Epub 2014 Apr 5]. PMID: 24706083.
Milroy M.J. (2015) Breast ultrasound in rural surgical practice. In: Halverson A., Borgstrom D., editors. Advanced surgical techniques for rural surgeons. Springer: New York, NY. https://doi.org/10.1007/978-1-4939-1495-1_13M.
Devolli-Disha E, Manxhuka-Kërliu S, Ymeri H, Kutllovci A. Comparative accuracy of mammography and ultrasound in women with breast symptoms according to age and breast density. Bosn J Basic Med Sci. 2009 May;9(2):131–6.
Garg P, Yadav P. Comparison between FNAC and core needle biopsy in the diagnosis of palpable breast lesions. Sch J App Med Sci. 2017. 5(11A):4366-70. Available from: http://saspublisher.com/wp-content/uploads/2017/11/SJAMS-511A4366-4370.pdf
Blackwood O, Deb R. Multidisciplinary team approach in breast cancer care: benefits and challenges. Indian J Pathol Microbiol. 2020 Feb 1;63(5):105. https://doi.org/10.4103/IJPM.IJPM_885_19
El Saghir NS, Keating NL, Carlson RW, Khoury KE, Fallowfield L. Tumor boards: optimizing the structure and improving efficiency of multidisciplinary management of patients with cancer worldwide. Am Soc Clin Oncol Educ Book. Am Soc Clin Oncol Annu Meet. 2014;34:e461-466. https://doi.org/10.14694/EdBook_AM.2014.34.e461
Akram M, Siddiqui SA. Breast cancer management: past, present and evolving. Indian J Cancer. 2012 Jul 1;49(3):277. https://doi.org/10.4103/0019-509X.104486
Gnanaraj J, Chakhesang M. The zooming rural surgeons. mdCurrentIndia. 2020 Aug 31;9. Available from: https://www.researchgate.net/publication/343985693_The_Zooming_Rural_Surgeons
Marios Konstantinos Tasoulis. Controversies in the surgical management of breast cancer [Internet]. ASCO Daily News. [cited 2020 Oct 30]. Available from: https://dailynews.ascopubs.org/do/10.1200/ADN.19.190465/full/
Chabba N, Tin Tin S, Zhao J, Abrahimi S, Elwood JM. Geographic variations in surgical treatment for breast cancer: a systematic review [Internet]. Ann Cancer Epidemiol. 2020 Mar 17 [cited 2020 Oct 27];4(0). Available from: http://ace.amegroups.com/article/view/5463
Muralee M, Mathew AP, Cherian K, Chandramohan K, Augustine P, Prabhakar J, et al. Oncological safety of breast conservation surgery in young females. Indian J Surg Oncol. 2016 Sep;7(3):332–5. https://doi.org/10.1007/s13193-016-0535-z
Matuschek C, Bolke E, Haussmann J, Mohrmann S, Nestle-Kramling C, Gerber PA, et al. The benefit of adjuvant radiotherapy after breast conserving surgery in older patients with low risk breast cancer—a meta-analysis of randomized trials [Internet]. Rad Oncol. 2017[cited 2020 Oct 30];60. Available from: https://ro-journal.biomedcentral.com/articles/10.1186/s13014-017-0796-x
Li J, Chen X, Qi M, Li Y. Sentinel lymph node biopsy mapped with methylene blue dye alone in patients with breast cancer: a systematic review and meta-analysis. PloS One. 2018;13(9):e0204364. https://doi.org/10.1371/journal.pone.0204364
Chintamani C, Tandon M, Mishra A, Agarwal U, Saxena S. Sentinel lymph node biopsy using dye alone method is reliable and accurate even after neo-adjuvant chemotherapy in locally advanced breast cancer–a prospective study. World J Surg Oncol. 2011 Feb 8;9:19. https://doi.org/10.1186/1477-7819-9-19
DeCoster RC, Bautista R-MF, Burns JC, Dugan AJ, Edmunds RW, Rinker BD, et al. Rural-urban differences in breast reconstruction utilization following oncologic resection. J Rural Health Off J Am Rural Health Assoc Natl Rural Health Care Assoc. 2020 Jun;36(3):347–54. https://doi.org/10.1111/jrh.12396
O’Neil DS, Keating NL, Dusengimana JMV, Hategekimana V, Umwizera A, Mpunga T, et al. Quality of breast cancer treatment at a rural cancer center in Rwanda. J Glob Oncol. 2017 May 12;(4):1–11. https://doi.org/10.1200/JGO.2016.008672
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