From the set-up of a screening program of breast cancer patients to the identification of the first BRCA mutation in the DR Congo

Abstract

Background: Breast cancer incidence in African population is low compared to western countries but the mortality rate is higher and the disease presents at a younger age and at a more advanced stage. The World Health Organisation and the Breast Health Global Initiative concluded that in low and middle income countries early breast cancer detection can be achieved by informing women on symptoms of breast cancer, on the practice of breast self-examination and clinical breast examination by trained health care workers. Based on these recommendations, we set up a breast cancer awareness campaign in Kinshasa, Democratic Republic of Congo (DRC). This paper describes the strategy that was established and the results that were achieved.

Methods: A breast cancer awareness campaign was started in 2010 and data were collected until the end of 2012. Clinicians (expert group) trained nurses and health care workers (awareness groups) on clinical, technical and social aspects of breast cancer. Different channels were used to inform women about the campaign and clinical data (on medical and family history) were collected. The participating women were investigated with clinical breast examination by the awareness group. Women in whom a palpable mass was detected were referred to the hospital: they received a mammography and ultrasound and--in case of suspicious findings--additionally a core needle biopsy. In case of a positive family history, a blood sample was taken for genetic investigation.

Results: In total, 4,315 women participated, resulting in 1,113 radiological breast examinations, performed in the General Hospital of Kinshasa of which 101 turned out to be malignant lesions. Fifty six percent of the women with breast cancer were less than 50 years old and 75% (65/87) were stage III tumors. A BRCA gene mutation was identified in a family with a severe history of breast cancer.

Conclusions: Even without financial support, it was possible to start an awareness campaign for breast cancer in Kinshasa. This campaign increased the awareness on cancer of the women in Kinshasa. The results demonstrate that this campaign had an immediate impact on patients and their families.

Figure 1

Organisation of the breast cancer awareness campaign.

Figure 2

Map of the Democratic Republic of Congo and of Kinshasa (capital). 2a/Kinshasa (in red): 8,415,000 inhabitants, Bas-Congo (in green): 3,500,000 inhabitants with 1 = Kimpese, 2 = Matadi, 3 = Boma, 4 = Muanda. 2b/Kinshasa, capital with 24 communes.

Figure 3

Evolution of the number of mammograms (2009 till 2012).

Figure 4

Distribution of breast cancer for the different age categories.

Figure 5

Pedigree of the family that underwent BRCA1/2 genetic testing. The age of disease presentation is indicated. The arrow refers to the index patient; blacked-in shapes indicate a breast cancer diagnosis.