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. 2025 Mar 29;25(1):149.
doi: 10.1186/s12905-025-03667-6.

Real-world breast cancer treatment patterns and guideline-concordant treatment completion among Malawian women

Affiliations

Real-world breast cancer treatment patterns and guideline-concordant treatment completion among Malawian women

Jennifer Morgan et al. BMC Womens Health. .

Abstract

Purpose: In Sub-Saharan Africa (SSA), resource-stratified guidelines for breast cancer treatment are increasingly recommended, but treatment receipt and outcomes according to these guidelines are underreported. Here, we describe breast cancer treatment patterns by stage and curative-intent guideline-concordant treatment (GCT) receipt among Malawian women.

Methods: A prospective cohort of breast cancer patients were enrolled from December 2016 to October 2018 at Kamuzu Central Hospital with an assessment of demographics, stage, and treatment received, including neoadjuvant (NAC), adjuvant (AdC) and palliative chemotherapy and breast surgery. Curative-intent GCT was defined as having completed breast surgery and at least 4 cycles of chemotherapy. Overall survival (OS) was calculated using Kaplan Meier methods and odds ratios using logistic regression.

Results: 91 patients were included, of whom 13 (14%) presented as stage II, 54 (59%) as stage III, and 24 (26%) as stage IV. Curative treatment was recommended for 65 of 91 (71%) patients, of whom 47 (72%) were initiated on NAC, 14 (22%) on upfront breast surgery, and 4 (6%) received no treatment. Only 63% (41/65) of patients received curative-intent GCT as recommended with non-GCT associated with stage III (vs. stage II) disease (OR 0.10 CI (0.01-0.89)), HIV positivity ((OR 0.25 CI (0.06-0.99)) and hormone receptor (HR) negative/HER2 positive subtype ((OR 0.07 CI (0.01-0.49)). Curative-intent GCT was associated with improved OS (44.1 vs. 23.2 months; p = 0.00) compared to non-GCT.

Conclusion: While curative-intent GCT was associated with improved survival in this Malawian cohort, treatment completion rates were suboptimal. Resource-stratified guidelines must be paired with locally relevant, multilevel implementation strategies to target barriers to treatment completion.

Keywords: Breast cancer; Malawi; Treatment.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was approved by the Institutional Review Board at UNC and the Malawi National Health Science Research Committee in compliance with the Declaration of Helsinki. All patients provided written informed consent at the time of enrollment. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Guideline-concordant treatment pathways among a prospective cohort of Malawian women with breast cancer, December 2016-October 2018, by stage at presentation
Fig. 2
Fig. 2
a) Overall survival of women with newly diagnosed breast cancer in a prospective Malawian cohort enrolled December 2016-October 2018, by first chemotherapy received b) Overall survival of women with newly diagnosed breast cancer in a prospective Malawian cohort enrolled December 2016-October 2018, by completion of guideline-concordant treatment

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