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Case report
peer-reviewed

Complete Remission in Locally Advanced Breast Cancer: What Comprehensive Multi-Modality Treatment Has to Offer in Sub-Saharan Africa



Abstract

Locally advanced breast cancer presents as a heterogeneous disease, but it is often best treated with aggressive combined modality therapy.  Commonly, it carries a more guarded prognosis. Given the above, it can be a particularly challenging entity to treat in resource-limited settings.

We identify one such case with a relative lack of hormone receptor positivity in the sub-Saharan country of Zambia. Management of the disease was hampered by the challenges of resource constraints and communication gaps that are especially acute in low- to middle-income nations as compared to Western societies. However, with skilled interdisciplinary advice and the means available at a tertiary care facility, our patient was able to afford a superior clinical outcome in the form of a pathologic complete response via the use of surgical, systemic, and radiotherapy modalities. Additionally, the ensuing remission was corroborated by a careful follow-up regime.

We thus reinforce the feasibility and value of a team-based approach in the management of this disease regardless of the setting.



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Case report
peer-reviewed

Complete Remission in Locally Advanced Breast Cancer: What Comprehensive Multi-Modality Treatment Has to Offer in Sub-Saharan Africa


Author Information

Gaurav Bhattacharya Corresponding Author

Radiation Oncology, The Ottawa Hospital Cancer Centre, The University of Ottawa

Susan C. Msadabwe-Chikuni

Clinical and Radiation Oncology, Cancer Diseases Hospital, Lusaka, Zambia

Roanne Segal

Medical Oncology, The Ottawa Hospital Cancer Centre, The University of Ottawa

Omkar Inamdar

Clinical and Radiation Oncology, Cancer Diseases Hospital, Lusaka, Zambia

Catherine K. Mwaba

Clinical and Radiation Oncology, Cancer Diseases Hospital, Lusaka, Zambia


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. University of Zambia Biomedical Research Ethics Committee issued approval MH/CDH/101/18/1. Conflicts of interest: The authors have declared that no conflicts of interest exist.

Acknowledgements

The authors thank Dr. Mupeta Songwe (Pathology Department, University Teaching Hospital, Lusaka, Zambia) and Dr. Aurelia Busca (Department of Pathology and Laboratory Medicine, University of Ottawa, Canada) for their assistance in the case.


Case report
peer-reviewed

Complete Remission in Locally Advanced Breast Cancer: What Comprehensive Multi-Modality Treatment Has to Offer in Sub-Saharan Africa


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Case report
peer-reviewed

Complete Remission in Locally Advanced Breast Cancer: What Comprehensive Multi-Modality Treatment Has to Offer in Sub-Saharan Africa

  • Author Information
    Gaurav Bhattacharya Corresponding Author

    Radiation Oncology, The Ottawa Hospital Cancer Centre, The University of Ottawa

    Susan C. Msadabwe-Chikuni

    Clinical and Radiation Oncology, Cancer Diseases Hospital, Lusaka, Zambia

    Roanne Segal

    Medical Oncology, The Ottawa Hospital Cancer Centre, The University of Ottawa

    Omkar Inamdar

    Clinical and Radiation Oncology, Cancer Diseases Hospital, Lusaka, Zambia

    Catherine K. Mwaba

    Clinical and Radiation Oncology, Cancer Diseases Hospital, Lusaka, Zambia


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. University of Zambia Biomedical Research Ethics Committee issued approval MH/CDH/101/18/1. Conflicts of interest: The authors have declared that no conflicts of interest exist.

    Acknowledgements

    The authors thank Dr. Mupeta Songwe (Pathology Department, University Teaching Hospital, Lusaka, Zambia) and Dr. Aurelia Busca (Department of Pathology and Laboratory Medicine, University of Ottawa, Canada) for their assistance in the case.


    Article Information

    Published: July 06, 2017

    DOI

    10.7759/cureus.1432

    Cite this article as:

    Bhattacharya G, Msadabwe-chikuni S C, Segal R, et al. (July 06, 2017) Complete Remission in Locally Advanced Breast Cancer: What Comprehensive Multi-Modality Treatment Has to Offer in Sub-Saharan Africa. Cureus 9(7): e1432. doi:10.7759/cureus.1432

    Publication history

    Received by Cureus: May 23, 2017
    Peer review began: June 20, 2017
    Peer review concluded: July 02, 2017
    Published: July 06, 2017

    Copyright

    © Copyright 2017
    Bhattacharya et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Locally advanced breast cancer presents as a heterogeneous disease, but it is often best treated with aggressive combined modality therapy.  Commonly, it carries a more guarded prognosis. Given the above, it can be a particularly challenging entity to treat in resource-limited settings.

We identify one such case with a relative lack of hormone receptor positivity in the sub-Saharan country of Zambia. Management of the disease was hampered by the challenges of resource constraints and communication gaps that are especially acute in low- to middle-income nations as compared to Western societies. However, with skilled interdisciplinary advice and the means available at a tertiary care facility, our patient was able to afford a superior clinical outcome in the form of a pathologic complete response via the use of surgical, systemic, and radiotherapy modalities. Additionally, the ensuing remission was corroborated by a careful follow-up regime.

We thus reinforce the feasibility and value of a team-based approach in the management of this disease regardless of the setting.



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Create a free account to continue reading this article.

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Gaurav Bhattacharya, M.D.

Radiation Oncology, The Ottawa Hospital Cancer Centre, The University of Ottawa

For correspondence:
gbhattacharya@toh.ca

Susan C. Msadabwe-Chikuni

Clinical and Radiation Oncology, Cancer Diseases Hospital, Lusaka, Zambia

Roanne Segal

Medical Oncology, The Ottawa Hospital Cancer Centre, The University of Ottawa

Omkar Inamdar

Clinical and Radiation Oncology, Cancer Diseases Hospital, Lusaka, Zambia

Catherine K. Mwaba

Clinical and Radiation Oncology, Cancer Diseases Hospital, Lusaka, Zambia

Gaurav Bhattacharya, M.D.

Radiation Oncology, The Ottawa Hospital Cancer Centre, The University of Ottawa

For correspondence:
gbhattacharya@toh.ca

Susan C. Msadabwe-Chikuni

Clinical and Radiation Oncology, Cancer Diseases Hospital, Lusaka, Zambia

Roanne Segal

Medical Oncology, The Ottawa Hospital Cancer Centre, The University of Ottawa

Omkar Inamdar

Clinical and Radiation Oncology, Cancer Diseases Hospital, Lusaka, Zambia

Catherine K. Mwaba

Clinical and Radiation Oncology, Cancer Diseases Hospital, Lusaka, Zambia