Breast cancer is the most frequently occurring cancer in women, with approximately 1.7 million new cases and nearly 522,000 related deaths worldwide in 2012 . In Ethiopia the incidence of new cases of breast cancer is currently increasing and has become one of the most common cancer types causing high rates of morbidity and mortality [2,3,4]. According to the study by Memirie et al. breast cancer is the most common cancer, constituting 33% of the cancers in women and 23% of all cancers in Ethiopia. The Estimated national Age Standardized Incidence rate for women was about 43 per 100,000 population .
The recently reported, first data from the Addis Ababa City Population based cancer registry shows that breast cancer is the most common cancer in women and one of the top Ten cancers in men. Breast cancer incidence has shown a steady yearly growth at the Tikur Anbessa Specialized Hospital, the only hospital in the country where cancer patients have access to oncology care [6, 7]. Furthermore, the majority of patients have at the time of presentation advanced disease with 67% presented with locally advanced and 25% metastatic disease . The combination of all the aforementioned factors leads to unsatisfactory treatment outcomes [8, 9].
The Ethiopian government has recognized this as a major problem and has set a priority the advancement of cancer care in the country. In 2015 the Ethiopian healthcare authorities developed a cancer control plan, which is focusing on the prevention as well as the general improvement of cancer care in the country [10, 11]. One of the most significant steps taken was the establishment of 6 specialized cancer centers at the teaching university hospitals of Gondar, Hawassa, Mekelle, Jimma, Haramaya and St. Paul’s Hospital .
Cancer care at the university hospital of Gondar
The University of Gondar Hospital is a tertiary teaching hospital, located in the North-West Ethiopia providing healthcare for a population of approximately 5,000,000 people. The hospital has around 600 beds with 400,000 patients treated annually. The hospital has more than sixty years’ experience in teaching, research, health care delivery and other community services employing 250 general practitioners, 20 internal medicine specialists, 14 surgeons, 12 pediatricians, 7 gynecologists and more than 30 other medical specialists. The University Hospital also has more than Ten years of experience and participation in clinical trials focusing mainly on infectious diseases such as leishmania and HIV infection [13, 14]. Until recently however, specialized and comprehensive cancer care was not offered at the hospital, with just selected cases being operated on and with the bulk of diagnostic and interventional procedures being referred to the Tikur Anbessa Specialized Hospital located 900 km from Gondar.
In January 2015 the Gondar University Hospital together with the BEZA Association of Switzerland, established the first cancer treatment center in the region . The center includes Ten beds for outpatients as well as an in-patient care unit with Eight trained nurses, Two general practitioners and One senior oncology resident from the Tikur Anbessa Hospital on a monthly rotation. Furthermore, a senior oncologist from Switzerland regularly visits the center. One of the major achievement of the center was the establishment of a regular multidisciplinary tumor board consisting of a group of medical professionals including a pathologist, a radiologist, a surgeon and the attending physician.
The histopathological evaluation is limited on the morphology, with immunohistochemistry and other molecular tests currently unavailable. The department of radiology is equipped with a CT-Scanner, an X-ray machine and Ultrasound devices. The University of Gondar Hospital cancer center provides medical oncology service such as the administration of chemotherapy and hormone therapy for several tumor entities. Radiotherapy is still not available at the center and those patients requiring radiotherapy are referred to Tikur Anbessa Hospital in Addis Ababa.
Breast cancer is one of the most common cancer entities treated at the University of Gondar Hospital, therefore a retrospective evaluation was conducted to detect patterns of care and evaluate early results .