Table 3 NCCN and Tanzanian Guidelines Based Opportunities for Improvement.

Lymph Node Evaluation

Node evaluation should be performed minimally with a full axillary lymph node dissection.

Before intervention, an attempt should be made to stage all patients using proper TNM parameters.

• 75/164 (56%) received axillary staging

• 60/164 (44%) no axillary staging

Axillary evaluation for all patients

Staging Evaluation

If symptomatic, chest imaging (x-ray/CT) and abdominal imaging (ultrasound/CT) should be performed.

Chest x-ray and CT chest with contrast if pulmonary symptoms, abdominal pelvic US should always be performed.

• All treated breast cancer patients presented with focal breast symptoms

• Abdominal pelvic US in 107/164 (65%) of patients

• Only 37/164 (23%) underwent both chest and abdominal imaging

Abdominal US for all patients given high burden of late-stage disease

Histopathology

Cancer diagnosis should be confirmed with histopathology.

Histopathology should be reported by specialist pathologists, and reviewed with a panel of pathologists before treatment is instituted at a specialist

treatment center.

• 113/164 (69%) histopathology confirmed cases

• 51/164 (31%) treated on the basis of clinical suspicion

Confirmation histopathology for diagnosis in all patients

Hormone Receptor Testing

Hormone receptor testing should be performed to subtype cancer and guide treatment.

Immunohistochemistry for ER and PR must be done.

• 13/164 (9%) underwent ER/PR testing

• 144/164 (91%) did not undergo receptor testing

ER/PR receptor testing at for all patients to select patients for adjuvant endocrine therapy