Biomarkers in breast cancer: Quantifying discordance with best practice when hormone receptor status is an extravagance

SA Journal of Oncology

Field Value
Title Biomarkers in breast cancer: Quantifying discordance with best practice when hormone receptor status is an extravagance
Creator Mushonga, Melinda Ndlovu, Ntokozo Nyakabau, Anna M. Ndarukwa-Jambwa, Sandra Kassam, Zahra Kadzatsa, Webster Liu, Zhihui Wong, Rebecca K.S.
Subject Breast cancer treatment; Biomarkers in breast cancer breast cancer; biomarkers; treatment guidelines; limited resources; sub-Saharan Africa
Description Background: In Zimbabwe, the hormone receptor status is not always available when patients with breast cancer are started on treatment.Aim: This study evaluated the discordance of treatment approach in such patients, with National Comprehensive Cancer Network (NCCN) guideline recommendations as the reference standard when these results are eventually available.Setting: Female patients who presented to the Parirenyatwa Central Hospital Radiotherapy and Oncology Centre with a histological diagnosis of breast cancer, managed between 1 January 2014 and 31 December 2016.Methods: Patients with breast cancer having unknown receptor status at diagnosis, and the hormone receptor status were subsequently available either clinically or the tissues were available for study-specific analysis, were eligible for the study. The level of agreement between treatments received and the NCCN recommendations if the receptor status was known was tested using Kappa statistic.Results: Patients in stage I–III received treatment that were in strong agreement with the use of chemotherapy, and endocrine treatments with agreement scores of 1 (95% CI 0.91–1) and 0.81 (95% CI 0.65–0.95), respectively; but moderate agreement with regard to the choice of chemotherapy regimen, with a score of 0.5 (95% CI 0.32–0.68). There was a median delay of 8 (range 3–27) months for the availability of receptor status. Of the 38 stage IV patients, 33 (87%) were recommended chemotherapy. Of the 38 patients, 25 (66%) had hormone driven disease. There was somewhat agreement for use of chemotherapy, choice of chemotherapy regimen and use of endocrine treatments as initial choice with agreement scores of 0.53 (95% CI 0.36,0.69), 0.18 (95% CI 0.07, 0.35) and 0.68 (95% CI 0.51,0.82) respectively.Conclusion: Treatment approaches were largely in agreement with the NCCN guidelines for patients in stage I–III. Discordance was noted in stage IV patients with under-utilisation of hormone therapy as the initial treatment when the receptor status was unknown.
Publisher AOSIS
Contributor Lancet Laboratory Zimbabwe
Date 2020-10-22
Type info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion — Retrospective Review
Format text/html application/epub+zip text/xml application/pdf
Identifier 10.4102/sajo.v4i0.134
Source South African Journal of Oncology; Vol 4 (2020); 8 pages 2523-0646 2518-8704
Language eng
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Coverage Sub Saharan Africa 2014-2016 Women, Breast Cancer
Rights Copyright (c) 2020 Melinda Mushonga, Ntokozo Ndlovu, Anna M. Nyakabau, Sandra Ndarukwa-Jambwa, Zahra Kassam, Webster Kadzatsa, Zhihui (Amy) Liu, Rebecca K.S. Wong