Metastatic breast cancer in resource-limited settings: insights from a retrospective cross-sectional study at a radiotherapy centre in Sub-Saharan Africa

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Background: Metastatic breast cancer (MBC) is a significant cause of cancer-related mortality worldwide, with unique challenges in resource-limited settings. Radiotherapy centers play a critical role in the management of MBC, but there is limited data on the clinical and pathological profiles as well as treatment patterns in these settings. Aim: To describe the socio-demographic characteristics, clinico-pathological features, molecular profiles and treatment patterns of patients with MBC at a major radiotherapy centre in sub-Saharan Africa. Methods: This was a quantitative retrospective cross-sectional study involving patients with MBC managed between 2016 and 2020. Data were extracted from patients' medical records and analysed with STATA software (version 16). Descriptive statistics were used to summarise the data. Results: The study involved 154 MBC patients with a median age of 48 years (IQR 19) ranging from 26 to 79 years. Young adults (< 39 years) comprised 29.9% whereas patients ≥60 years accounted for 12.9%. Triple-negative breast cancers comprised 28.6% whereas human epidermal growth factor receptor-2/Neu - enriched tumours constituted 18.8%. Only 29.9% were diagnosed with de novo metastasis. A considerable majority (85.1%) were treated with palliative intent whereas 14.9% received best supportive care only, with none receiving curative treatment. The sites of first occurrence of distant metastasis were bone tissue (38.3%), lung (34.4%), liver (14.9%) and the brain (12.4%). Overall, 63% had solitary metastatic sites whereas 27.9% and 7.8% had double and triple metastatic sites, respectively. About a quarter (24.7%) presented to the radiotherapy center within 6 months of the onset of symptoms, whereas the majority (84.5%) sought care within 24 months. Conclusion: Bone, lung, liver and brain were the primary metastatic sites, with complex combinations involving these organs, reflecting the heterogeneity of the disease. Context-specific strategies are needed to address the high burden of advanced-stage disease and improve oncological care for patients with MBC in limited-resource settings.

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