Transforming Breast Cancer Treatment in Ethiopia
Six-year pilot project strengthened diagnosis and treatment capabilities at Tikur Anbessa University Hospital
Worldwide, breast cancer is the most commonly diagnosed cancer and the leading cause of cancer death in women. Currently, just under half of all new cases occur in the developing world. But this is changing: the incidence of breast cancer in low- and middle-income countries is growing by up to 5% per year as populations age, and as many people adopt unhealthy modern lifestyles that increase the risk of cancer.
Developing countries accounts for the majority of breast cancer deaths. Diagnostic and treatment services are limited and most patients are first seen when the disease is advanced. In sub-Saharan Africa only 32% of women are still alive five years after diagnosis, compared with 81% in the US. Developing countries have little experience of what is feasible and effective in resource-poor settings, and the Axios breast cancer project in Ethiopia was a unique attempt to fill that gap.
Funded by AstraZeneca, it was run in collaboration with Tikur Anbessa, the main referral hospital in Addis Ababa, with the aim of making it a centre of excellence for breast cancer management and treatment.
At the project launch in 2005, there was a single oncologist and only one radiotherapy unit in Ethiopia. There was no estrogen and progesterone hormone receptor test (ER/PR test); no access to life-saving cancer drugs; and very limited awareness of breast cancer among health staff and the public. The project began with a participatory assessment of needs at Tikur Anbessa Hospital. Then, together with hospital staff and the Ethiopian Cancer Association, Axios developed a plan for a six-year project to strengthen breast cancer management and treatment at the hospital, and to raise public awareness.
The pilot project included the development of clinical guidelines for breast cancer treatment and palliative care, capacity building, patient management and follow-up systems, the installation of mammography and ultrasound equipment, and drug donations. The project provided support to the Ethiopian Cancer Association, helping to build the organizational structures, as well as to undertake public awareness and fund-raising activities.
By late 2008, a total of 3,634 patients had been screened, diagnosed, or treated at Tikur Anbessa and were being monitored in follow up.
Furthermore, Ethiopia’s Ministry of Health has established a committee to develop cancer control policies in collaboration with staff from Tikur Anbessa.
In 2008 the project focused on activities aimed at boosting long term sustainability. This included the introduction of a maintenance program for radiotherapy equipment and drug management systems, as well as training for pathologists and other laboratory staff in new diagnostic technologies.In 2009, Axios and its partners in Ethiopia developed a plan to ensure the sustainability of the program beyond the pilot phase. Putting a cost to its activities helped make the Ethiopian breast cancer initiative not only an inspiration to others, but a practical proposition to be adopted elsewhere in the developing world.