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Breast Cancer Management: A Comprehensive Approach Part 3

Moderator: Sponsor: AstraZeneca Presenters:

  1. Dr. Daniel Ojuka, Consultant General & Breast Surgeon & Lecturer, University of Nairobi
  2. Dr. Andrew Odhiambo, Consultant Medical Oncologist & Lecturer, University of Nairobi

Breast cancer is the most common cancer in women globally. Although the surgery was previously the most successful form of treatment; it was associated with mortality (approximately 15%) and increased morbidity, hence was abandoned in the 1960s. Consequently, advances in general anesthesia and antiseptic techniques facilitated more extensive procedures. In Kenya, the current changes in breast cancer management are driven by early detection and diagnosis and timely referrals, resulting in better outcomes. Unfortunately, late diagnosis is still frequent.  The current breast cancer management approach is multidisciplinary, consisting of a multidisciplinary team (MDT), of highly qualified specialists and a coordinator. The MDTs are economical and result in service improvement and better outcomes. To date, breast surgery involves MRM-Auchoncloss, skin, and nipple-sparing mastectomy techniques, which are selected depending on patient morphology, breast ptosis, and type of reconstruction planned.  Since the female breast is a symbol of beauty, fertility, and femininity, and surgery causes disfigurement, mastectomy for younger women requires proper communication and engagement with the patient, especially on the use of an aesthetic approach to breast conservation and rehabilitation therapy. Alternative approaches to surgery include hormonal therapy, targeted therapy, and chemotherapy, where the choice depends on the stage, setting, disease biology, patient characteristics, and the genomic patterns of the patients. A combination of approaches such as the use of neoadjuvant chemotherapy before surgery has proven to be beneficial especially in ulcerated patients. Considering the anatomical and molecular staging, the stage-based treatment survival rate is dependent on the subtypes of breast cancer. The national cancer treatment protocols and training programs for capacity building have been availed to all the counties by the Ministry of Health, Kenya, to support the treatment of cancer patients, especially in the counties.

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