Breast cancer is a major global health problem. Its incidence is increasing and low-and middle-income countries (LMIC) are being disproportionately affected. Africa suffers the greatest burden of breast cancer with the highest age-standardized mortality rates in the world. Breast cancer incidence in Nigeria is rising, with 80% of cases presenting at an advanced stage and less than 25% overall survival. Screening programs are required to improve survival by identifying earlier stage patients. In Nigeria, however, there are little data to guide breast cancer screening. The studies below are seeking to address some of these challenges.
Prospective collection and banking of breast cancer specimens and database containing clinical information – ARGO has built a large prospective colorectal cancer database in sub-Saharan Africa as well as a biobank to store specimens. This will facilitate the development of prevention, treatment, and Cancer control plans. There are two -80 freezers housed at OAU that hold specimens.
Prevent Cancer Foundation-funded study of iBreast, a handheld device for detecting breast tumors, in Nigeria – Creating a community education program to improve early diagnosis of breast cancer in Nigeria and Harlem: Similar to colorectal cancer, the majority of patients present with late-stage IV breast cancer. Clinical breast examination is a low-cost method of detecting breast masses when they are small. We enrolled approximately 3,000 women in a questionnaire study to determine their knowledge of and barriers to breast cancer screening in the community.
Using our knowledge of barriers to screening, we have now developed a large community-based screening study, combining clinical breast examination and the iBreast device. This handheld breast screening device has been studied in India and it was found to have better sensitivity and specificity compared with clinical breast examination. We will compare results of this device in Nigeria with results at the MSK Harlem Breast Center.
NIH-funded R21 US-guided breast biopsy pilot study in Nigeria – One major barrier to timely breast cancer treatment in LMIC is the lack of affordable and appropriate breast cancer diagnosis by ultrasound (US)-guided biopsy. While it is the standard of care in high-income countries (HIC), it is not performed by radiologists in LMIC despite the Breast Health Global Initiative’s recommendation. Most radiologists in LMIC do not have the required skills to perform US-guided breast biopsy; hence, breast cancer is often diagnosed by blind biopsy or surgical excision. Until recently, the prohibitive cost of US devices limited their availability in LMIC. US is the mainstay of diagnostic imaging in LMIC and so they are in near constant clinical use and not available for capacity building.
New technologies have overcome this barrier because mobile health (mHealth) US-devices are now FDA approved products, which are the perfect low-cost alternative. These hand held, battery operated point-of-care (POC) mhealth US devices offer a safe, simple and sustainable solution. The gap in LMIC affordable and appropriate breast cancer diagnosis is no longer technology, equipment, infrastructure or staff but the lack of an established US-guided breast biopsy-training program. Therefore, the goal of our proposal is building scalable US-guided breast biopsy capacity. In Aim 1, we will develop a competency-based mHealth US-guided breast biopsy-training program for LMIC radiologists and validate the assessment metrics. In Aim 2, we will train ten ARGO Nigerian radiologists to perform US-guided breast biopsies using the competency-based mHealth training program. ARGO (The African Research Group for Oncology) is a network of physicians and hospitals that have already demonstrated success in breast cancer research with a focus on early detection and committed to participating in this project.
Pilot study of quality of life among Nigerian women with breast cancer, post-mastectomy and treated with adjuvant chemotherapy. We will translate the BREAST-Q instrument to utilize it in Nigerian women with breast cancer to determine patient reported outcomes. This first of its kind study in sub-Saharan Africa will provide much needed data to improve the experience women with breast cancer have in Nigeria.
Pilot study of white adipose tissue inflammation (WATi) in Nigerian patients with breast cancer – This study seeks to
- determine levels of WATi (detected through the presence of crown like structures CLS histologically) in Nigerian women undergoing mastectomy for breast cancer treatment. This is unknown in Nigerian women however has been previously shown be an indicator of local and systemic perturbations which promote tumor growth in breast cancer patients at MSKCC.(20) It is hypothesized that Breast WATi may be a driver of breast cancer risk and progression in Nigerian women and correlate with specific diet, physical activity and body composition patterns
- Determine levels of physical activity, dietary habits and nutritional status through the use of a validated questionnaire administered to patients undergoing mastectomy,
- Determine how WATi and its associated blood biomarkers correlate with gene expression changes in the tumor and features of tumor aggressiveness. The genetic profile of tumors in Nigerian patients will be compared to WATi findings in the same breast tissue.