title: Benign and Malignant Breast Disease at Rwanda's First Public Cancer Referral Center.
abstract: Breast cancer incidence is rising in low- and middle-income countries. Understanding the distribution of breast disease seen in clinical practice in such settings can guide early detection efforts and clinical algorithms, as well as support future monitoring of cancer detection rates and stage.
  
  
  
  We conducted a retrospective medical record review of 353 patients who presented to Butaro Cancer Center of Excellence in Rwanda with an undiagnosed breast concern during the first 18 months of the cancer program.
  
  
  
  Eighty-two percent of patients presented with a breast mass. Of these, 55% were diagnosed with breast cancer and 36% were diagnosed with benign disease. Cancer rates were highest among women 50 years and older. Among all patients diagnosed with breast cancer, 20% had stage I or II disease at diagnosis, 46% had locally advanced (stage III) disease, and 31% had metastatic disease.
  
  
  
  After the launch of Rwanda's first public cancer referral center and breast clinic, cancer detection rates were high among patients presenting with an undiagnosed breast concern. These findings will provide initial data to allow monitoring of changes in the distribution of benign and malignant disease and of cancer stage as cancer awareness and services expand nationally.
  
  
  
  The numbers of cases and deaths from breast cancer are rising in low-income countries. In many of these settings, health care systems to address breast problems and efficiently refer patients with symptoms concerning for cancer are rudimentary. Understanding the distribution of breast disease seen in such settings can guide early detection efforts and clinical algorithms. This study describes the characteristics of patients who came with a breast concern to Rwanda's first public cancer referral center during its first 18 months. More than half of patients with a breast mass were diagnosed with cancer; most had late-stage disease. Monitoring changes in the types of breast disease and cancer stages seen in Rwanda will be critical as breast cancer awareness and services grow.
authors.affiliation: Brigham and Women's Hospital, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA lepace@partners.org.
authors.forename: Lydia E
authors.initials: LE
authors.lastname: Pace
authors.affiliation: Partners in Health/Inshuti Mu Buzima, Kigali, Rwanda.
authors.forename: Jean-Marie V
authors.initials: JM
authors.lastname: Dusengimana
authors.affiliation: Ministry of Health, Kigali, Rwanda.
authors.forename: Vedaste
authors.initials: V
authors.lastname: Hategekimana
authors.affiliation: Partners in Health/Inshuti Mu Buzima, Kigali, Rwanda.
authors.forename: Hamissy
authors.initials: H
authors.lastname: Habineza
authors.affiliation: Partners in Health/Inshuti Mu Buzima, Kigali, Rwanda.
authors.forename: Jean Bosco
authors.initials: JB
authors.lastname: Bigirimana
authors.affiliation: Brigham and Women's Hospital, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA Partners in Health/Inshuti Mu Buzima, Kigali, Rwanda.
authors.forename: Neo
authors.initials: N
authors.lastname: Tapela
authors.affiliation: Ministry of Health, Kigali, Rwanda.
authors.forename: Cadet
authors.initials: C
authors.lastname: Mutumbira
authors.affiliation: Ministry of Health, Kigali, Rwanda.
authors.forename: Egide
authors.initials: E
authors.lastname: Mpanumusingo
authors.affiliation: Brigham and Women's Hospital, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Jane E
authors.initials: JE
authors.lastname: Brock
authors.affiliation: Brigham and Women's Hospital, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Meserve
authors.affiliation: Ministry of Health, Kigali, Rwanda.
authors.forename: Alain
authors.initials: A
authors.lastname: Uwumugambi
authors.affiliation: Brigham and Women's Hospital, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Dillon
authors.affiliation: Brigham and Women's Hospital, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Keating
authors.affiliation: Harvard Medical School, Boston, Massachusetts, USA Partners in Health/Inshuti Mu Buzima, Kigali, Rwanda Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
authors.forename: Lawrence N
authors.initials: LN
authors.lastname: Shulman
authors.affiliation: Ministry of Health, Kigali, Rwanda.
authors.forename: Tharcisse
authors.initials: T
authors.lastname: Mpunga
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D012017:Referral and Consultation; D012189:Retrospective Studies; D012432:Rwanda / Q000453:epidemiology
keywords: Africa; Benign breast disease; Breast cancer; Rwanda