title: Characterizing breast conditions at an open-access breast clinic in South Africa: a model that is more than cancer care for a resource-limited setting.
abstract: While most breast-related research focuses on cancer, presentation of symptomatic persons in non-screened environments requires understanding the spectrum of breast diseases so as to plan services in resource-constrained settings. This study presents the variety of breast disease managed at a government, open-access breast clinic in South Africa.
  
  
  
  We performed a retrospective file review using a systematic random sample of patients 18 years and above presenting for breast care over a 14-month period. We collected demographics, clinical characteristics, management and final diagnoses from the first visit and twelve subsequent months.
  
  
  
  The final sample contained 365 individuals (97 · 5% women). Most were black, unmarried and South African citizens with a median age of 43 years (IQR 31-55) . Of those reporting their status (24 · 1%) 38 · 6% were HIV-positive. A mass (57 · 0%) and/or pain (28 · 5%) were the most common symptoms. Imaging and breast biopsies were required in 78 and 25% of individuals, respectively. Nearly half of biopsies identified breast cancer (44 · 1% of women ≤40 and 57 · 3% for women >40). Benign conditions (47 · 7%) and no abnormality (18 · 2%) were common final classifications among women. There was no difference between the final classifications of patients who self-referred versus those who were formally referred from another health care provider. Nearly half of the participants (46 · 6%) travelled 20 km or more to attend the clinic.
  
  
  
  Benign breast conditions far outweighed cancer diagnoses. As breast cancer awareness increases in resource-limited countries, facilities offering breast care require administrative and clinical preparation to manage a range of non-cancer related conditions.
authors.affiliation: Helen Joseph Breast Care Clinic, Helen Joseph Hospital, Johannesburg, South Africa. sarah.rayne@wits.ac.za.|Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. sarah.rayne@wits.ac.za.
authors.forename: Sarah
authors.initials: S
authors.lastname: Rayne
authors.affiliation: Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Naomi
authors.initials: N
authors.lastname: Lince-Deroche
authors.affiliation: Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Hendrickson
authors.affiliation: Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Kate
authors.initials: K
authors.lastname: Shearer
authors.affiliation: Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Faith
authors.initials: F
authors.lastname: Moyo
authors.affiliation: Cytology Unit, National Health Laboratory Service and Department of Anatomical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Pam
authors.initials: P
authors.lastname: Michelow
authors.affiliation: Department of Radiology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Grace
authors.initials: G
authors.lastname: Rubin
authors.affiliation: Helen Joseph Breast Care Clinic, Helen Joseph Hospital, Johannesburg, South Africa.|Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Carol
authors.initials: C
authors.lastname: Benn
authors.affiliation: Clinical HIV Research Unit, Department of Internal Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.|Right to Care, Johannesburg, South Africa.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Firnhaber
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D000970:Antineoplastic Agents / Q000191:economics / Q000627:therapeutic use*; D044383:Black People; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000191:economics; D005260:Female; D006679:HIV Seropositivity / Q000453:epidemiology; D006295:Health Resources; D006801:Humans; D008297:Male; D008875:Middle Aged; D016522:Oncology Service, Hospital / Q000458:organization & administration* / Q000592:standards; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology; D062606:Tertiary Care Centers
chemical_list: D000970:Antineoplastic Agents
keywords: Benign breast disease; Breast cancer; Diagnosis; Global health; Open access