Breast Cancer in the surgical department of Saint Boniface Hospital: Descriptive and observational analysis

Introduction: Breast cancer is a global public health problem and is considered the leading cause of cancer death in women. While the incidence of breast cancer in low-income countries was 51% in 2010, it is estimated that this figure will double by 2030 (1). With an incidence of around 60%, Haiti has the highest rate in the Caribbean (2). However, there is nonational or regional database in the country (2). Hence the objective of this work is to draw up the epidemiological and clinical picture of breast cancer at Hôpital Saint Boniface (HSB). Methodology: 79 cases of breast CA were recorded in the database of the surgical department of Hôpital Saint Boniface, over a period of 1 year. The patients were prepared and operated on according to the department's protocols and specimens were taken for anapathological analysis (at Port-au-Prince). After the results they were contacted and oriented according to the anapathological findings for chemotherapy sessions. The data were collected and analyzed using SPSS and Excel software. Discussion: The mean age of our patients was 52.4 years (median: 50 years and IQR: 23), and more than half was between 41 and 64 years. It is estimated in rich countries that the mean age is around 62 years (1), which makes a difference of 10 years less. All our patients were women. Nearly half (48.1%) was in advanced stage 3, which is not different from the study conducted at the HUM (University Hospital of Mirebalais) where 49% of the patients operated on was in stage 3 (2). This is the same scenario observed in the majority of low-income countries where nearly 75% of patients arrive at stage 3 or 4 (1). This is justified by a lack of awareness, cultural stigma (4) and knowledge of the disease among people who are often uneducated or living in areas far from hospitals where adequate care is available (5). This corroborates the observation made at the HUM where 61% of the patients come from the Western department (1). In our study, this department represents 53%. Another fact justifying this observation is the cost of care. These two hospitals, HUM and HSB, have surgical care programs that are practically free of charge (3), contrary to Port-au- Prince, where in centers of acceptable quality the cost of surgical care is very high. More than 4/5 (81%) of the patients had a modified radical mastectomy, at IHI (Innovation Health Institute) this surgical technique was performed in 57% of cases (1). Samples for anapathological analysis were taken and 91.02% of patients had it done. Ductal carcinoma was the predominant type with 78.5%, of which infiltrating carcinoma represented 72.2%. At HUM 82% of patients had anapathological examination and the predominant type was infiltrating ductal carcinoma (2). It should be noted that 46.8% of the specimens did not have the stage mentioned, this was also the case at HUM where 41% of the stage was not reported (2). Only 19% of our patients had chemotherapy which is not available locally at HSB, and very often they are referred to IHI for follow-up. In their study at IHI there were 23% of patients under chemotherapy (1), while at HUM it was 53% (2). Broader observations are needed for better evaluation and strengthening of oncology care in the country and particularly at the HSB, the main referal center for surgery in the South of the country. Reference 1.DeGennaro V, Jiwani F, Patberg E, et al. Histopathological Features of Breast Cancer in Haiti. J Glob Oncol. Published online 2018. doi:https://doi.org/10.1200/JGO.17.0013510.1200/JGO.17.00135 2.FADELU T, DAMUSE R, LORMIL J, et al. Patient Characteristics and Outcomes of Nonmetastatic Breast Cancer in Haiti: Results from a Retrospective Cohort. Oncologist. 2020;25:1372-1381. doi:10.1634/theoncologist.2019-0951 3.Padovany MMN, Patterson RH, Bowder AN, et al. Impact of out- pocket expenses for surgical care on households in rural methods study Haiti: a mixed- . BMJ Open. 2022;12:1-10. doi:10.1136/bmjopen-2022-061731 4.Raynault M, Féthière C, Côté D. Social inequalities in breast cancer screening: evaluating written communications with immigrant Haitian women in Montreal. 2020;0:1-10. 5.Joseph JP, Bhangdia K, Damuse R, Lormil J, Triedman S, Fadelu T. Impact of geospatial barriers on breast cancer care in Haiti: a retrospective cohort study. Lancet Oncol. 2022;23:S40. doi:10.1016/S1470-2045(22)00439-9

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