12Feb 2020

A REVIEW OF BREAST CANCER TREATMENT MODALITIES IN UGANDA : AN APPRAISAL OF THE BREAST CANCER DIAGNOSTIC PROCESS, REGULATORY APPROVAL AND SUPPLY SYSTEM OF STANDARDIZED ANTI-BREAST CANCER MEDICINES

  • Mbarara University of Science and Technology, Pharmbiotechnology and Traditional Medicine Centre, Faculty of Medicine, P.O Box 1410, Mbarara, Uganda.
  • Makerere University, College of Health Sciences, P.O Box 7062, Kampala, Uganda.
  • Makerere University, College of Natural Sciences, P.O Box 7062, Kampala, Uganda.
  • Malawi University of Science and Technology, Institute of Technology, P. O. Box 5196, Limbe, Malawi.
  • Uganda Cancer Institute, P.O Box 3935, Kampala, Uganda.
Crossref Cited-by Linking logo
  • Abstract
  • Keywords
  • References
  • Cite This Article as
  • Corresponding Author

Breast cancer is the leading cause of cancer death among women and the third incident cancer in the world, contributing 1.7 million of the 17.2 million annual incident cancer cases. For Uganda, breast cancer is the third incident cancer and fourth cause of cancer related deaths. The Uganda cancer treatment guidelines focuses on treatment of five cancers that constitute 60% of the national cancer burden, namely; Kaposi sarcoma, cancer of cervix, prostate cancer, esophageal cancer and breast cancer. We present a review of the treatment modalities of breast cancer based upon Ugandas treatment guidelines as well as documented clinical practices. Diagnosis of breast cancer is delayed in most patients and based on clinical evaluation of risk factors, clinical manifestations and laboratory investigations. Staging is based on The American Joint Committee on Cancer TNM system. Surgery, radiotherapy and chemotherapy are the recommended treatment options administered singly or in combination with each other depending on the stage of breast cancer at the time of diagnosis. We found 21 standard treatment regimens based on 17 drug molecules have been recommended for various breast cancers. Seven of these molecules are among 13 other cytotoxic drugs approved by WHO as essential anti-breast cancer medicines. 39 brands of these drug molecules were found registered by the National drug Authority in Uganda as of 23rdAugust 2018, accounting for 0.01% of all the registered drugs for human use in Uganda.


  1. ?Cancer Facts & Figures 2016 | American Cancer Society. [Online]. Available: https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2016.html. [Accessed: 26-Dec-2019].
  2. L. Siegel, K. D. Miller, and A. Jemal, ?Cancer statistics, 2019, CA: A Cancer Journal for Clinicians, vol. 69, no. 1, pp. 7?34, 2019, doi: 10.3322/caac.21551.
  3. ?Global Burden of Disease Study 2016 (GBD 2016) Cancer Incidence, Mortality, Years of Life Lost, Years Lived with Disability, and Disability-Adjusted Life Years 1990-2016 | GHDx. [Online]. Available: http://ghdx.healthdata.org/record/ihme-data/gbd-2016-cancer-incidence-mortality-years-life-lost-years. [Accessed: 26-Dec-2019].
  4. Independent, ?The growing burden of cancer in Uganda, The Independent Uganda:, 04-Dec-2017. [Online]. Available: https://www.independent.co.ug/growing-burden-cancer-uganda/. [Accessed: 26-Dec-2019].
  5. Uganda Cancer Institute, ?UCI Financial Year 2014/15 Performance at a glance, Uganda Cancer Institute Newsletter, vol. 1, no. 4, Sep-2015.
  6. Uganda Cancer Institute, ?H.E Yoweri K. Museveni commissions the Research and out patients facility, Uganda Cancer Institute Newsletter, vol. 1, no. 3, Jun-2015.
  7. ?Risk factors to health, Risk factors and disease burden, Australian Institute of Health and Welfare. [Online]. Available: https://www.aihw.gov.au/reports/biomedical-risk-factors/risk-factors-to-health/contents/risk-factors-and-disease-burden. [Accessed: 26-Dec-2019].
  8. Uganda Cancer Institute, ?Cancer treatment guidelines. UCI Uganda, 2017.
  9. L. Holliday and V. Speirs, ?Choosing the right cell line for breast cancer research, Breast Cancer Res., vol. 13, no. 4, p. 215, Aug. 2011, doi: 10.1186/bcr2889.
  10. Dai, H. Cheng, Z. Bai, and J. Li, ?Breast Cancer Cell Line Classification and Its Relevance with Breast Tumor Subtyping, J Cancer, vol. 8, no. 16, pp. 3131?3141, Sep. 2017, doi: 10.7150/jca.18457.
  11. Lacroix and G. Leclercq, ?Relevance of breast cancer cell lines as models for breast tumours: an update, Breast Cancer Res. Treat., vol. 83, no. 3, pp. 249?289, Feb. 2004, doi: 10.1023/B:BREA.0000014042.54925.cc.
  12. ?5. The Health Care Delivery System | The Future of the Publics Health in the 21st Century | The National Academies Press. [Online]. Available: https://www.nap.edu/read/10548/chapter/7. [Accessed: 26-Dec-2019].
  13. ?A framework for improving early detection of breast cancer in sub-Saharan Africa: A qualitative study of help-seeking behaviors among Malawian women. - PubMed - NCBI. [Online]. Available: https://www.ncbi.nlm.nih.gov/pubmed/27528411. [Accessed: 26-Dec-2019].
  14. P. Akuoko, E. Armah, T. Sarpong, D. Y. Quansah, I. Amankwaa, and D. Boateng, ?Barriers to early presentation and diagnosis of breast cancer among African women living in sub-Saharan Africa, PLoS ONE, vol. 12, no. 2, p. e0171024, 2017, doi: 10.1371/journal.pone.0171024.
  15. Odongo, T. Makumbi, S. Kalungi, and M. Galukande, ?Patient delay factors in women presenting with breast cancer in a low income country, BMC Research Notes, vol. 8, no. 1, p. 467, Sep. 2015, doi: 10.1186/s13104-015-1438-8.
  16. Meacham, J. Orem, G. Nakigudde, J. A. Zujewski, and D. Rao, ?Exploring stigma as a barrier to cancer service engagement with breast cancer survivors in Kampala, Uganda, Psycho-Oncology, vol. 25, no. 10, pp. 1206?1211, 2016, doi: 10.1002/pon.4215.
  17. Espina, F. McKenzie, and I. Dos-Santos-Silva, ?Delayed presentation and diagnosis of breast cancer in African women: a systematic review, Ann Epidemiol, vol. 27, no. 10, pp. 659-671.e7, 2017, doi: 10.1016/j.annepidem.2017.09.007.
  18. E. Pace et al., ?Delays in Breast Cancer Presentation and Diagnosis at Two Rural Cancer Referral Centers in Rwanda, Oncologist, vol. 20, no. 7, pp. 780?788, Jul. 2015, doi: 10.1634/theoncologist.2014-0493.
  19. Luyeye Mvila et al., ?From the set-up of a screening program of breast cancer patients to the identification of the first BRCA mutation in the DR Congo, BMC Public Health, vol. 14, no. 1, p. 759, Jul. 2014, doi: 10.1186/1471-2458-14-759.
  20. Meier-Meitinger et al., ?Accuracy of radiological tumour size assessment and the risk for re-excision in a cohort of primary breast cancer patients, Eur J Surg Oncol, vol. 38, no. 1, pp. 44?51, Jan. 2012, doi: 10.1016/j.ejso.2011.10.008.
  21. Olayide, A. J. Halimat, O. A. Samuel, R. A. Ganiyu, and O. A. Soliu, ?Level of Awareness and Knowledge of Breast Cancer in Nigeria. A Systematic Review, Ethiop J Health Sci, vol. 27, no. 2, pp. 163?174, Mar. 2017.
  22. ?Cancer Institute halts radiotherapy services, Daily Monitor. [Online]. Available: https://www.monitor.co.ug/News/National/Cancer-Institute-halts-radiotherapy-services/688334-5306412-a3pleg/index.html. [Accessed: 26-Dec-2019].
  23. ?Cancer Institute racing to fix radiotherapy machine. [Online]. Available: https://observer.ug/news/headlines/58611-cancer-institute-racing-to-fix-radiotherapy-machine. [Accessed: 26-Dec-2019].
  24. ?COBALT-60 RADIOTHERAPY MACHINE INSTALLED ? RADIOTHERAPY SERVICES RESTORED AT UGANDA CANCER INSTITUTE | Ministry of Health. [Online]. Available: http://health.go.ug/content/cobalt-60-radiotherapy-machine-installed-%E2%80%93-radiotherapy-services-restored-uganda-cancer. [Accessed: 26-Dec-2019].
  25. ?100 Cancer Patients Treated at Agha Khan Hospital :, Uganda Radionetwork. [Online]. Available: https://ugandaradionetwork.net/story/100-cancer-patients-treated-at-agha-khan-hospital. [Accessed: 26-Dec-2019].
  26. Roth, M. Adler, T. Jain, and D. Bempong, ?Monographs for medicines on WHOs Model List of Essential Medicines, Bull. World Health Organ., vol. 96, no. 6, pp. 378?385, Jun. 2018, doi: 10.2471/BLT.17.205807.
  27. M. L. Nayyar et al., ?Responding to the Pandemic of Falsified Medicines, The American Journal of Tropical Medicine and Hygiene, vol. 92, no. 6_Suppl, pp. 113?118, Jun. 2015, doi: 10.4269/ajtmh.14-0393.
  28. World Health Organization, ?WHO Model List of Essential Medicines, 20TH Edition, Geneva, pages 26-31. Mar-2017.
  29. ?Drugs Approved for Breast Cancer, National Cancer Institute, 05-Apr-2011. [Online]. Available: https://www.cancer.gov/about-cancer/treatment/drugs/breast. [Accessed: 26-Dec-2019].
  30. Blagosklonny, ?Analysis of FDA approved anticancer drugs reveals the future of cancer therapy, Cell cycle (Georgetown, Tex.), vol. 3, pp. 1035?1042, Aug. 2004.
  31. Lumachi, A. Brunello, M. Maruzzo, U. Basso, and S. M. M. Basso, ?Treatment of estrogen receptor-positive breast cancer, Curr. Med. Chem., vol. 20, no. 5, pp. 596?604, 2013, doi: 10.2174/092986713804999303.
  32. ?NDA profile, National Drug Authority. [Online]. Available: https://www.nda.or.ug/nda-profile-page/. [Accessed: 26-Dec-2019].
  33. National Drug Authority, ?Drug register of medicines for human use in Uganda. 23-Aug-2018.
  34. ?Pharmacists question NDA ability to detect fake Hepatitis B vaccine, PML Daily, 20-Mar-2018. [Online]. Available: https://www.pmldaily.com/news/2018/03/pharmacists-question-nda-ability-to-detect-fake-hepatitis-b-vaccine.html. [Accessed: 26-Dec-2019].
  35. Degardin, Y. Roggo, and P. Margot, ?Understanding and fighting the medicine counterfeit market, Journal of pharmaceutical and biomedical analysis, vol. 87, Jan. 2013, doi: 10.1016/j.jpba.2013.01.009.
  36. ?Guidance on legal requirements for importation of drugs into Uganda, National Drug Authority, 27-Jun-2018. [Online]. Available: https://www.nda.or.ug/guidance-on-legal-requirements-for-importation-of-drugs-into-uganda/. [Accessed: 26-Dec-2019].
  37. ?Human Medicine Guidelines, National Drug Authority. [Online]. Available: https://www.nda.or.ug/human-medicine-guidelines/. [Accessed: 26-Dec-2019].
  38. ?THE HEALTH SECTOR PERFORMANCE IN LINE WITH THE NRM MANIFESTO 2016-2021 | Ministry of Health. [Online]. Available: http://health.go.ug/content/health-sector-performance-line-nrm-manifesto-2016-2021. [Accessed: 16-Jan-2020].
  39. Jaikumar and R. Jasmine, ?A review on a few medicinal plants possessing anticancer activity against human breast cancer, vol. 9, pp. 333?365, Jan. 2016.
  40. Gakwaya et al., ?Cancer of the breast: 5-year survival in a tertiary hospital in Uganda, Br J Cancer, vol. 99, no. 1, pp. 63?67, Jul. 2008, doi: 10.1038/sj.bjc.6604435.

[Stephen Lutoti, Pakoyo F. Kamba, Esther Katuura, Raphael Wangalwa, Andrew Mtewa, Patrick E. Ogwang, Jackson Mukonzo and Noleb Mugisha Mugume (2020); A REVIEW OF BREAST CANCER TREATMENT MODALITIES IN UGANDA : AN APPRAISAL OF THE BREAST CANCER DIAGNOSTIC PROCESS, REGULATORY APPROVAL AND SUPPLY SYSTEM OF STANDARDIZED ANTI-BREAST CANCER MEDICINES Int. J. of Adv. Res. 8 (2). 23-32] (ISSN 2320-5407). www.journalijar.com


Stephen Lutoti
Mbarara University of Science and Technology

DOI:


Article DOI: 10.21474/IJAR01/10431       DOI URL: http://dx.doi.org/10.21474/IJAR01/10431


Share this article