Monday, January 3, 2022





THE ISSUE:   Breast Cancer is the leading cause of cancer death in women in the world. Globally approximately 700,000 women will die from Breast Cancer in 2022.  While there has been great progress in treatment in high income countries. Low and middle income countries lag behind because of lack of access to diagnosis and affordable  treatments. While the 5 year survival rate for all breast cancer exceeds 80% in rich countries, the 5 year survival is approximately 15% in low income countries. Breast cancer is the second leading cause of death in women in Tanzania.  Even worse, breast cancer rates in Tanzania are projected to increase by 80% in the next decade. There are several reasons for these inequities.


THE PROBLEMS: 1) Late presentation. For cultural and geographic reasons breast cancer is still a hidden disease in Tanzania. Many Patients, families and communities consider this an unspeakable problem. This results in women presenting late in their disease which limits successful treatments.

     2) Lack of diagnostic facilities for pathological testing: There are many different kinds of breast cancer. Treatment begins with a surgical biopsy and then the biopsy specimen is sent to a laboratory. Identifying which kind of breast cancer the patient has determines what is the best treatment. Optimal treatment depends on the presence of estrogen receptors  ( ER) in the tumor. Estrogen receptor positive ( ER+) tumors can be treated with effective medicine taken as a pill. Estrogen receptor negative ( ER-) tumors  requires IV chemotherapy and / or radiation therapy. There a very few pathologists and pathology labs that are able to perform accurate diagnostic identification of breast biopsy specimens Tanzania. Additionally, there a very few patients who can afford to pay for pathological testing.

    3) Unaffordable and inaccessible treatments. Currently chemo and radiation therapy are only accessible at a few centers in the country. In contrast to expensive intravenous chemotherapy  or radiation therapy Tamoxifen, an estrogen receptor blocker, is inexpensive and easy to administer pill which is effective in treating ER+ breast tumors.

    ONE SOLUTION:  What if the diagnosis of a type of breast didn’t depend on a surgical biopsy or a hard to access expensive pathology lab? Could diagnosis be made with a simple blood specimen? It turns out there are blood tests that can identify  inflammatory agents ( biomarkers) that reflect the presence of  estrogen receptor positive ( ER+) breast cancer. This testing at local hospitals and clinics to identify the breast tumor sub type is called  Point of Care testing (POC). Point of care testing simplifies access and reduces cost. Estrogen Receptor ( ER) status determines treatment. ER+ breast cancers respond to hormonal therapy drugs such as Tamoxifen. 

   Targeted pragmatic treatment: Tamoxifen, which is classified as a WHO essential drug, is a low cost effective agent to treat ER+ breast tumors. This  could negate the need for radiation or chemo therapy which are prohibitive for poor rural populations.

   RESEARCH PROPOSAL: Instead of relying on hospital based pathological testing. This research project proposes to test the accuracy and efficiency of a  point of care

( POC) blood serum based analysis to identify a specific inflammatory BIO marker that identifies  ER+ breast tumors. ER status determines treatment. ER + breast tumors respond to Tamoxifen. This simplified and cost effective approach could save and extend lives in a resource poor country like Tanzania.

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