Abstract

Breast cancer is not only the most commonly occurring cancer among women, but also the most frequent cause of the cancer-related deaths in women in developing countries. Mortality rate is marginally higher in developing countries than in developed countries with about 60% of the death occurring in developing countries. In Tanzania for example, breast cancer is the second leading cancer in terms of incidence and mortality among women after cervical cancer. Approximately half of all women diagnosed with breast cancer in Tanzania die of the disease. This is due to poor and shortage of medical facilities for cancer screening and diagnosis, poor number of oncologists and pathologists and the diagnosis costs in the country. Due to the mentioned factors, it is approximated that, 80% of breast cancer cases in in Tanzania are diagnosed at advanced stages (III or IV), when treatment is less effective and outcomes are poor. By 2030, new breast cancer cases are approximated to increase by 82% in Tanzania. The diagnosis/screening of breast cancer starts with breast imaging with ultrasound and mammograms. Suspected cases are then subjected into pathology for confirmatory tests. Although breast imaging plays a major role in both breast cancer screening and diagnosis, the service is largely not available in many developing countries. Our study found absence of routinely breast cancer screening in Tanzania, resulting in late-stage detection of many cases. This is mainly due to lack of enough well-trained radiologists to read the images and the costs of the process. This study aimed at exploring the role and challenges of breast imaging in the screening and diagnosis of breast cancer in Tanzania, a developing country. Our results found that, there is a significant number of malignancies under the recommended age of breast cancer screening of fifty years of age. Our study also found a very high Inter variability among radiologists, which suggest the necessity of at least two radiologists reading same case before conclusion of the diagnosis. This study also discovered in our sample size that 66% patients did not have their samples taken for confirmation by the pathologists. This might be due to the costs of the process or loss of follow ups as many patients came far from diagnosis centre. Due to the challenges observed in breast imaging, this study recommends the use of Computer Aided Diagnosis (CAD) with Artificial Intelligence to assist the few numbers of radiologists available.

Keywords: Cancer; Diagnosis; Low-and Middle-Income Countries (LMICs); Pathology