[Management of breast cancer in Madagascar]

Retrospective analysis of management and outcome of breast cancer in Madagascar.

From January 1996 to December 1998, 259 women with breast cancer were seen in the only department of oncology of the island, located in Antananarivo. It is equipped with a cobalt unit (unavailable in 1996). There was no uniform policy on surgery. Chemotherapy and hormonotherapy were not available for all patients. Reduced equipment enabled a minimal pre-therapeutic workshop.

Mean age was 48.5 years. One hundred and fifty-six women were premenopausal. The majority (69%) lived less than 50 km from the department. Tumours were at an advanced stage in 67% of the cases; the mean delay for diagnosis was 9.4 months. Treatments were done with curative intent in 118 cases and with palliative intent in 64 cases. Partial surgery (89) was adequate in 40.5% of the cases; total mastectomy concerned 94 women. Axillary lymph node dissection was done in 94 cases and was positive in 76 cases. The number of involved nodes was noticed in 47 cases. Curative radiotherapy concerned 106 patients, 41 after total mastectomy and 44 after lumpectomy, and was exclusive in 21 cases. Palliative irradiation was done locally with hypofractionation for 35 patients. Chemotherapy was performed in 86 women. The 4-year survival of the 136 assessable patients was 73%.

Improvement in breast cancer treatment outcome in Madagascar is the result of earlier diagnosis of the disease. Information and education of the population together with caregivers are necessary, because updating and improving technical equipment is not currently possible due to the economic problems that the country has to face.