Gaps in Primary Breast Cancer Management: Lessons from a Tertiary Centre's Referrals in Central India

Area of Science:

• Oncology
• Public Health
• Health Services Research

Background:

• Standardized breast cancer management, including triple assessment, significantly reduces mortality in developed countries.
• Adherence to these evidence-based practices is suboptimal in many resource-limited settings.
• Limited data exists on the quality of primary breast cancer management and referral patterns in these areas.

Purpose of the Study:

• To evaluate the adherence to standard breast cancer diagnostic and management protocols in secondary care facilities within a resource-limited setting.
• To identify deviations from established guidelines in primary breast cancer evaluation and surgical staging.
• To assess the impact of non-adherence on patient management and outcomes.

Main Methods:

• Retrospective analysis of 105 breast cancer patient records referred to a tertiary care center between January 2023 and December 2024.
• Review of primary evaluation, diagnostic procedures (mammography, core needle biopsy, fine needle aspiration cytology), and surgical interventions (lumpectomy, axillary staging) performed at secondary care facilities.
• Assessment of referral practices and documentation quality.

Main Results:

• None of the 105 patients received bilateral mammography or core needle biopsy, despite clear indications.
• 96 patients underwent lumpectomy based solely on fine needle aspiration cytology, without axillary staging.
• All patients were referred for chemotherapy post-lumpectomy, irrespective of further surgical indications, and primary surgical documentation was often inadequate.

Conclusions:

• Significant divergence from standard breast cancer management protocols was observed in secondary care facilities.
• Non-adherence to recommended diagnostic assessments and surgical staging compromises patient outcomes.
• Targeted education, infrastructural improvements, and systemic reforms are crucial to ensure adherence to evidence-based guidelines and improve breast cancer care in resource-constrained settings.