一次医療における乳がん管理のギャップ：インド中部における三次医療センターへの紹介からの教訓

Early detection and standardized management of breast cancer through triple assessment have significantly reduced mortality in developed nations. However, the adherence to these practices remains suboptimal in many resource-limited settings, with little data on primary management quality and referral practices. We retrospectively analyzed the records of 105 breast cancer patients referred to our tertiary care centre between January 2023 and December 2024, after undergoing primary evaluation and surgery at secondary care facilities. None of the patients underwent bilateral mammography or core needle biopsy, despite clear indications. Ninety-six patients had lumpectomy based solely on fine needle aspiration cytology, without axillary staging. Post-lumpectomy, all patients were referred for chemotherapy, regardless of further surgical indications. Documentation of primary surgery was often inadequate, leaving gaps in critical treatment details. Our findings reveal a significant divergence from standard breast cancer management protocols at secondary care facilities. Such non-adherence to recommended diagnostic assessments and surgical staging compromises patient outcomes. Addressing these gaps requires targeted education for secondary care physicians, infrastructural upgrades, and systemic reforms to ensure adherence to evidence-based guidelines. Bridging these gaps is essential to improve breast cancer outcomes in resource-constrained settings.