PDF(Pubmed)
Abstract：
BACKGROUND: Breast cancer poses a significant health challenge in Sub-Saharan Africa, particularly in Ghana, where late-stage diagnoses and limited healthcare access contribute to elevated mortality rates. This study focuses on the crucial role of pathology and laboratory medical (PALM) services in the timely diagnosis of breast cancer within Ghana.
METHODS: A cross-sectional survey of hospitals was completed from November 2020 to October 2021, with 94.8% of identified in-country hospitals participating. Pathology service-related parameters assessed included whether pathology was available for the diagnosis of breast cancer on-site or via external referral, the number of pathology personnel, additional breast cancer diagnostic capabilities including estrogen and progesterone and/or HER2 testing, and the time from biopsy to patients receiving their results. Geospatial mapping was used to identify areas of limited access.
RESULTS: Of the 328 participating hospitals, 136 (41%) reported breast cancer pathology services, with only 6 having on-site capabilities. Pathology personnel, comprising 15 consultants and 15 specialists, were concentrated in major referral centers, particularly in Greater Accra and Kumasi. An assessment of referral patterns suggested that 75% of the population reside within an hour of breast cancer pathology services. Among the 136 hospitals with access to breast cancer pathology, only a limited number reported that results included ER/PR (38%) and HER2 testing (33%).
CONCLUSIONS: Ghana has been able to ensure significant pathology service availability through robust referral pathways with centralized labs. Despite this, difficulties persist with the majority of pathology results not including hormone receptor testing which is important in providing tumor specific treatment.
METHODS: A cross-sectional survey of hospitals was completed from November 2020 to October 2021, with 94.8% of identified in-country hospitals participating. Pathology service-related parameters assessed included whether pathology was available for the diagnosis of breast cancer on-site or via external referral, the number of pathology personnel, additional breast cancer diagnostic capabilities including estrogen and progesterone and/or HER2 testing, and the time from biopsy to patients receiving their results. Geospatial mapping was used to identify areas of limited access.
RESULTS: Of the 328 participating hospitals, 136 (41%) reported breast cancer pathology services, with only 6 having on-site capabilities. Pathology personnel, comprising 15 consultants and 15 specialists, were concentrated in major referral centers, particularly in Greater Accra and Kumasi. An assessment of referral patterns suggested that 75% of the population reside within an hour of breast cancer pathology services. Among the 136 hospitals with access to breast cancer pathology, only a limited number reported that results included ER/PR (38%) and HER2 testing (33%).
CONCLUSIONS: Ghana has been able to ensure significant pathology service availability through robust referral pathways with centralized labs. Despite this, difficulties persist with the majority of pathology results not including hormone receptor testing which is important in providing tumor specific treatment.
摘要：
背景：乳腺癌在撒哈拉以南非洲构成了重大的健康挑战，尤其是在加纳，晚期诊断和有限的医疗保健服务导致死亡率上升。这项研究的重点是病理学和实验室医学（PALM）服务在加纳乳腺癌的及时诊断中的关键作用。
方法：2020年11月至2021年10月完成了对医院的横断面调查，94.8%的国内医院参与了调查。评估的病理服务相关参数包括病理是否可用于现场或通过外部转诊诊断乳腺癌，病理学人员的数量，额外的乳腺癌诊断能力，包括雌激素和孕激素和/或HER2检测，以及从活检到患者接受检查结果的时间。地理空间制图用于识别访问受限的区域。
结果：在参与的328家医院中，136（41%）报告乳腺癌病理服务，只有6个有现场能力。病理学人员,由15名顾问和15名专家组成，集中在主要的转诊中心，特别是在大阿克拉和库马西。对转诊模式的评估表明，75％的人口居住在乳腺癌病理服务的一个小时内。在获得乳腺癌病理学的136家医院中，只有有限数量的报告结果包括ER/PR(38%)和HER2检测(33%).
结论：加纳已经能够通过集中实验室的强大转诊途径确保显著的病理学服务可用性。尽管如此,困难仍然存在，大多数病理结果不包括激素受体测试，这对提供肿瘤特异性治疗很重要。
方法：2020年11月至2021年10月完成了对医院的横断面调查，94.8%的国内医院参与了调查。评估的病理服务相关参数包括病理是否可用于现场或通过外部转诊诊断乳腺癌，病理学人员的数量，额外的乳腺癌诊断能力，包括雌激素和孕激素和/或HER2检测，以及从活检到患者接受检查结果的时间。地理空间制图用于识别访问受限的区域。
结果：在参与的328家医院中，136（41%）报告乳腺癌病理服务，只有6个有现场能力。病理学人员,由15名顾问和15名专家组成，集中在主要的转诊中心，特别是在大阿克拉和库马西。对转诊模式的评估表明，75％的人口居住在乳腺癌病理服务的一个小时内。在获得乳腺癌病理学的136家医院中，只有有限数量的报告结果包括ER/PR(38%)和HER2检测(33%).
结论：加纳已经能够通过集中实验室的强大转诊途径确保显著的病理学服务可用性。尽管如此,困难仍然存在，大多数病理结果不包括激素受体测试，这对提供肿瘤特异性治疗很重要。
