14 Advancing Breast Cancer Diagnosis in Rural Kenya: Bridging Histopathological Gaps Toward Global Breast Cancer Initiative (GBCI) Goals

Background

Breast cancer disproportionately impacts low-middle income countries such as Kenya. In Kisumu, over 75% of cases present with advanced disease due to high diagnostic costs, limited access, low awareness, and systemic delays. The World Health Organization (WHO) Global Breast Cancer Initiative targets diagnosis within 60 days; Kenya’s National Cancer Control Strategy (2023-2028) emphasizes equitable diagnostic access. We have implemented an accelerated histopathological diagnostic project to reduce delays and improve access to diagnosis at Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) through subsidized breast core needle biopsy (CNB), histopathology, and immunohistochemistry (IHC) with patient navigation.

Materials and Methods

Prospective cohort study between JOOTRH, Africa Cancer Foundation, Matibabu Foundation, and Tiba Foundation (January-December 2025) identified 158 patients presenting with breast masses for subsidized CNB, histology, IHC, and navigation (Table). Diagnostic turnaround times (TAT) and patient-level data were tracked.

Results

A total of 104 patients with invasive breast carcinoma were included; contact-to-biopsy TAT averaged 0.22 days (100% met<2-day target). Average laboratory TAT for histopathology and IHC were 21.4 days (8.65% met 10-day target) and 11.3 days (32.69% met 10-day target), respectively. Mean patient age was 50.11 years (±15.4). A total of 48.08% were premenopausal, with a mean of 36.7 years (±7.5). Most were rural (84.2%), were unemployed/informally employed (82.40%), faced median 8-month prediagnostic delays, visited multiple hospitals before diagnosis (mean, 3.79 hospitals/hospital visits), and reported financial barriers (75%). Also, 48.8% of patients were hormone receptor positive, 14.42% were HER2 amplified, and 28.85% had triple-negative breast cancer (TNBC). The median duration of symptoms was 11.5 months (IQR, 20.0), and 92.31% presented after more than 3 months of symptomatology. Self-reported barriers to diagnosis were primary household delays (78.85%) and hospital diagnostic delays (88.46%). Seventeen women (16.35%) have died; median duration of follow-up before mortality was 86.1 days.

Conclusion

Access to breast cancer diagnosis remains a challenge in Western Kenya. Importantly, receptor status was unknown compared with Western populations. The project established baseline data on breast cancer in the region: Patients are younger, present with more advanced and aggressive disease, and experience higher mortality rates compared with high-income countries. Critical to designing a comprehensive cancer approach was understanding that rates of HER2-amplified/TNBC comprised over 43% of patients. These data have allowed for targeted planning to shorten histopathology TAT, strengthen referral pathways to chemotherapy, and secure sustainable financing for diagnostic services and infrastructure to reduce the mortality and to meet WHO and National Cancer Control program targets.