Overcoming challenges of cancer treatment programmes in developing countries: a sustainable breast cancer initiative in Ethiopia.

The incidence of breast cancer is rising in many developing countries. Here we describe a programme to improve the support infrastructure for the management of patients with breast cancer in Addis Ababa, Ethiopia. Tamoxifen, a cheap, oral, yet effective, anti-cancer agent was made available freely to encourage staff and patients to follow well-defined, but achievable, protocols of care. Mammography, improved histopathological review, tissue hormone receptor assays, agreed treatment algorithms with a cycle of continuous audit of over 250 patients and cross-departmental patient management groups led to a considerable improvement in the management of breast cancer patients in a single institution. Aspects of this programme are now being extended to other regional hospitals in Ethiopia. Fairly limited investments in programmes for cancer can stimulate considerable improvements in the overall approach to malignant disease by encouraging a positive approach, even in very low resource environments.