Titles and Affiliations
Assistant Professor of Medical Oncology
Duke Cancer Institute
Conquer Cancer, the ASCO Foundation
Research area
Assessing precision treatment strategies in managing breast cancer in South Africa
Impact
Breast cancer patients in South Africa face significantly different outcomes compared to those in resource-abundant countries, including lower survival rates and higher rates of recurrence of cancer. One promising approach to improve these outcomes is implementing de-escalation strategies in patients with early-stage, low-risk breast cancer. Treatment de-escalation in patients with low-risk breast cancer has been shown to be safe and effective in high-income countries. The benefits are two-fold: de-escalation can minimize patients’ exposure to unnecessary treatment-related side effects and free up medical resources that are needed for those who have more aggressive cancer.
Progress Thus Far
For her Conquer Cancer research supported by BCRF, Dr. Kwaramba and her team are analyzing data from the South Africa Breast Cancer and HIV Outcomes (SABCHO) cohort to determine how many patients are eligible for de-escalation strategies. These include omitting radiation therapy in older patients with early-stage, HR-positive breast cancer who undergo breast-conserving surgery and omitting chemotherapy after surgery in patients with early breast cancer who are at low risk for recurrence. Among nearly 2,600 women studied, a small percentage qualified for reduced radiation or chemotherapy. Of those, many still received the full treatments. Notably, survival rates were similar whether or not eligible women received these intensive treatments.
What’s Next
Dr. Kwaramba’s findings suggest that carefully reducing treatment in some patients could lower side effects, ease strain on the healthcare system, and still provide effective cancer care in South Africa. Further research is needed to support clinical adoption, and she will continue to assess current treatment patterns, recurrence rates, survival rates, and side effects experienced by patients to inform the decision-making process regarding de-escalation strategies.
Biography
Tendai Kwaramba, MSc, MD is an Assistant Professor of Medical Oncology at the Duke Cancer Institute. Before joining Duke University, she was a hematology/oncology fellow at Yale New Haven Hospital. Dr. Kwaramba received an MD at the University of North Carolina in Chapel Hill followed by an internal medicine residency at Tulane University where she was selected as a global health scholar and, in this capacity, traveled to Bugando Medical Center in Mwanza Tanzania. Her research has focused on global oncology and delivery of care, particularly racial disparities in the surveillance and epidemiology of cervical cancer which has led to several publications and presentations of her global work.
