Table 3.

NCCN and Tanzanian Guidelines Based Opportunities for Improvement.

Category	NCCN Harmonized Guideline	Tanzania Guideline	Data from Bugando Medical Centre	Recommendation
Lymph Node Evaluation	Node evaluation should be performed minimally with a full axillary lymph node dissection.	Before intervention, an attempt should be made to stage all patients using proper TNM parameters.	• 75/164 (56%) received axillary staging • 60/164 (44%) no axillary staging	Axillary evaluation for all patients
Staging Evaluation	If symptomatic, chest imaging (x-ray/CT) and abdominal imaging (ultrasound/CT) should be performed.	Chest x-ray and CT chest with contrast if pulmonary symptoms, abdominal pelvic US should always be performed.	• All treated breast cancer patients presented with focal breast symptoms • Abdominal pelvic US in 107/164 (65%) of patients • Only 37/164 (23%) underwent both chest and abdominal imaging	Abdominal US for all patients given high burden of late-stage disease
Histopathology	Cancer diagnosis should be confirmed with histopathology.	Histopathology should be reported by specialist pathologists, and reviewed with a panel of pathologists before treatment is instituted at a specialist treatment center.	• 113/164 (69%) histopathology confirmed cases • 51/164 (31%) treated on the basis of clinical suspicion	Confirmation histopathology for diagnosis in all patients
Hormone Receptor Testing	Hormone receptor testing should be performed to subtype cancer and guide treatment.	Immunohistochemistry for ER and PR must be done.	• 13/164 (9%) underwent ER/PR testing • 144/164 (91%) did not undergo receptor testing	ER/PR receptor testing at for all patients to select patients for adjuvant endocrine therapy

TNM: Tumor, Node, Metastases; CT: Computed Tomography; ER: Estrogen Receptor; PR: Progesterone Receptor