Over 50% of breast cancers in Kenya are locally advanced on presentation, making their management in our resource-poor setting very difficult. When possible, published protocols for managing LABC – such as those from the NCCN in the USA – are followed; however, in many cases these are unsuitable, as they are predicated on resources that are unavailable to most Kenyans. Surgery becomes a more important option due to its relatively low cost compared to other treatment modalities, such as chemotherapy, radiotherapy and biological therapies. Wide and complete excision of localized breast cancer is often the only option, so techniques and skill to do this are vital to the breast surgeon. Advances in Universal Health Coverage in Kenya show promise in improving the multidisciplinary care of these patients.

Using breast cancer as an example this presentation will provide a situational analysis of sample handling processes in sub -Saharan Africa, specifically in Kenya, and its impact on hormone receptor and HER2 results.The presentation will also discuss the efforts being made to standardise the pre-analytic processes of sample handling in Kenya and the move towards sample handling guideline development.

Sentinel lymph node biopsy (SLNB) has become standard of care for early breast cancer. SLNB has several advantages over axillary lymph node dissection (ALND) including decreased intra-operative complications, operative time, post-operative recovery and significantly decreased rates of post-operative lymphoedema. Traditionally, sentinel lymph node biopsies have been done with a dual technique including a blue dye and nuclear medicine nanocolloid. Until a few years ago, most patients undergoing SLNB required frozen section to confirm the status of the sentinel node. The need for nuclear medicine facilities and on site pathology has made SLNB biopsy inaccessible for many surgeons in Sub-Saharan Africa. New technologies in SLNB which utilise lymphophilic microparticles that are not radioactive are emerging. For example, one such technology uses iron microparticles coupled with a magnetic probe and is increasingly being used in both the developed and developing world. At the same time, indications for intra operative frozen section are changing with new practice guidelines suggesting sampling the clinically and radiologically node negative axilla without proceeding to frozen section +- ALND. These changes have the potential to make SLNB more accessible to regional and district hospitals in the Sub-Saharan context.