{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,15]],"date-time":"2026-11-15T06:27:41Z","timestamp":1794724061163,"version":"4.9.1"},"reference-count":41,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T00:00:00Z","timestamp":1763596800000},"content-version":"unspecified","delay-in-days":19,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,10,8]]},"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The expenses associated with cancer treatment are increasing at a rapid pace. The financial strain of providing care is experienced worldwide, but is particularly pronounced in low and middle-income countries (LMICs). This has resulted in a growing acknowledgement of the importance of value-based cancer care. Choosing Wisely Africa (CWA) is an initiative aimed at reducing the excessive use and expenses associated with cancer treatment. In this study, we assessed adherence to CWA recommendations for the treatment of breast cancer in three high-volume cancer centres in Sub-Saharan Africa (SSA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>\n                      A cross-sectional study across Rwanda, Ghana and Tanzania was conducted, involving a review of medical records to assess adherence to five measurable CWA practices in breast cancer care. The study used inferential statistics, such as \u03c7\n                      <jats:sup>2<\/jats:sup>\n                      tests, to compare adherence among these countries.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Settings<\/jats:title>\n                    <jats:p>This study was conducted in three cancer centres (Ocean Road Cancer Institute, Rwanda Military Hospital and Korle Bu Teaching Hospital) in three countries (Tanzania, Rwanda and Ghana, respectively).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>A total of 542 patients were recruited. Eligible patients were those with a breast cancer diagnosis and complete data as pertaining to five CWA recommendations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 542 participants with a mean age of 51 years were included. Participants were well distributed across Ghana (37%), Rwanda (34%) and Tanzania (29%). Female patients represented 97% of the study cohort. Half (51%) of the participants had some form of insurance. The study observed high adherence to cancer staging (94%) before treatment and histological confirmation (91%) before breast lump removal across all sites. Hypofractionation was used in 0% of cases in Rwanda, 42% in Ghana and 70% in Tanzania.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study provides critical insights into the implementation of CWA recommendations in breast cancer care in SSA. It highlights the disparities in adherence to CWA recommendations across different centres, showing the need for policy-driven changes and healthcare infrastructure improvement to standardise cancer care practices in LMICs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-093973","type":"journal-article","created":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T14:40:15Z","timestamp":1763736015000},"page":"e093973","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Adherence to Choosing Wisely Africa recommendations in breast cancer care: a cross-sectional study across three Sub-Saharan African centres"],"prefix":"10.1136","volume":"15","author":[{"given":"Fidel","family":"Rubagumya","sequence":"first","affiliation":[{"name":"Rwanda Military Hospital, Kigali, Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0385-3706","authenticated-orcid":false,"given":"Eulade","family":"Rugengamanzi","sequence":"additional","affiliation":[{"name":"Department of Oncology, Butaro Hospital, Burera, Rwanda"},{"name":"School of Medicine, University of Global Health Equity, Kigali, Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah K","family":"Nyagabona","sequence":"additional","affiliation":[{"name":"Department of Oncology, Muhimbili National Hospital, Dar es Salaam, Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jerry","family":"Ndumbalo","sequence":"additional","affiliation":[{"name":"Department of Oncology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Kwizera","sequence":"additional","affiliation":[{"name":"Department of Research, RD Rwanda, Kigali, Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aline","family":"Uwimbabazi","sequence":"additional","affiliation":[{"name":"Department of Research, RD Rwanda, Kigali, Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaligirwa","family":"Celyna","sequence":"additional","affiliation":[{"name":"Department of Oncology, Korle Bu Teaching Hospital, Accra, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Ayettey","sequence":"additional","affiliation":[{"name":"Department of Oncology, Korle Bu Teaching Hospital, Accra, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Verna","family":"Vanderpuye","sequence":"additional","affiliation":[{"name":"Department of Oncology, Korle Bu Teaching Hospital, Accra, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilma M","family":"Hopman","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, Queen\u2019s University, Kingston, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nazik","family":"Hammad","sequence":"additional","affiliation":[{"name":"Department of Oncology, St Michael\u2019s Hospital, Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher M","family":"Booth","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, Queen\u2019s University, Kingston, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,11,21]]},"reference":[{"key":"2026111421175000000_15.11.e093973.1","doi-asserted-by":"crossref","unstructured":"Johansen NJ , Saunders CM . 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