COMPARATIVE ANALYSIS OF MEDICAL EVACUATION VERSUS LOCAL SURGICAL MISSIONS FOR BREAST DISEASE MANAGEMENT IN RESOURCE-LIMITED SETTINGS: A CASE STUDY FROM GUINEA-BISSAU AND PORTUGAL jfmarques@ulslo.min-saude.pt

 

COMPARATIVE ANALYSIS OF MEDICAL EVACUATION VERSUS LOCAL SURGICAL MISSIONS FOR BREAST DISEASE MANAGEMENT IN RESOURCE-LIMITED SETTINGS: A CASE STUDY FROM GUINEA-BISSAU AND PORTUGAL

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Portugal

Poster Exhibition only

Breast cancer represents a significant and growing health concern in sub-Saharan Africa, where healthcare infrastructure limitations often result in late-stage presentations and limited treatment options. This study compares two approaches to breast disease management in resource-limited settings: medical evacuation to Portugal and local surgical missions in Guinea-Bissau.

We conducted a retrospective analysis of 57 patients (24 malignant, 33 benign) evacuated to Portugal and compared them with 97 patients treated during surgical missions in Guinea-Bissau. Statistical analyses included descriptive statistics, chi-square tests for categorical variables, independent t-tests for continuous variables, and multivariate logistic regression.

Patients in the evacuation cohort were significantly older (39.6 vs. 33.9 years, p=0.003) and had better access to diagnostic imaging (80.7% vs. 17.5%, p<0.001). The surgical mission cohort had significantly higher rates of advanced disease (100% vs. 70.8%) and lower follow-up compliance (7.7% vs. 83.3%, p<0.001). Multivariate analysis revealed that delayed presentation (OR 3.65, 95% CI 1.89-7.03), lack of diagnostic imaging (OR 2.41, 95% CI 1.32-4.39), and socioeconomic factors were independently associated with advanced disease. Medical evacuation was the strongest predictor of follow-up compliance.

Medical evacuation and local surgical missions serve complementary roles in breast disease management. Our findings support a risk-stratified approach, where complex cases benefit from evacuation while strengthening local capacity addresses more straightforward cases. This dual approach optimizes outcomes while building sustainable healthcare infrastructure in alignment with WHO's Global Breast Cancer Initiative Framework targets to reduce mortality.