Ethiopia

Advancing Breast Cancer Care in War-Torn Ethiopia

With breast cancer the most commonly diagnosed malignancy and the second leading cause of death among women ages 35-45 here, Lesley Taylor, M.D., has worked to expand access to diagnostics and treatment for over a decade

While Ethiopia has been in the grip of war and unrest for years, another battle is being waged on the medical front.

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Ethiopia on the map.

At 116 million people, Ethiopia has the 12th largest population in the world. Yet, with 80% of the population residing in rural areas on self-sustaining farms, the country has one of the lowest per capita incomes.  

Cancer is a leading cause of death here, with breast cancer the most commonly diagnosed malignancy and the second leading cause of death among women ages 35 to 45 (complications from pregnancy and childbirth is No. 1), according to the most recent data from the World Health Organization. Two-thirds of those breast cancer cases are estrogen-positive, a sometimes easier-to-treat form of the disease.  

Despite the civil unrest, “Breast cancer patients still need care. Nurses and physicians still show up, go to their hospitals and carry on their day,” said Lesley Taylor, M.D., a breast cancer surgeon at City of Hope®. “Research still needs to be done, and medical staff still need to be educated.”

Lesley Taylor, M.D.
Lesley Taylor, M.D.

Dr. Taylor, associate clinical professor in the Division of Breast Surgery, Department of Surgery, has always had a global view of health issues.

In 2009, when she was a surgical resident at the Albert Einstein College of Medicine in the Bronx, New York, she assembled a team to bring breast cancer services to a remote area in the Ecuadorean Andes. In one week, they were able to screen more than 800 women and arrange treatment when cancer was found.

Following the success of that program, Dr. Taylor’s mentor, Carol Harris, M.D., director of the Einstein Institute of Global HIV Medicine, told her, “‘There’s a huge problem in Ethiopia. Come with me, and let’s see what we can do about it,’” Dr. Taylor recalled. Soon after, she made her first trip to Ethiopia, in 2011.

What Has Been Achieved

Since then, Dr. Taylor has been dedicated to improving breast cancer care in the country. Although political instability in Ethiopia has led the U.S. State Department to restrict non-essential travel, the work of Dr. Taylor and her colleagues has not slowed down one bit.

“I haven't been in Ethiopia since 2016,” said Dr. Taylor. “We were doing this work with Zoom, even before Zoom became a thing during the pandemic.”

Despite these challenges, significant progress has been made. 

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Dr. Taylor with Netsanet Bogale, M.D., who leads the Hawassa University Comprehensive Specialized Hospital-Cancer Treatment Center. The photo shows two laptops and three iPads donated by City of Hope. The iPads are used by nurses as part of a study surveying patients on how best to support them as they prepare for surgery. 

In 2013, the first clinical oncology training program was established at Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia’s capital. Approximately 50 trained clinical and radiation oncologists have graduated from the program. The first graduating class in 2016 included Netsanet Bogale, M.D., who now leads the Hawassa University Comprehensive Specialized Hospital–Cancer Treatment Center, which is where Dr. Taylor’s team conducts the bulk of its work. This is only the second comprehensive treatment center for breast cancer in the country.

Since 2013, access to essential cancer drugs has also improved. Through initiatives like the Chemotherapy Access Partnership, led by the Clinton Health Access Initiative and the American Cancer Society, chemotherapy and hormone therapies have become more widely available. Additionally, Ethiopia now manufactures its own morphine, crucial for managing cancer pain.

In terms of diagnostics, the integration of genomics and advanced tumor analysis is essential for effective cancer treatment. Currently, most Ethiopians lack access to these technologies. “A diagnosis will confirm breast cancer but typically does not identify estrogen positivity,” Dr. Taylor explained. Only those who can afford private labs gain this critical information, which can affect treatment strategies and outcomes.

To address this gap, City of Hope is working to enhance diagnostic capabilities. Since January 2022, Dr. Taylor and colleagues have conducted trainings on manual immunohistochemistry, enabling local labs to check for antigen markers in resource-limited settings. 

Radiation treatment has expanded as well, with Hawassa launching the fourth operational radiation machine in the country in March 2024. 

Helping Reduce Breast Cancer Deaths Worldwide

A defining call to action has shaped Dr. Taylor’s approach to her most recent work in Ethiopia and her plans moving forward. 

In 2021, the World Health Organization’s Global Breast Cancer Initiative issued a call to reduce breast cancer deaths by 2.5% per year to save 2.5 million lives by 2040. 

In response to the WHO call, Dr. Taylor and a team at City of Hope created such projects as a nursing research and education program, a capacity-building program for pathology and a project aimed at expanding cancer treatment services.

Through their Comprehensive Oncology Nurse Training program, Dr. Taylor and team have trained 90 nurses. The program employs a train-the-trainer strategy, featuring in-person instruction led by Ethiopian faculty. 

Dr. Taylor and her team also developed educational films that teach nurses and other medical professionals how to perform clinical breast examinations, as well as fine needle aspirations to extract fluid to check for cancer cells. These films will become part of a continuing medical education course in 12 regional facilities across Kenya, extending their impact beyond Ethiopia.

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Ethiopian health care workers are trained in pathology in 2021. 

Dr. Taylor and her team have also worked to ensure accurate diagnoses by making sure preservatives and specimen containers are available for tissue samples. This pathology initiative also has provided training on specimen handling at 15 facilities. Beyond immediate training, the effort established a network of collaborators in sub-Saharan Africa that now includes nine countries, with 100 individuals engaged in ongoing education. 

Additionally, several key databases have been established to support ongoing research and treatment initiatives, such as the Breast Cancer Specific Database, which houses data on 154 patients, and the Population-Based Cancer Registry for Hawassa City, which has documented 400 cases, laying the groundwork for comprehensive cancer surveillance.

A quarterly Ethiopia Breast Tumor Board was also established, bringing together specialists to discuss cases and refine treatment standards. A new protocol was also introduced to support surgical patients, focusing on palliative, spiritual, supportive and rehabilitation care.

Finally, recognizing the importance of community engagement, Dr. Taylor’s team trained a cohort of individuals to educate the local population about breast cancer awareness.

Through these concerted efforts, the initiative is making strides in improving cancer care and outcomes in the region.

Recognition for the City of Hope-Ethiopia Breast Cancer Initiative

Dr. Taylor’s impressive work in Ethiopia has not gone unnoticed and has received support and recognition from both the private and public sectors.

Dr. Taylor, along with others from City of Hope and a medical team in Ethiopia, partnered with RevitaLash® Cosmetics to create the Ethiopia Breast Cancer Initiative to improve the detection, diagnosis and treatment of breast cancer, specifically in the people of Hawassa. Many of the  projects at the Hawassa University Comprehensive Specialized Hospital Cancer Treatment Center were made possible through this partnership.

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Ethiopian women gather wood near Hawassa City in 2023. 

In addition, the Ethiopia Breast Initiative and the Hawassa treatment center were among programs recognized by the Biden Administration as aligning with a Cancer Moonshot priority “to decrease the burden of cancer in Africa.”

A statement from the White House says these projects were chosen based on their “shared vision” to deliver improved health outcomes on the continent.

“Breast cancer mortality worldwide is highest in sub-Saharan Africa,” Dr. Taylor said. “We can prevent up to one-third of the projected deaths in the region from breast cancer with improved diagnosis and treatment. That’s the goal of this initiative. We are so delighted that the Biden Administration has recognized our work.”


Main image: Pathology faculty and residents looking at slides together at Hawassa University Comprehensive Specialized Hospital's Department of Pathology in 2022.