Challenges of implementing an integrated electronic health record system in the Breast and Endocrine Clinic at Tygerberg Hospital, Cape Town, South Africa.

To the Editor: In low- to middle-income countries, the majority of patients with breast cancer are diagnosed with locally advanced disease. This remains a problem at the Tygerberg Hospital breast clinic in Cape Town, South Africa, with ~60% of all patients presenting with stage 3 or 4 disease at the time of diagnosis. The reasons cited are multiple and include fear, unawareness of disease severity, concerns surrounding losing a breast, unreliable transportation, referral difficulties and financial constraints.[1].