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Introduction One major limitation to cancer prevention and control in Africa has been lack of accurate and reliable epidemiological data. To date, there is no publicly available systematic review and meta-analysis on the prevalence of breast cancer in Africa. This data is important to understand the burden of the disease in Africa and identify areas lacking reliable studies. Objective The objective of this review was to examine the prevalence of breast cancer in Africa based on region, subtype, and screening. Methods A systematic search of MEDLINE, EMBASE, PUBMED, ISI Web of Science, BIOSIS, African Journal Online, and Global Health was conducted. We included population-based or hospital-based cancer registry studies on breast cancer conducted on African populations and providing estimates of breast cancer cases or prevalence over a period. A random effect meta-analysis was done to determine the pooled prevalence of breast cancer in Africa based on region, subtype and screening, using Stata Statistical Software: Release 16. College Station, TX: StataCorp LLC. Results Our search of databases yielded 2030 references that were imported into Covidence. A total of 44 studies were included in the review. The overall pooled prevalence of breast cancer in Africa was 0.48% (95% CI: 0.05-0.92). With regards to regional prevalence, the estimated prevalence of breast cancer among women in Sub-Saharan Africa (SSA), 0.68% (-0.03 - 0.1.39) was remarkably higher than that of women in North Africa (NA) 0.16% (95% CI: -0.11-0.42). Also, the overall prevalence of triple negative breast cancer (TNBC) among female breast cancer patients was 29.51% (CI: 23.94-35.08). A sub-group analysis revealed, TNBC was more prevalent in women from SSA 29.51 (CI: 23.94- 35.08, 18 studies) than women from NA 20.17(14.63-25.71, 8 studies). Meta-analysis of African women participation in Breast Self-Examination (BSE) produced a prevalence of 29.57 (CI: 7.90-51.25). This was higher than the prevalence of African women participation in Clinical Breast Examination and mammography, 12.22 (7.58-16.86). Conclusions Though the incidence of breast cancer in Africa is relatively low, the same cannot be said of its prevalence. Also, within Africa, there are clear regional and sub-regional differences in both breast cancer prevalence and the prevalence of TNBC among breast cancer patients. This may be attributed to limited infrastructure needed for breast cancer control and prevention especially within SSA regions. Establishment of robust hospital-based cancer registries in Africa will boost the collection of accurate and complete cancer data that can be used in epidemiological research, patient care improvement, and cancer control which will ultimately lead to the reduction of breast cancer burden in Africa. Citation Format: Livingstone Aduse-Poku, Kurt Fernando, Sabrina I. Fossi, Sylvester Antwi, Haythem Ali, Eleanor Walker, Evelyn M. Jiagge. A systematic review and meta-analysis of the prevalence of breast cancer in Africa: Identifying unanswered questions [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-152.

Introduction According to GLOBOCAN 2018 data, breast cancer (BC) is the leading cancer in women and the second cause of cancer mortality. Most BC studies in Ghana and other nations in the Sub-Saharan African regions have revealed that these BC are very aggressive and have poor prognostic features. However, previous studies on the clinical and pathological characteristics have been limited to data from single institutions and have used smaller sample sizes. Here we are reporting on the data from a pathology lab (Pathologists Without Borders) that serves patients from each of 16 regions of Ghana that are representative of more than 50% of the BC patients seen over the span of two years; this is due to the unique ability to sustain immunohistochemistry services for an entire year. Objectives The objective of this study is to more accurately report the clinical and histological characteristics of BC across the country to determine the distribution by age and subtype to better understand the relationship between West sub-Saharan African ancestry and aggressive triple negative BC. Methods With ethical approval, demographic, clinical and pathology data on patients with histological diagnosis of BC between 5/1/18 and 5/14/20 at participating healthcare facilities in Ghana were entered into a database. Immunohistochemistry for the estrogen receptor, progesterone receptor, and human epidermal growth factor (HER2) is based on the bio-SB semi-automated platform. A descriptive analysis on variables such as age, clinical diagnosis, tumor size, number of lymph nodes, tumor grade, and BC subtypes was performed. A comparative analysis of the various variables was done using IBM Statistical Package for Social Sciences (SPSS) for windows, version 26.0 at 5% confidence interval. Results A total of 1741 BC cases with a mean age of diagnosis, 51.70 ± 16.68 were included in the study. BC was diagnosed most frequently in patients ≥50 years (41.5%) and occurred more frequently on the left side (45.7%). The majority of BC were <1000g (61.7%), >5cm in size (67.8%) had no lymph nodes involvement (35.8%) and were grade II (49.7%). 32.0% of the patients were triple negative. Triple Negative Breast Cancers (TNBCs) were more frequently diagnosed in patients <40 years old (41.2%) who had T3 tumors (30.6%) that was <1000g (37.9%), >5cm in size, grade III (49.5%), and had >10 lymph nodes involved N3 (33.3%). Conclusion TNBCs and HER2+ tumors are the most frequently diagnosed BC in Ghana. The majority of the tumors present with aggressive features such as premenopausal diagnosis, large size, high grade, and have more lymph node involvement. This data is more representative of the characteristics of BC across the country. Here we demonstrate the importance of a standardized pathology reporting system across the country. Research should be carried into the molecular pathology of Ghanaian BC to ascertain reasons for high number of aggressive forms. Citation Format: Kafui Akakpo, Livingstone Aduse-Poku, Kurt Fernando, Lawrence Edusai, Simon Naporo, Sabrina I. Fossi, Sylvester Antwi, Evelyn M. Jiagge. Breast cancer in Ghana: A study of the characteristics of breast cancers reported nationally from 2018 to 2020 [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PR01.

Primary compression is known to be the major component in the settlement mechanism of Municipal Solid Waste (MSW). Presented in this paper are results obtained using a modified large-scale oedometer describing the primary compression characteristics of MSW dumped at the Hambantota open dump site in Sri Lanka. Samples from varying depths were extracted from the dump site to evaluate the compressibility characteristics of MSW in order to expand the existing dump site to landfill. The dumping area was divided into two categories corresponding to the age of the fill. Compressibility and composition of old (10 years) and new (2 years) waste showed similar characteristics. One-dimensional confined compression tests were conducted for shredded MSW recompacted at field densities. The compression index Cc was observed to vary from 0.15 to 0.27. However, after normalization by the initial void ratio eo, the modified compression index Cc ' varied in a narrow band between 0.08 and 0.11, signifying that Cc ' is the more suitable parameter to predict primary consolidation settlement of solid waste dump sites.

Objective This study aimed to elicit preferences for attributes of current and novel long-acting antiretroviral therapy for human immunodeficiency virus treatment. Methods Primary survey data were collected (July–October 2022) on a sample of 333 people living with human immunodeficiency virus in Germany from a patient recruitment agency. Respondents were invited by e-mail to respond to a web-based questionnaire. After performing a systematic literature review, we conducted qualitative semi-structured interviews to identify and select the key attributes of drug therapy for patients’ preferences for human immunodeficiency virus treatment. Based on this, a discrete choice experiment survey elicited preferences for long-acting antiretroviral therapy characteristics, including the type of medication, frequency of dosing, the location of treatment, the risk of both short-term and long-term side effects, as well as possible interactions with other medications or (party) drugs. A statistical data analysis was performed using multinomial logit models. An additional latent class multinomial logit was performed to evaluate subgroup differences. Results Overall, 226 respondents (86% male, mean age 46.1 years) were included in the analysis. The frequency of dosing (36.1%) and the risk of long-term side effects (28.2%) had the greatest influence on preferences. The latent class analysis identified two patient groups. While the first class ( n = 135; 87% male, mean age 44.4 years) found the frequency of dosing (44.1%) to be most important, the second class ( n = 91; 85% male, mean age 48.6 years) focused on the risk of long-term side effects (50.3%). The evaluation of structural variables showed that male respondents, those living in small cities or villages, and those with better health status results were significantly more likely to be assigned to the second class ( p < 0.05 each). Conclusions All attributes included in our survey were important to participants when choosing an antiretroviral therapy. We found evidence that the frequency of dosing as well as the risk of long-term side effects have a particular impact on the acceptance of novel therapy regimens and should be considered in order to optimize adherence and satisfaction. Supplementary Information The online version contains supplementary material available at 10.1007/s40271-023-00641-y.