Breast Cancer as a Model to Improve Outcome of Cancer Care in Low‐ and Middle‐Income Countries

Elzawawy, Ahmed

doi:10.1007/s00268-014-2913-4

Cited by 1 publication

(1 citation statement)

References 6 publications

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“…Geographical isolation, inadequate financial resources, a preference for consulting traditional healers linked with cultural and religious beliefs, and a shortage of adequately trained healthcare professionals and facilities to diagnose and treat cancer are also widespread. Most LMICs also have limited cancer prevention and control policies and cancer registries able to monitor incidence and mortality [ 4 , 12 , 15 , 23 , 27 , 28 , 30 , 31 , 61 ].…”

Section: Discussionmentioning

confidence: 99%

Barriers to early presentation of breast cancer among women in Soweto, South Africa

et al. 2018

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PurposeReported breast cancer incidence is rising in South Africa, where some women are diagnosed late and have poor outcomes. We studied patient and provider factors associated with clinical stage at diagnosis among women diagnosed at the Chris Hani Baragwanath Academic Hospital in Soweto, Johannesburg in 2015–2016.MethodsFrom face-to-face interviewer-administered questionnaires we compared self-reported socioeconomics, demographics, comorbidities, risk factors, personal and health system barriers, and from patient clinical records, clinical staging, receptor subtype, and tumor grade among 499 consecutive women newly diagnosed with advanced stage (III/IV) breast cancer versus those diagnosed early (stage 0/I/II). Logistic regression models were used to identify factors associated with advanced stage at diagnosis.ResultsAmong the women, 243 (49%) were diagnosed at early and 256 (51%) at advanced stages. In the multiple logistic regression adjusted model, completion of high school or beyond (odds ratio (OR) 0.59, and greater breast cancer knowledge and awareness (OR 0.86) were associated with lower stage of breast cancer at presentation. Advanced stage was associated with Luminal B (OR 2.25) and triple-negative subtypes (OR 3.17) compared to luminal A, with delays >3 months from first breast symptoms to accessing the health system (OR 2.79) and with having more than 1 visit within the referral health system (OR 3.19) for 2 visits; OR 2.73 for ≥3 visits).ConclusionsLimited patient education, breast cancer knowledge and awareness, and health system inefficiencies were associated with advanced stage at diagnosis. Sustained community and healthcare worker education may down-stage disease and improve cancer outcomes.

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