Breast cancer in sub‐Saharan Africa: How does it relate to breast cancer in African‐American women?

Abstract

BACKGROUND African‐American women have had a lower incidence, yet higher mortality rate from breast cancer compared with White‐American women. African‐American women also have had a higher risk for early‐onset, high‐grade, node‐positive, and hormone receptor‐negative disease. Similar features have characterized hereditary breast cancer, prompting speculation that risk factors could be genetically transmitted. Further evaluation of this theory required the study of breast cancer among women from sub‐Saharan Africa because of their shared ancestry with African‐American women. METHODS Publications from 1988 to 2004 of English‐language literature on breast cancer in Africa were reviewed. RESULTS Women from sub‐Saharan Africa were found to have a low incidence of breast cancer. This was partly explained by a largely protective reproductive history, including late menarche, early menopause, high parity with prolonged breastfeeding, irregular menses, and fewer ovulatory cycles. The average age at diagnosis, however, was approximately 10 years younger than breast cancer patients of western nations, and disease stage distribution was shifted toward more advanced disease, which resulted in higher mortality rates. These features were found to be similar to data on breast cancer in African‐American women. Mutations in BRCA1 and BRCA2 have been reported in African‐American women, but the extent of the contribution of BRCA1 and BRCA2 to breast cancer burden in Africa was uncertain. Limited financial resources lead to suboptimal cancer data collection, as well as delayed diagnosis and treatment of many African breast cancer patients. CONCLUSIONS Parallels between breast cancer burdens of African‐American and sub‐Saharan–African women were provocative, indicating the need for further exploration of possible genetically transmitted features related to estrogen metabolism and/or breast cancer risk. Cancer 2005. © 2005 American Cancer Society.

Factors Delaying Presentation of Sudanese Breast Cancer Patients: an Analysis Using Andersen's Model

“…Such delayed diagnoses have been described as the main determinants of advanced stage BC (Unger-Saldaña, 2014;Fregene and Newman, 2005). Advanced cancers among Sudanese is a well-known issue since early eras.…”

Young breast cancer patients in the developing world: incidence, choice of surgical treatment and genetic factors

“…It is estimated that 70% of new cancer cases will occur in inhabitants of developing countries by the year 2020, and a vast number these cancers occurring in females will be of the breast. 5,10 There are differences in the breast cancer incidence and mortality rates in the different geographical areas of the continent. This may be due to poor reporting and data availability, difficulty in estimating population denominators or different ethnic compounds from region to region.…”

“…This may be due to poor reporting and data availability, difficulty in estimating population denominators or different ethnic compounds from region to region. 5 In developing countries, the average age at diagnosis of breast cancer may be younger than in developed countries, as data from eastern populations suggest. 7,12,14 In eastern Africa, it is estimated that the age standardised incidence rates (per 100,000 women) is 19.5 .…”

“…Late menarche, early age at birth of first child, multiparity and extended lactation all result in fewer ovulatory cycles, with lower endogenous oestrogen levels during a woman's lifetime. 5,15,16 Other protective factors such as being physically active, a diet rich in vegetables and grains, and low alcohol consumption are cited as benefits of the rural lifestyle. 5,15,16 With urbanisation, the Western lifestyle is frequently adopted, and thus the differences in incidence rates of breast cancer.…”

“…Of importance is the fact that African patients are more likely to be premenopausal when diagnosed with breast cancer 5 and present with breast cancer almost a decade earlier than their Western counterparts. 17 Breast cancer incidence is highest between the ages of 35-45 years in western Africa.…”