Breast cancer survival in Ethiopia: A cohort study of 1,070 women

Abstract

There is little information on breast cancer (BC) survival in Ethiopia and other parts of sub-Saharan Africa. Our study estimated cumulative probabilities of distant metastasis-free survival (MFS) in patients at Addis Ababa (AA) University Radiotherapy Center, the only public oncologic institution in Ethiopia. We analyzed 1,070 females with BC stage 1-3 seen in [2005][2006][2007][2008][2009][2010]. Patients underwent regular follow-up; estrogen receptor-positive and -unknown patients received free endocrine treatment (an independent project funded by AstraZeneca Ltd. and facilitated by the Axios Foundation). The primary endpoint was distant metastasis. Sensitivity analysis (worst-case scenario) assumed that patients with incomplete follow-up had events 3 months after the last appointment. The median age was 43.0 (20-88) years. The median tumor size was 4.96 cm [standard deviation (SD) 2.81 cm; n 5 709 information available]. Stages 1, 2 and 3 represented 4, 25 and 71%, respectively (n 5 644). Ductal carcinoma predominated (79.2%, n 5 1,070) as well as grade 2 tumors (57%, n 5 509). Median follow-up was 23.1 (0-65.6) months, during which 285 women developed metastases. MFS after 2 years was 74% (69-79%), declining to 59% (53-64%) in the worst-case scenario. Patients with early stage (1-2) showed better MFS than patients with stage 3 (85 and 66%, respectively). The 5-year MFS was 72% for stages 1 and 2 and 33% for stage 3. We present a first overview on MFS in a large cohort of female BC patients (1,070 patients) from sub-Saharan Africa. Young age and advanced stage were associated with poor outcome.

Biological and Clinicopathological Characteristics of Breast Cancer at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

“…Studies in Ghana indicated 25.6% of luminal A, 12.2% of luminal B and 49.9% of TNBC (27). The reasons for these difference results might be due to several reasons like variation in sampling size, method, period and protocol, in addition to reproductive factors, environmental and genetic factors [13,42]. We have also investigated the histological characteristics, the pathological stages and grades of breast cancer in the study subjects.…”

“…Absence of better treatment facilities and poor awareness of the public about breast cancer also contributes to the low survival rate in this region [10][11][12]. Breast cancer has got low attention and, still, the burden is extremely increasing in African countries, including Ethiopia [13]. The incidence is significantly lower in Eastern Africa with approximately 18,000 new cases each year.…”

Cost of Illness of Breast Cancer Patients on Chemotherapy in Addis Ababa Public Hospitals, the Case of Tikur Anbessa Specialized Teaching Hospital-Cross-Sectional Types of Study

“…There is also a huge financial strain on the patients and their care givers because the cost of treatment and follow-up [12]. This is severe in Ethiopia, since patients endure long appointment period for treatment from several weeks to months [13].…”

Why Do Women with Breast Cancer Get Diagnosed and Treated Late in Sub-Saharan Africa Perspectives from Women and Patients in Bamako, Mali

“…Most of the patients in Africa are not diagnosed or treated early enough to fully benefit from treatment, and 30.3-100% (depending on region) are diagnosed at a late stage with an average duration of symptoms of 8-12 months before diagnosis [3]. A median tumor size of 4.96 cm has been reported in a hospital cohort in Ethiopia [4]. Mammography screening programs are lacking for most African countries [5,6], and there is an urgent need to develop affordable and adequate approaches for early detection and efficient treatment [7][8][9][10].…”