Determinants of advanced stage presentation of breast cancer in 87,969 Brazilian women

Abrahão, Karen de Souza; Bergmann, Anke; Aguiar, Suzana Sales de; Thuler, Luiz Cláudio Santos

doi:10.1016/j.maturitas.2015.07.021

Cited by 47 publications

(44 citation statements)

References 24 publications

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“…6,24,34 In other similar settings, less developed areas reportedly have more advanced stage at diagnosis than the cities. 27 We also found stage at diagnosis to be significantly better in secondary level facilities than at tertiary centres, perhaps because women may first present at secondary facilities, which may delay their presentation at tertiary hospitals, but more research is needed to confirm this.…”

Section: Discussionmentioning

confidence: 64%

“…23 The mean age at BC diagnosis was similar to that reported by other studies conducted in Nigeria 6,24 and other SSA countries. 25,26 Although some authors have associated younger age at diagnosis with later stage at presentation, 27 others have found the reverse. 14 We did not find an association between age at diagnosis and stage.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies in Nigeria 10 , other SSA countries 35 and other developing countries (e.g. Brazil 27 ) as well as multi-ethnic studies in the US 36 have associated low educational level with later stage diagnosis of BC. Educational level was also positively correlated with knowledge of BC symptoms in our study similar to findings by Marcu et al in the United Kingdom.…”

Section: Discussionmentioning

confidence: 99%

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Determinants of stage at diagnosis of breast cancer in Nigerian women: sociodemographic, breast cancer awareness, health care access and clinical factors

Jedy‐Agba

McCormack

Olaomi

et al. 2017

Cancer Causes Control

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Purpose Advanced stage at diagnosis is a common feature of breast cancer in Sub-Saharan Africa (SSA), contributing to poor survival rates. Understanding its determinants is key to preventing deaths from this cancer in SSA. Methods Within the Nigerian Integrative Epidemiology of Breast Cancer Study (NIBBLE) multicentre case-control study on breast cancer, we studied factors affecting stage at diagnosis of cases, i.e. women diagnosed with histologically confirmed invasive breast cancer between January 2014 and July 2016 at six secondary and tertiary hospitals in Nigeria. Stage was assessed using clinical and imaging methods. Ordinal logistic regression was used to examine associations of socio-demographic, breast cancer awareness, health care access and clinical factors with odds of later stage (I, II, III or IV) at diagnosis. Results A total of 316 women were included, with a mean age (SD) of 45.4 (11.4) years. Of these, 94.9% had stage information: 5 (1.7%), 92 (30.7%), 157 (52.4%), and 46 (15.3%) were diagnosed at stages I, II, III and IV, respectively. In multivariate analyses, lower educational level (odds ratio (OR) 2.35, 95% confidence interval: 1.04, 5.29), not believing in a cure for breast cancer (1.81: 1.09, 3.01), and living in a rural area (2.18: 1.05, 4.51) were strongly associated with later stage, whilst age at diagnosis, tumour grade and oestrogen receptor status were not. Being Muslim (vs. Christian) was associated with lower odds of later stage disease (0.46: 0.22, 0.94). Conclusion Our findings suggest that factors that are amenable to intervention concerning breast cancer awareness and health care access, rather than intrinsic tumour characteristics, are the strongest determinants of stage at diagnosis in Nigerian women.

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Determinants of stage at diagnosis of breast cancer in Nigerian women: sociodemographic, breast cancer awareness, health care access and clinical factors

Jedy‐Agba

McCormack

Olaomi

et al. 2017

Cancer Causes Control

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“…It results in approximately half a million deaths and approximate loss of 15 million disability‐adjusted life years . In Brazil, where its incidence increases by 1.8 cases per 100 000 inhabitants per year, existing socioeconomic inequality greatly influences the early diagnosis and prevention of breast cancer, thereby, creating a great challenge to the public health services focusing on the disease.…”

Section: Correlation Of Variables With Indicators Of Breast Cancer Inmentioning

confidence: 99%

Risk factors for breast cancer mortality: Evidence from Brazil

et al. 2018

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Breast cancer remains the leading type of cancer in women globally and accounts for 25% of all cancer cases diagnosed. It results in approximately half a million deaths and approximate loss of 15 million disability-adjusted life years. 1 In Brazil, where its incidence increases by 1.8 cases per 100 000 inhabitants per year, 2 existing socioeconomic inequality greatly influences the early diagnosis and prevention of breast cancer, 3 thereby, creating a great challenge to the public health services focusing on the disease.In addition to socioeconomic inequality, other existing forms of inequality in Brazil 4 can also influence the outcomes related to breast cancer. Moreover, all these factors contribute to increased rates of smoking, physical inactivity, excessive alcohol consumption, and overweight, which are risk factors for chronic diseases and are also related to breast cancer. 5 In this context, from a public health point of view, it is important to know which of these factors are associated with the incidence and mortality of such disease.Thus, we performed an ecological study analyzing secondary data obtained from the Department of Information Technology of SUS (DATASUS) and the United Nations Development Program (UNDP). The units of analysis were the years between 2006 and 2014. Deaths and hospital admissions for breast cancer in women were collected from the Mortality Information System and Hospital Information System (HIS), respectively. Both are available for public access in the Department of Information Technology of the Brazilian Unified Health System (SUS), maintained by the Brazilian Ministry of Health. Hospital admission and mortality rates were estimated by 100 000 women and age-standardized by age according to the World Health Organization by the direct method. After univariate analysis of the Pearson's correlation, a multiple linear regression was performed, adopting the stepwise backward strategy, using the criteria for the withdrawal of P > 0.20 model. The level of significance was 5%. The program used was Stata® (Stata Corp., College Station, TX, USA) 11.0. The main results found were that between 2006 and 2014, overweight, average cost of hospital admission, number of available SUS mammographs, and the HDI were the main factors that influenced the mortality and hospital admission rate of breast cancer in Brazil (Table 1). The model that analyzes the socioeconomic aspects presented better explanatory capacity (r 2 = 0.99) than the models related to T A B L E 1 Correlation of variables with indicators of breast cancer in Brazil Indicator Mortality a Hospital admission rate a r P b r P b Lifestyle Overweight women rate 0.927 <0.001 0.807 0.008 Rate of physically inactive women 0.422 0.257 0.317 0.405 Rate of women with alcohol abuse 0.204 0.597 0.069 0.859 Excessive smoking rate among women −0.698 0.036 −0.669 0.048 Health service Doctors c 0.979 <0.001 0.864 0.002 Beds c −0.935 0.002 −0.871 0.010 Mammographs in SUS c 0.959 <0.001 0.878 0.002 Socioeconomic Human development index 0.994 <0.001 0...

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“…Previous studies have demonstrated that delays in breast cancer presentation increase the chance of advanced disease at diagnosis, which results in more aggressive treatments and worse survival (Caplan, ; Richards et al, ). In Brazil, one study has indicated that younger age, low educational level, living in less developed geographical regions and presenting invasive ductal carcinoma and invasive lobular carcinoma and determinant factors associated with advanced stage breast cancer presentation in Brazilian women (Abrahão, Bergmann, Aguiar, & Thuler, ). In addition to advanced staging, other factors also directly influence prognosis, such as individual characteristics, molecular and tumoral aspects, health services use and time until diagnosis or treatment initiation (Balabram et al, ; Caplan, ; Richards et al, ).…”

Section: Introductionmentioning

confidence: 99%

Factors influencing delay in symptomatic presentation of breast cancer in Brazilian women

Medeiros

Thuler

Bergmann

2019

Health Soc Care Community

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The aim of this study was to evaluate delays in the presentation of symptomatic breast cancer in women (time interval between the perception of their first sign or symptom until the first medical appointment) and its risk factors. A cohort study composed of patients with breast cancer (symptomatic) admitted to an oncological centre in the city of Rio de Janeiro, Brazil was performed. The patients were interviewed during their first hospital visit. To assess time interval as a continuous variable, the median and interquartile ranges (IQR) were calculated. The outcome comprised delay in breast cancer presentation when time from the first sign or symptom perception to the first medical appointment was ≥90 days. A descriptive analysis was performed. The association between independent variables (epidemiological, social and demographic data, related to individual healthcare, clinical and current disease) and the outcome (delay in symptomatic presentation) was assessed by a univariate analysis applying odds ratios (OR). Associations with p < .20 in the univariate analysis were included in the multiple logistic regression model. Variables with a p < .05 were retained in the final model. A total of 388 women were included. The median time was of 41 days (interquartile range — IQR: 13.2–130.0); 34.3% delayed presentation at ≥ 90 days. After adjustment, the variables associated with a delay in presentation were frequency of gynaecological examination of over than 1 year (OR: 2.59, 95% CI: 1.67–4.05), no family history of breast cancer (OR: 1.96, 95% CI: 1.15–3.35), and income lower than the minimum wage (OR: 1.62, 95% CI: 1.03–2.55). A higher score in tangible support (OR: 0.98; 95% CI: 0.96–0.99) was associated with a lesser chance of delay in presentation. Thus, delay in presentation was associated with social barriers, access to health service, health information and individual factors.

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Determinants of advanced stage presentation of breast cancer in 87,969 Brazilian women

Cited by 47 publications

References 24 publications

Determinants of stage at diagnosis of breast cancer in Nigerian women: sociodemographic, breast cancer awareness, health care access and clinical factors

Determinants of stage at diagnosis of breast cancer in Nigerian women: sociodemographic, breast cancer awareness, health care access and clinical factors

Risk factors for breast cancer mortality: Evidence from Brazil

Factors influencing delay in symptomatic presentation of breast cancer in Brazilian women

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