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

Abstract

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.

Perceived barriers to early diagnosis of breast Cancer in south and southwestern Ethiopia: a qualitative study

“…Being from a rural residence and remote areas also contributes to delays in early diagnosis, similar to other studies conducted in African countries [20,21]. General lack of access to information through magazines, newspapers and media in rural areas was also described as a contributing factor for patients not seeking early medical attention when they noticed breast abnormalities.…”

“…Breast cancer awareness and knowledge about the benefits of early detection and diagnosis are poor in most sub-Saharan African countries including in Ethiopia, and consequently, advanced stage presentation is a common problem in the region [16][17][18][19]; and women living in rural areas present at a later stage of breast cancer than women living in urban areas [20,21].…”

Understanding Women’s Perspectives on Breast Cancer is essential for cancer control: Knowledge, Risk Awareness, and Care-seeking in Mwanza, Tanzania

“…This is worrisome that severity of symptoms is a motivator since it is the opposite of cancer controls "early detection" goal. Late presentation, diagnosis, and treatment have been serious challenges for breast cancer control in many other LMICs, but elevated breast cancer awareness has shown to be associated with higher breast self-examination practice frequency, screening participation, earlier presentation, and better follow-up to referral and treatment (8,15,25,26,(30)(31)(32)(33).…”

Implementing oncology clinical trials in Nigeria: A model for Capacity building.

“…Although Westernized lifestyle may be contributing to this surge in cancer incidence, the accompanying higher mortality rates in these vulnerable populations is alarming. [1] Compared to HICs, patients in LMICs present more often with locally-advanced stage or metastatic breast cancer due to patients' and health care providers' lack of knowledge and understanding of the disease, as well as the paucity of data on the biology of cancer in patients of African descent [2,3]. Providing cancer care in this environment has many challenges, such as lack of health infrastructure, clinical expertise, research infrastructure, human resources and non-implementation of health policies [4,5].…”