Epidemiological Trends of Breast Cancer in Southern Ethiopia: A Seven-Year Retrospective Review

Abstract

Introduction African women are affected by cancer at an early age of their productivity. However, the exact prevalence and incidence of cancer, including breast cancer is not known in most sub-Saharan African countries, including Ethiopia because of lack of well-established cancer registry. This study aims to assess the epidemiology of breast cancer at Hawassa University Comprehensive Specialized Hospital (HUCSH), the biggest referral hospital with cancer treatment center serving the southern part of the country. Methods Retrospective review of charts of all patients with a diagnosis of breast cancer between 2013 and 2019 at HUCSH was conducted. A standardized questionnaire was used to collect relevant data that include sociodemographic, symptoms, type of diagnosis, treatment, and outcomes. Data were entered using epidata version 3.1 and analyzed using MS Excel and SPSS version 20. Results Five hundred fifty-nine (18.6%) breast cancer cases were retrieved in 7 years between 2013 and 2019. Of this, 548 (98%) were women. The median ages of the patents were 38 years. Invasive ductal carcinoma was the leading 309 (55.3%) histologic type followed by 185 (33.1%) lobular carcinoma. One hundred seventy-seven (31.7%) were moderately differentiated and 155 (27.7%) were poorly differentiated. Three hundred seventy-two (66.5%) were advanced breast cancer (Stages III and IV). Trends of breast cancer showed the case load is continuously increasing except with a slight reduction of cases in between 2015 and 2016. The majority were advanced breast cancer occurring at an early age by the time diagnosis made. Invasive ductal carcinomas were the predominant one. The trend also showed a continuous increment of cancer case load. Therefore, cancer registration center establishment, community awareness creation, and intensive early detection strategy are mandatory.

Epidemiology of Breast Cancer in Sub-Saharan Africa

“…The median and peak ages have also been reported in some studies. The peak age of incidence of 47.8%, 52.5%, 57.4%, 57.5% and 57.9% between the 3rd and 5 th decades among patients in Rwanda, Lagos-Nigeria, Southern Ethiopia, Central African Republic and Northwest Amhara regions of Ethiopia, respectively [9,17,[19][20][21]. Similar report was observed among breast cancer patients in Adis Ababa Ethiopia with 63.1% at the same peak range [22].…”

“…Almost two-thirds of breast cancer patients are below 50 years old in Burkina Faso [23]. Gabretsadik A et al, in a seven-year (2013-2019) review, reported a median age of 38 years among patients in Southern Ethiopia [21]. Ouedraogo [9,18,19,23].…”

“…For example, Gabretsadik et al reported a higher number of cases in zones and districts closest to the tertiary hospital in Hawassa city; with the number of cases observed to thin out as the distance increases away from this specialist University hospital. It can be said that, unless a population-based survey is done, the true incidence/ prevalence and distribution of breast cancer in communities in sub-Saharan Africa may be unknown and estimates from institutions will be affected by Berksonian Bias [21].…”

“…In southern Ethiopia, there has been an increasing incidence of breast cancer between 2013 and 2019 according to institutional records. It has increased from 12.3% in 2013 to 19.0% in 2019 [21]. Nigeria has continuously shown increases in incident rates from 13.7 ASR between 1960 and 1969 to 50.4 ASR between 2000 and 2012 and has been projected to 84.2 ASR between 2013 and 2050 [3].…”

Epidemiology, Diagnosis and Survival of Breast Cancer: Data from the Population-Based Cancer Registry of the City of Parakou from 2017 to 2021

“…In our study, 88.88% of breast cancers were diagnosed with an advanced clinical stage (III and IV). The observation is the same in several other developing countries where 65% to 90% of breast cancers are seen in consultation at a late stage [18] [23] [26] [27] [28] [29] [30]. In developed countries, such Australia and England, 55.9% and 56.8% of breast cancers are diagnosed at a localized stage respectively [31] [32].…”