Geospatial barriers to healthcare access for breast cancer diagnosis in sub‐Saharan African settings: The African Breast Cancer—Disparities in Outcomes Cohort Study

Abstract

We examined the geospatial dimension of delays to diagnosis of breast cancer in a prospective study of 1541 women newly diagnosed in the African Breast Cancer—Disparities in Outcomes (ABC‐DO) Study. Women were recruited at cancer treatment facilities in Namibia, Nigeria, Uganda and Zambia. The baseline interview included information used to generate the geospatial features: urban/rural residence, travel mode to treatment facility and straight‐line distances from home to first‐care provider and to diagnostic/treatment facility, categorized into country/ethnicity (population)‐specific quartiles. These factors were investigated in relation to delay in diagnosis (≥3 months since first symptom) and late stage at diagnosis (TNM: III, IV) using logistic regression, adjusted for population group and sociodemographic characteristics. The median (interquartile range) distances to first provider and diagnostic and treatment facilities were 5 (1‐37), 17 (3‐105) and 62 (5‐289) km, respectively. The majority had a delay in diagnosis (74%) and diagnosis at late stage (64%). Distance to first provider was not associated with delay in diagnosis or late stage at diagnosis. Rural residence was associated with delay, but the association did not persist after adjustment for sociodemographic characteristics. Distance to the diagnostic/treatment facility was associated with delay (highest vs lowest quartile: odds ratio (OR) = 1.56, 95% confidence interval (CI) = 1.08‐2.27) and late stage (overall: OR = 1.47, CI = 1.05‐2.06; without Nigerian hospitals where mostly local residents were treated: OR = 1.73, CI = 1.18‐2.54). These findings underscore the need for measures addressing the geospatial barriers to early diagnosis in sub‐Saharan African settings, including providing transport or travel allowance and decentralizing diagnostic services.

Factors associated with advanced stage diagnosis of breast cancer in North West Ethiopia. a cross-sectional study

“…This finding could be explained by the fact that patients from rural areas are farther away from diagnostic healthcare facilities and have low levels of information about breast cancer and transportation access; as a result, they present after the disease is advanced and metastasised. This result is in line with a study carried out in sub-Saharan Africa in which distance to the diagnostic/treatment facility is a problem in most African countries [43].…”

“…Distance to the nearby healthcare facility ≥5 km was also associated with late presentation of patients with breast cancer. Women living in the rural areas presented with advanced metastatic disease than women living in urban areas in Sudan and sub-Saharan Africa [ 42 , 43 ]. This might be due to the long distance travelling to cancer diagnostic centres as well as the difficulty of getting information access about breast cancer to understand the early symptoms of the disease.…”

Surveying and mapping breast cancer services in Ghana: a cross-sectional pilot study in the Eastern Region

“…The African Breast Cancer Disparities in Outcomes Cohort Study Open identified that distance to a diagnostic health facility was independently associated with a delay in diagnosis of greater than 3 months and late diagnosis (stage III/ IV) for women with breast cancer in Namibia, Uganda and Zambia. 37 In Ethiopia, rural residence and a distance greater than 5 km from a cancer referral centre were associated with a delay greater than 3 months between onset of symptoms and medical consultation. 38 Lastly, a diagnostic hospital in South Africa identified that their patients who lived farther from the hospital were more likely to have late stage (stage III/IV) breast cancer at time of diagnosis.…”

Self-reported arm and shoulder problems in breast cancer survivors in Sub-Saharan Africa: the African Breast Cancer-Disparities in Outcomes cohort study

“…In our study, a higher breast cancer stage at diagnosis was the most important determinant of self-reporting an ASP. In contrast to HICs where most women have an early stage diagnosis, late stage diagnosis for breast cancer is common in SSA due to low breast cancer awareness among both women and healthcare professionals, and long delays to presentation of symptomatic women to a healthcare provider, final diagnosis and treatment initiation, with disadvantaged populations being particularly affected [ 11 , 12 , 22 , 23 ]. In our cohort, three quarters of women had a late stage breast cancer at diagnosis, with nearly half having a tumour size over five centimetres and about two thirds positive lymph nodes at diagnosis.…”