Stage at diagnosis of breast cancer in sub-Saharan Africa: a systematic review and meta-analysis

Abstract

Summary Background The incidence of breast cancer in sub-Saharan Africa is relatively low, but as survival from the disease in the region is poor, mortality rates are as high as in high-income countries. Stage at diagnosis is a major contributing factor to poor survival from breast cancer. We aimed to do a systematic review and meta-analysis on stage at diagnosis of breast cancer in sub-Saharan Africa to examine trends over time, and investigate sources of variations across the region. Methods We searched MEDLINE, Embase, Web of Knowledge, and Africa-Wide Information to identify studies on breast cancer stage at diagnosis in sub-Saharan African women published before Jan 1, 2014, and in any language. Random-effects meta-analyses were done to investigate between-study heterogeneity in percentage of late-stage breast cancer (stage III/IV), and meta-regression analyses to identify potential sources of variation. Percentages of women with late-stage breast cancer at diagnosis in sub-Saharan Africa were compared with similar estimates for black and white women in the USA from the Surveillance, Epidemiology, and End Results database. Findings 83 studies were included, which consisted of 26788 women from 17 sub-Saharan African countries. There was wide between-study heterogeneity in the percentage of late-stage disease at diagnosis (median 74.7%, range 30.3–100%, I2=93.3%, p<0.0001). The percentage of patients with late-stage disease at diagnosis did not vary by region in black women, but was lower in non-black women from southern Africa than in black women in any region (absolute difference [AD] from black women in western Africa [reference group] −18.1%, 95% CI −28.2 to −8.0), and higher for populations from mixed (urban and rural) settings rather than urban settings (13.2%, 5.7 to 20.7, in analyses restricted to black women). The percentage of patients with late-stage disease at diagnosis in black Africans decreased over time (−10.5%, −19.3 to −1.6; for 2000 or later vs 1980 or before), but it was still higher around 2010 than it was in white and black women in the USA 40 years previously. Interpretation Strategies for early diagnosis of breast cancer should be regarded as a major priority by cancer control programmes in sub-Saharan Africa. Funding None.

Early detection and treatment strategies for breast cancer in low-income and upper middle-income countries: a modelling study

“…78% of patients with breast cancer in this region present with advanced-stage disease. 20 This proportion of advanced-stage distribution is substantially higher than the 60% advanced-stage rate in the Connecticut Tumor Registry from 1935 to 1941, 15 suggesting that many people with early stage disease are not accessing health care to be diagnosed and counted. The efficacy of organised screening depends on all patients having access to care and more than 70% of the population being screened, 33 which is not feasible in the East African region.…”

“…20 The underlying causes include patient delays in seeking care and inability of primary care health-care providers to recognise early stage tumours; more than 40% of cases in the East African region have delayed diagnosis (>12 months from symptomatic presentation to diagnosis). 21 Although patients with cancer undergo surgical resection, standard drug therapy (endocrine or chemotherapy) is not consistently available.…”

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

“…This fact is probably related to genetic and demographic differences [2], has enormous additional negative effects on children and families, and represents a great economic and social burden for countries. 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].…”

Mammogram history in Nigerian women: Age-related risk factors for breast cancer and educational implications

“…8 Therefore, these factors must be considered in health education initiatives to improve breast cancer awareness. 9 Breast cancer patients from sub-Saharan Africa are often of a younger chronological age, with an average age of onset of 35-49 years, 10 compared to around 71 years in European women. 11 The majority of breast cancer cases diagnosed in Africa occur in women aged ≤ 50 years.…”

“…Even women younger than 50 years should be specifically targeted by such health promotion campaigns, given the lower age of breast cancer onset in Nigerian women. 12 Lower uptake of mammography amongst younger women may contribute to the high proportion of advanced (stage III or IV) breast cancer cases reported in Nigeria (the highest in Africa), 10 because breast pathology may remain undetected for years.…”