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. 2020 Mar 1;146(5):1208-1218.
doi: 10.1002/ijc.32406. Epub 2019 Jun 14.

Breast cancer survival in sub-Saharan Africa by age, stage at diagnosis and human development index: A population-based registry study

Walburga Y Joko-Fru  1   2 , Adalberto Miranda-Filho  3 , Isabelle Soerjomataram  3 , Marcel Egue  4 , Marie-Therese Akele-Akpo  4 , Guy N'da  5 , Mathewos Assefa  6 , Nathan Buziba  7 , Anne Korir  8 , Bakarou Kamate  9 , Cheick Traore  9 , Shyam Manraj  10 , Cesaltina Lorenzoni  11 , Carla Carrilho  11 , Rolf Hansen  12 , Anne Finesse  13 , Ntuthu Somdyala  14 , Henry Wabinga  15 , Tatenda Chingonzoh  16 , Margaret Borok  17 , Eric Chokunonga  17 , Biying Liu  1   2 , Eva Kantelhardt  18 , Paul McGale  19 , Donald M Parkin  1   2
Affiliations

Breast cancer survival in sub-Saharan Africa by age, stage at diagnosis and human development index: A population-based registry study

Walburga Y Joko-Fru et al. Int J Cancer. .

Abstract

Breast cancer is the leading cancer diagnosis and second most common cause of cancer deaths in sub-Saharan Africa (SSA). Yet, there are few population-level survival data from Africa and none on the survival differences by stage at diagnosis. Here, we estimate breast cancer survival within SSA by area, stage and country-level human development index (HDI). We obtained data on a random sample of 2,588 breast cancer incident cases, diagnosed in 2008-2015 from 14 population-based cancer registries in 12 countries (Benin, Cote d'Ivoire, Ethiopia, Kenya, Mali, Mauritius, Mozambique, Namibia, Seychelles, South Africa, Uganda and Zimbabwe) through the African Cancer Registry Network. Of these, 2,311 were included for survival analyses. The 1-, 3- and 5-year observed and relative survival (RS) were estimated by registry, stage and country-level HDI. We equally estimated the excess hazards adjusting for potential confounders. Among patients with known stage, 64.9% were diagnosed in late stages, with 18.4% being metastatic at diagnosis. The RS varied by registry, ranging from 21.6%(8.2-39.8) at Year 3 in Bulawayo to 84.5% (70.6-93.5) in Namibia. Patients diagnosed at early stages had a 3-year RS of 78% (71.6-83.3) in contrast to 40.3% (34.9-45.7) at advanced stages (III and IV). The overall RS at Year 1 was 86.1% (84.4-87.6), 65.8% (63.5-68.1) at Year 3 and 59.0% (56.3-61.6) at Year 5. Age at diagnosis was not independently associated with increased mortality risk after adjusting for the effect of stage and country-level HDI. In conclusion, downstaging breast cancer at diagnosis and improving access to quality care could be pivotal in improving breast cancer survival outcomes in Africa.

Keywords: Africa; breast cancer; human development index; stage; survival.

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Figures

Figure 1
Figure 1
Overall Kaplan–Meier survival for all registries combined (a), by age (b), stage (c) and country level Human Development Index (d).
Figure 2
Figure 2
Relative survival (RS) from breast cancer at 1, 3 and 5 years after diagnosis, by registry. [Color figure can be viewed at http://wileyonlinelibrary.com]
Figure 3
Figure 3
Relative survival by country‐level Human Development Index (HDI) and stage at diagnosis. [Color figure can be viewed at http://wileyonlinelibrary.com]
See this image and copyright information in PMC

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