Global Stage Distribution of Breast Cancer at Diagnosis: A Systematic Review and Meta-Analysis

Abstract

Importance: Stage at diagnosis is a key prognostic factor for cancer survival.

Objective: To assess the global distribution of breast cancer stage by country, age group, calendar period, and socioeconomic status using population-based data.

Data sources: A systematic search of MEDLINE and Web of Science databases and registry websites and gray literature was conducted for articles or reports published between January 1, 2000, and June 20, 2022.

Study selection: Reports on stage at diagnosis for individuals with primary breast cancer (C50) from a population-based cancer registry were included.

Data extraction and synthesis: Study characteristics and results of eligible studies were independently extracted by 2 pairs of reviewers (J.D.B.F., A.D.A., A.M., R.S., and F.G.). Stage-specific proportions were extracted and cancer registry data quality and risk of bias were assessed. National pooled estimates were calculated for subnational or annual data sets using a hierarchical rule of the most relevant and high-quality data to avoid duplicates.

Main outcomes and measures: The proportion of women with breast cancer by (TNM Classification of Malignant Tumors or the Surveillance, Epidemiology, and End Results Program [SEER]) stage group.

Results: Data were available for 2.4 million women with breast cancer from 81 countries. Globally, the proportion of cases with distant metastatic breast cancer at diagnosis was high in sub-Saharan Africa, ranging from 5.6% to 30.6% and low in North America ranging from 0.0% to 6.0%. The proportion of patients diagnosed with distant metastatic disease decreased over the past 2 decades from around 3.8% to 35.8% (early 2000s) to 3.2% to 11.6% (2015 onwards), yet stabilization or slight increases were also observed. Older age and lower socioeconomic status had the largest proportion of cases diagnosed with distant metastatic stage ranging from 2.0% to 15.7% among the younger to 4.1% to 33.9% among the oldest age group, and from 1.7% to 8.3% in the least disadvantaged groups to 2.8% to 11.4% in the most disadvantaged groups.

Conclusions and relevance: Effective policy and interventions have resulted in decreased proportions of women diagnosed with metastatic breast cancer at diagnosis in high-income countries, yet inequality persists, which needs to be addressed through increased awareness of breast cancer symptoms and early detection. Improving global coverage and quality of population-based cancer registries, including the collection of standardized stage data, is key to monitoring progress.

Figure 1.. PRISMA 2020 Flow Diagram for New Systematic Reviews, Which Included Searches of Databases and Registers Only

Figure 2.. Proportion of Patients With Metastatic Breast Cancer at Diagnosis According to Country and World Region

^aProportion of missing stage was larger than 50%.

Figure 3.. Proportion of Patients With Metastatic Breast Cancer at Diagnosis According to Age Group, Country, and World Region

Young, middle, or older correspond to individuals with breast cancer aged younger than 50 years, aged 50 to 69 years, and older than 70 years, respectively. ^aThe age categories (young, middle, and older) of these countries differ. For a detailed list of the ages included in each group in these countries see eTable 4 in Supplement 1.