Breast cancer survival and survival gap apportionment in sub-Saharan Africa (ABC-DO): a prospective cohort study

McCormack, Valerie; McKenzie, Fiona; Foerster, Milena; Zietsman, Annelle; Galukande, Moses; Adisa, Charles; Anele, Angelica A.; Parham, Groesbeck P.; Pinder, Leeya; Cubasch, Herbert; Joffe, Maureen; Beaney, Thomas; Quaresma, Manuela; Togawa, Kayo; Abedi‐Ardekani, Behnoush; Anderson, Benjamin O.; Schüz, Joachim; dos‐Santos‐Silva, Isabel

doi:10.1016/s2214-109x(20)30261-8

Cited by 144 publications

(180 citation statements)

References 26 publications

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“…Yet, despite this baseline poor prognosis among the general breast cancer population, this meta-analysis showed that WLWH in Sub-Saharan Africa do even worse in terms of survival compared to HIV-negative Sub-Saharan African women, despite adjustment for age, stage and subtype. This has been recently confirmed by the survival analysis of the ABC-DO study, showing that age-stage adjusted HR for 3-year all-cause mortality was 1.48 (95% CI, 1.22-1.81) among WLWH compared to HIV-negative women, which is similar to our findings [48].…”

Section: Discussionsupporting

confidence: 91%

Impact of HIV infection on baseline characteristics and survival of women with breast cancer

Brandão

Bruzzone

Franzoi

et al. 2020

Aids

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Background: As women living with HIV (WLWH) become older, their risk of developing breast cancer increases. Nonetheless, literature is conflicting regarding tumor stage, distribution of subtypes and overall survival among WLWH vs HIV-negative women with breast cancer. We assessed differences in clinicopathological characteristics and overall survival between these two groups. Methods: Systematic review and meta-analysis using MEDLINE, Scopus, ISI Web of Knowledge, LILACS, SciELO and conference abstracts up to 1/January/2020. Cross-sectional/cohort studies comparing baseline characteristics (stage and/or subtypes) and/or overall survival of WLWH vs HIVnegative women with breast cancer were included. We performed random-effects meta-analyses to estimate summary statistics and subgroup analyses according to region of the world. Results: 18 studies (4 from North America, 14 from Sub-Saharan Africa [SSA]) were included, with 3,174 WLWH and 2,394,598 HIV-negative women. WLWH from North America and SSA were more likely to present with stage III/IV disease compared to HIV-negative womenpooled odds ratio (pOR) 1.76 (95% confidence interval [CI]:1.58-1.95) and pOR 1.23 (95%CI:1.06-1.42), respectively. WLWH from SSA were also less likely to have estrogen receptor-positive/HER2-negative tumors (pOR 0.81; 95%CI:0.66-0.99). After adjustment, WLWH had worse overall survival compared to HIV-negative women, both in North America (pooled adjusted hazard ratio [aHR] 2.45; 95%CI:1.11-5.41) and SSA (aHR 1.43; 95%CI:1.06-1.92). Conclusions: Compared to HIV-negative women, WLWH are diagnosed with breast cancer at a more advanced stage and have a worse overall survival. These results should raise awareness regarding the detection and survival gap among WLWH with breast cancer and further studies are needed to decipher the reasons behind these disparities.

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Section: Discussionsupporting

confidence: 91%

Impact of HIV infection on baseline characteristics and survival of women with breast cancer

Brandão

Bruzzone

Franzoi

et al. 2020

Aids

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“…Because organized, population‐based mammography screening programs may not be cost effective or feasible in low‐resource settings, 50 efforts to promote early detection through improved breast cancer awareness and clinical breast examination by skilled health providers, 51,52 followed by timely and appropriate treatment, are essential components to improving survival 53 . A recent study conducted in 5 sub‐Saharan African countries estimated that 28% to 37% of breast cancer deaths in these countries could be prevented through earlier diagnosis of symptomatic disease and adequate treatment, with a fairly equal contribution of each 54 . The Breast Health Global Initiative has established a series of evidence‐based, resource‐stratified guidelines that supports phased implementation into real‐world practice 55‐57 …”

Section: Resultsmentioning

confidence: 99%

Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries

Sung

Ferlay

Siegel

et al. 2021

CA A Cancer J Clinicians

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46,994

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This article provides an update on the global cancer burden using the GLOBOCAN 2020 estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer. Worldwide, an estimated 19.3 million new cancer cases (18.1 million excluding nonmelanoma skin cancer) and almost 10.0 million cancer deaths (9.9 million excluding nonmelanoma skin cancer) occurred in 2020. Female breast cancer has surpassed lung cancer as the most commonly diagnosed cancer, with an estimated 2.3 million new cases (11.7%), followed by lung (11.4%), colorectal (10.0 %), prostate (7.3%), and stomach (5.6%) cancers. Lung cancer remained the leading cause of cancer death, with an estimated 1.8 million deaths (18%), followed by colorectal (9.4%), liver (8.3%), stomach (7.7%), and female breast (6.9%) cancers. Overall incidence was from 2‐fold to 3‐fold higher in transitioned versus transitioning countries for both sexes, whereas mortality varied <2‐fold for men and little for women. Death rates for female breast and cervical cancers, however, were considerably higher in transitioning versus transitioned countries (15.0 vs 12.8 per 100,000 and 12.4 vs 5.2 per 100,000, respectively). The global cancer burden is expected to be 28.4 million cases in 2040, a 47% rise from 2020, with a larger increase in transitioning (64% to 95%) versus transitioned (32% to 56%) countries due to demographic changes, although this may be further exacerbated by increasing risk factors associated with globalization and a growing economy. Efforts to build a sustainable infrastructure for the dissemination of cancer prevention measures and provision of cancer care in transitioning countries is critical for global cancer control.

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“…The number of maternal orphans was associated with maternal deaths in women younger than 50 years, and owing to higher fertility levels, particularly affected HIV-negative women and women in rural communities. Lower socioeconomic groups, which have lower breast cancer survival, 5 result in more maternal orphans, thus propagating a cycle of disadvantage.…”

Section: Discussionmentioning

confidence: 99%

“…3 Although half (48%) of these deaths occur in women younger than 50 years (eFigure in the Supplement), we are not aware of quantifications of the resulting maternal orphans. In the present study, we examined these numbers in the African Breast Cancer-Disparities in Outcomes (ABC-DO) cohort 4,5 and highlight the outcomes of the deaths in families.…”

mentioning

confidence: 99%

Maternally Orphaned Children and Intergenerational Concerns Associated With Breast Cancer Deaths Among Women in Sub-Saharan Africa

et al. 2021

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IMPORTANCE Low breast cancer survival in sub-Saharan Africa's young population increases the likelihood that breast cancer deaths result in maternal orphans, ie, children (<18 years) losing their mother.OBJECTIVE To estimate the number of maternal orphans and their ages for every 100 breast cancer deaths in sub-Saharan African settings during 2014-2019 and to describe family concerns about the orphaned children.DESIGN, SETTING, AND PARTICIPANTS Deaths occurring between September 1, 2014, and July 1, 2019, in the African Breast Cancer-Disparities in Outcomes (ABC-DO) were examined in a cohort of women diagnosed with breast cancer during 2014-2017 at major cancer treatment hospitals in Namibia, Nigeria, Uganda, and Zambia. The cohort was actively followed up for vital status via a trimonthly mobile phone call to each woman or her next of kin (typically a partner, husband, or child). MAIN OUTCOMES AND MEASURESThe number (Poisson counts) and ages of new orphans at the time of maternal death.RESULTS This cohort study found that a total of 795 deaths resulted in 964 new maternal orphans, with deaths occurring in women younger than 50 years accounting for 85% of the orphans. For every 100 deaths in women younger than 50 years, there were 210 new orphans (95% CI, overall, with country-specific estimates of 189 in Nigerian, 180 in Namibian, 222 in Ugandan, and 247 in Zambian Black women. For every 100 deaths of the women at any age, there were 121 maternal orphans, 17% of whom were younger than 5 years, 32% aged 5 to 9 years, and 51% aged 10 to 17 years at the time of maternal death. In follow-up interviews, families' concerns for children's education and childcare were reported to be exacerbated by the financial expenses associated with cancer treatment. CONCLUSIONS AND RELEVANCEThis study provides evidence that the number of maternal orphans due to breast cancer exceeds the number of breast cancer deaths among women in sub-Saharan Africa. The intergenerational consequences associated with cancer deaths in sub-Saharan Africa appear to be large and support the need for continued action to improve survival.

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Breast cancer survival and survival gap apportionment in sub-Saharan Africa (ABC-DO): a prospective cohort study

Cited by 144 publications

References 26 publications

Impact of HIV infection on baseline characteristics and survival of women with breast cancer

Impact of HIV infection on baseline characteristics and survival of women with breast cancer

Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries

Maternally Orphaned Children and Intergenerational Concerns Associated With Breast Cancer Deaths Among Women in Sub-Saharan Africa

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