Preexisting morbidity profile of women newly diagnosed with breast cancer in sub‐Saharan Africa: African Breast Cancer—Disparities in Outcomes study

Abstract

The presence of preexisting morbidities poses a challenge to cancer patient care. There is little information on the profile and prevalence of multi‐morbidities in breast cancer patients across middle income countries (MIC) to lower income countries (LIC) in sub‐Saharan Africa (SSA). The African Breast Cancer–Disparities in Outcomes (ABC‐DO) breast cancer cohort spans upper MICs South Africa and Namibia, lower MICs Zambia and Nigeria and LIC Uganda. At cancer diagnosis, seven morbidities were assessed: obesity, hypertension, diabetes, asthma/chronic obstructive pulmonary disease, heart disease, tuberculosis and HIV. Logistic regression models were used to assess determinants of morbidities and the influence of morbidities on advanced stage (stage III/IV) breast cancer diagnosis. Among 2189 women, morbidity prevalence was the highest for obesity (35%, country‐specific range 15‐57%), hypertension (32%, 15‐51%) and HIV (16%, 2‐26%) then for diabetes (7%, 4%‐10%), asthma (4%, 2%‐10%), tuberculosis (4%, 0%‐8%) and heart disease (3%, 1%‐7%). Obesity and hypertension were more common in upper MICs and in higher socioeconomic groups. Overall, 27% of women had at least two preexisting morbidities. Older women were more likely to have obesity (odds ratio: 1.09 per 10 years, 95% CI 1.01‐1.18), hypertension (1.98, 1.81‐2.17), diabetes (1.51, 1.32‐1.74) and heart disease (1.69, 1.37‐2.09) and were less likely to be HIV positive (0.64, 0.58‐0.71). Multi‐morbidity was not associated with stage at diagnosis, with the exception of earlier stage in obese and hypertensive women. Breast cancer patients in higher income countries and higher social groups in SSA face the additional burden of preexisting non‐communicable diseases, particularly obesity and hypertension, exacerbated by HIV in Southern/Eastern Africa.

Multimorbidity and overall survival among women with breast cancer: results from the South African Breast Cancer and HIV Outcomes Study

“…In our previous studies, we found that women who were obese and hypertensive were more likely to present with early-stage breast cancer and that multimorbidity was not associated with the stage of breast cancer diagnosis [ 12 , 16 ]. We also found that in early-stage breast cancer, women with multimorbidity were less likely to have surgery, less likely to receive chemotherapy, and more likely to receive endocrine therapy than those with a low multimorbidity burden [ 12 ].…”

Multimorbidity in Sudanese women newly diagnosed with breast cancer: a retrospective cross-sectional study

“…Patients, and especially those who are elderly, may have comorbidities when they are diagnosed with cancer. 6 Previous studies have shown that 20-35% of women with breast cancer have one or more comorbidities at the time of breast cancer diagnosis. 6 The presence of comorbidities at the time of diagnosis of breast cancer poses an additional challenge for the management of the disease.…”

“…6 Previous studies have shown that 20-35% of women with breast cancer have one or more comorbidities at the time of breast cancer diagnosis. 6 The presence of comorbidities at the time of diagnosis of breast cancer poses an additional challenge for the management of the disease. 7 Communicable disease, urbanization, and cardiovascular disease are risk factors for breast cancer.…”

“…9 Investigating the presence of comorbidities along with breast cancer is very important not only because they are potential risk factors for breast cancer but also because they can affect the stage of the disease at diagnosis, the treatment modality, and the prognosis of the disease. 6,9 Breast cancer is the most frequent hospital-treated malignancy in Sudan. Its incidence and mortality in the country have been estimated at 22.5 and 16.6 per 100,000 women (among hospital treated malignancy), respectively.…”

“…12 Increased life expectancy also results in multimorbidity (coexisting diseases) at the personal level, including in breast cancer patients. 6 The aim of this study is to estimate the prevalence and associated factors for multimorbidity (hypertension, obesity, diabetes, cardiovascular disease, asthma, tuberculosis, and HIV) and their association with breast cancer stage in women newly diagnosed with breast cancer in eastern Sudan.…”