Stage at breast cancer diagnosis and distance from diagnostic hospital in a periurban setting: A South African public hospital case series of over 1,000 women

Abstract

Advanced stage at diagnosis contributes to low breast cancer survival rates in sub-Saharan Africa. Living far from health services is known to delay presentation, but the effect of distance, the radius at which the effect sets in and the women most affected has not been quantified. In a peri-urban South African setting, we examined the effect of a GIS-measured straight-line distance, from a patient’s residence to diagnostic hospital, on stage at diagnosis in 1071 public-sector breast cancer patients diagnosed during 2006–12. Generalized linear models were used to estimate risk ratios for late stage (stage III/IV vs stage I/II) associated with distance, adjusting for year of diagnosis, age, race and socioeconomic indicators. Mean age of patients was 55 years, 90% were Black African, and diagnoses were at stages I (5%), II (41%), III (46%) and IV (8%). 62% of patients with distances >20 km (n=347) had a late stage at diagnosis compared to 50% with distances <20 km (n=724, p=0.02). Risk of late stage at diagnosis was 1.25-fold higher (95% CI: 1.09, 1.42) per 30 km. Effects were pronounced in an under-represented group of patients over age 70. This positive stage-distance association held to 40 km, and plateaued or slightly reversed in patients (9%) living beyond this distance. Studies of woman and the societal and healthcare-level influences on these delays and on the late stage at diagnosis distribution are needed to inform interventions that improve diagnostic stage and breast cancer survival rates in this and similar settings.

African Breast Cancer—Disparities in Outcomes (ABC-DO): protocol of a multicountry mobile health prospective study of breast cancer survival in sub-Saharan Africa

“…Hospitals participating in ABC-DO to date are settings where: International Agency for Research on Cancer (IARC) had already established,16–25 or were developing, a successful collaboration in breast cancer research; the site has at least 100 newly diagnosed women with breast cancer each year; and the selected sites together span countries and hospitals with contrasting patient profiles, catchment populations and health systems. Notably, ABC-DO countries are at different stages of the breast cancer transition, with breast cancer age-standardised incidence rates per 100 000 women in 2012 ranging from 22–28 in Zambia, Namibia and Uganda, to 42–50 in South Africa and Nigeria 2.…”

“…Nevertheless, the potential for survival gains may be hampered by the relatively young patient profile in SSA, reflecting the young age structure of the underlying population, as younger age is associated with poorer survival 13. Further, while a predominance of more aggressive breast cancer subtypes (eg, triple-negative tumours) in some settings would impede survival prospects,14 15 the totality of evidence across SSA from the largest studies and from a meta-analysis demonstrate a clear predominance of better prognosis oestrogen receptor-positive tumours 1617…”

A Review on Breast Cancer Care in Africa

“…Clinical and pathological factors will be discussed on the basis of articles from 7 African countries: Republic of South Africa (RSA) [24], Egypt [25,26,27], Nigeria [28], Eritrea [29], Morocco [30], Cameroon [31,32], and Rwanda [33]. …”

Coming of age? Women’s sexual and reproductive health after twentyone years of democracy in South Africa

“…64,65 Cervical cancer mortality in sub-Saharan Africa is primarily due to poor pre-cancerous cervical screening and early stage cancer diagnosis and treatment. 62 Cervical cancer is the second commonest cancer among South African women and the leading cause of female cancer deaths.…”