Format

Send to

Choose Destination
Lancet Glob Health. 2016 Dec;4(12):e923-e935. doi: 10.1016/S2214-109X(16)30259-5.

Stage at diagnosis of breast cancer in sub-Saharan Africa: a systematic review and meta-analysis.

Author information

1
Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Institute of Human Virology, Abuja, Nigeria.
2
Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France.
3
Department of Epidemiology and Public Health, University of Maryland Marlene and Stewart Greenebaum Comprehensivew Cancer Center, Baltimore, MD, USA; Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.
4
Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK. Electronic address: isabel.silva@lshtm.ac.uk.

Abstract

BACKGROUND:

The incidence of breast cancer in sub-Saharan Africa is relatively low, but as survival from the disease in the region is poor, mortality rates are as high as in high-income countries. Stage at diagnosis is a major contributing factor to poor survival from breast cancer. We aimed to do a systematic review and meta-analysis on stage at diagnosis of breast cancer in sub-Saharan Africa to examine trends over time, and investigate sources of variations across the region.

METHODS:

We searched MEDLINE, Embase, Web of Knowledge, and Africa-Wide Information to identify studies on breast cancer stage at diagnosis in sub-Saharan African women published before Jan 1, 2014, and in any language. Random-effects meta-analyses were done to investigate between-study heterogeneity in percentage of late-stage breast cancer (stage III/IV), and meta-regression analyses to identify potential sources of variation. Percentages of women with late-stage breast cancer at diagnosis in sub-Saharan Africa were compared with similar estimates for black and white women in the USA from the Surveillance, Epidemiology, and End Results database.

FINDINGS:

83 studies were included, which consisted of 26 788 women from 17 sub-Saharan African countries. There was wide between-study heterogeneity in the percentage of late-stage disease at diagnosis (median 74·7%, range 30·3-100%, I2=93·3%, p<0·0001). The percentage of patients with late-stage disease at diagnosis did not vary by region in black women, but was lower in non-black women from southern Africa than in black women in any region (absolute difference [AD] from black women in western Africa [reference group] -18·1%, 95% CI -28·2 to -8·0), and higher for populations from mixed (urban and rural) settings rather than urban settings (13·2%, 5·7 to 20·7, in analyses restricted to black women). The percentage of patients with late-stage disease at diagnosis in black Africans decreased over time (-10·5%, -19·3 to -1·6; for 2000 or later vs 1980 or before), but it was still higher around 2010 than it was in white and black women in the USA 40 years previously.

INTERPRETATION:

Strategies for early diagnosis of breast cancer should be regarded as a major priority by cancer control programmes in sub-Saharan Africa.

FUNDING:

None.

Comment in

PMID:
27855871
PMCID:
PMC5708541
DOI:
10.1016/S2214-109X(16)30259-5
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Elsevier Science Icon for PubMed Central
Loading ...
Support Center