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Cancer Epidemiol. 2018 Feb;52:120-127. doi: 10.1016/j.canep.2017.12.007. Epub 2018 Jan 4.

Breast cancer survival in Soweto, Johannesburg, South Africa: A receptor-defined cohort of women diagnosed from 2009 to 11.

Author information

1
Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa; Batho Pele Breast Unit, Chris Hani Baragwanath Academic Hospital, 26 Chris Hani Road, Diepkloof, Johannesburg, 1864, South Africa; Wits Health Consortium, University of Witwatersrand, 8 Blackwood Ave, Parktown, Johannesburg, 2193, South Africa.
2
Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa. Electronic address: Caroline.dickens@wits.ac.za.
3
Batho Pele Breast Unit, Chris Hani Baragwanath Academic Hospital, 26 Chris Hani Road, Diepkloof, Johannesburg, 1864, South Africa; Wits Health Consortium, University of Witwatersrand, 8 Blackwood Ave, Parktown, Johannesburg, 2193, South Africa; Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa.
4
Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa.
5
Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa; Batho Pele Breast Unit, Chris Hani Baragwanath Academic Hospital, 26 Chris Hani Road, Diepkloof, Johannesburg, 1864, South Africa.
6
Wits Health Consortium, University of Witwatersrand, 8 Blackwood Ave, Parktown, Johannesburg, 2193, South Africa; Department of Radiation Oncology, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa.
7
Batho Pele Breast Unit, Chris Hani Baragwanath Academic Hospital, 26 Chris Hani Road, Diepkloof, Johannesburg, 1864, South Africa; Wits Health Consortium, University of Witwatersrand, 8 Blackwood Ave, Parktown, Johannesburg, 2193, South Africa.
8
Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, 630 W 168th St., New York, NY 10032, United States; Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY 10032, United States.
9
Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, 630 W 168th St., New York, NY 10032, United States; Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY 10032, United States; Department of Medicine, College of Physicians and Surgeons, Columbia University, 630 W 168th St, New York, NY 10032, United States.
10
Section of Environment and Radiation, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon CEDEX 08, France.
11
Wits Health Consortium, University of Witwatersrand, 8 Blackwood Ave, Parktown, Johannesburg, 2193, South Africa; Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa; Division of Medical Oncology, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa.

Abstract

BACKGROUND:

South Africa's public healthcare system is better equipped to manage breast cancer than most other SSA countries, but survival rates are unknown.

METHODS:

A historical cohort of 602 women newly diagnosed with invasive breast carcinoma during 2009-2011 at Chris Hani Baragwanath Academic Hospital, Soweto, Johannesburg, was followed using health systems data to December 2014. 'Overall survival' time was defined from diagnosis to death or terminal illness. Cox regression was used to estimate hazard ratios (HR) associated with woman and tumour characteristics.

RESULTS:

During a median 2.1 years follow-up (IQR 0.5-3.8), 149 women died or were classified terminally ill; 287 were lost-to-follow-up. 3-year survival was 84% for early stage (I/II) and 56% for late stage (III/IV) tumours (late v early: HR 2.8 (95% confidence interval (CI): 1.9-4.1), however the 42% cumulative losses to follow-up over this period were greater for late stage, half of which occurred within 6 months of diagnosis. After mutual adjustment for stage, grade, age, receptor subtype and HIV status, lower survival was also associated with triple negative (HR 3.1 (95% CI: 1.9-5.0)) and HER2-enriched (2.5 (95% CI: 1.4-4.5)) compared to ER/PR+ HER2- tumours, but not with age or HIV-infection (1.4 (95% CI: 0.8, 2.3)).

CONCLUSION:

In this South African cohort, breast cancer survival is suboptimal, but was better for early stage and hormone receptor-positive tumours. Efforts to reduce clinic losses in the immediate post-diagnosis period, in addition to early presentation and accelerated diagnosis and treatment, are needed to prevent breast cancer deaths, and survival improvements need to be monitored using prospective studies with active follow-up.

KEYWORDS:

Breast neoplasms; Historical cohort; South Africa; Stage at diagnosis; Survival

PMID:
29306221
PMCID:
PMC6127863
DOI:
10.1016/j.canep.2017.12.007
[Indexed for MEDLINE]
Free PMC Article

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