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Shamloo MBB, Elahi N, Shamsi A. Iranian Muslim women's adaptation after mastectomy. Int J Palliat Nurs 2024; 30:451-463. [PMID: 39276136 DOI: 10.12968/ijpn.2024.30.8.451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2024]
Abstract
BACKGROUND Breast cancer is the most common malignancy among women. Women with breast cancer need to adapt all aspects of their life following their diagnosis. AIM To investigate how women with breast cancer make adaptations in their lives to cope with the condition. METHODS A directed content analysis was used for this study and 23 participants were interviewed. The participants included women undergoing a mastectomy and their husbands, oncologists, oncology ward nurses and psychologists. Questions were asked regarding the participants' experiences of their adaptation to a mastectomy and cancer. RESULTS Data analysis led to the emergence of four dimensions; the physical dimension, self-concept, role-playing and interdependence. These four dimensions consisted of 21 main categories, 59 subcategories and 111 codes. CONCLUSION The present study showed that despite the emergence of different coping approaches, women undergoing mastectomy have had various physical and mental problems that lead to role disruption. It is recommended that solutions be adopted to increase the adaptation of these patients.
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Affiliation(s)
| | - Nasrin Elahi
- Associate Professor of Nursing, Department of Nursing, School of Nursing and Midwifery, Nursing Care Research Center in Chronic Diseases, Ahvaz Jundishapur University of Medical Sciences, Iran
| | - Aziz Shamsi
- Assistant Professor of Nursing, Mehabad Faculty of Medical Sciences, University of Medical Sciences, Iran
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Songiso M, Nuñez O, Cabanes A, Mutale M, Munalula J, Pupwe G, Henry-Tillman R, Parham GP. Three-year survival of breast cancer patients attending a one-stop breast care clinic nested within a primary care health facility in sub-Saharan Africa-Zambia. Int J Cancer 2024; 155:261-269. [PMID: 38525795 PMCID: PMC11096003 DOI: 10.1002/ijc.34920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 02/18/2024] [Accepted: 02/21/2024] [Indexed: 03/26/2024]
Abstract
In Zambia, women with breast symptoms travel through multiple levels of the healthcare system before obtaining a definitive diagnosis. To eradicate this critical barrier to care, we nested a novel breast specialty service platform inside a large public-sector primary healthcare facility in Lusaka, Zambia to offer clinical breast examination, breast ultrasound, and ultrasound-guided core needle biopsy in a one-stop format, tightly linked to referral for treatment. The objective of the study was to determine the life expectancy and survival outcomes of a prospective cohort of women diagnosed with breast cancer who were attended to and followed up at the clinic. The effect of breast cancer stage on prognosis was determined by estimating stage-specific crude survival using the Kaplan-Meier method. Survival analysis was used to estimate mean lifespan according to age and stage at diagnosis. We enrolled 302 women with histologically confirmed breast cancer. The overall 3-year survival was 73%. An increase in patients presenting with early breast cancer and improvements in their survival were observed. Women with early-stage breast cancer had a lifespan similar to the general population, while loss of life expectancy was significant at more advanced stages of disease. Our findings suggest that implementing efficient breast care services at the primary care level can avert a substantial proportion of breast cancer-related deaths. The mitigating factor appears to be stage of disease at the time of diagnosis, the cause of which is multifactorial, with the most influential being delays in the referral process.
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Affiliation(s)
- Mutumba Songiso
- Levy Mwanawasa University Teaching Hospital, Lusaka, Zambia
- Levy Mwanawasa Medical University, Lusaka, Zambia
| | - Olivier Nuñez
- National Center of Epidemiology (Pab,12) Instituto de Salud Carlos III Monforte de Lemos 5 28029 Madrid, Spain
| | | | - Mpimpa Mutale
- University of Lusaka, Department of Physiological Sciences, Lusaka, Zambia
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3
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Igbokwe KK. Comparative examination of breast cancer burden in sub-Saharan Africa, 1990-2019: estimates from Global Burden of Disease 2019 study. BMJ Open 2024; 14:e082492. [PMID: 38553071 PMCID: PMC10982725 DOI: 10.1136/bmjopen-2023-082492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 03/19/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVES In view of the widening gap in survival data between high-income and low-income countries, this study aimed to evaluate the most up-to-date burden of female breast cancer and analyse the leading risk factors in countries and regions in sub-Saharan Africa. DESIGN An analysis of Global Burden of Disease (GBD) data. SETTING The data of incidences, deaths, disability-adjusted life years (DALYs) and age-standardised rates (ASR) were retrieved from GBD Results Tool (1 January 1990─31 December 2019) covering 4 sub-Saharan African regions and 44 countries. The burden estimable to the risk factors of breast cancer was also estimated. All estimates were presented as counts and ASR per 100 000 population. PARTICIPANTS Participants included patients with female breast cancer. MAIN OUTCOMES AND MEASURES Absolute numbers and ASR/estimates of incidence, deaths and DALY of female breast cancer by location in 1990 and 2019, with their percentage changes from 1990 to 2019. The leading risk factors (eg, alcohol consumption) of breast cancer in sub-Saharan Africa. RESULTS In sub-Saharan Africa, the incidences of breast cancer increased by 247% in 2019 from 1990, with the highest incidence recorded in Nigeria. The deaths and DALYs of breast cancer increased by 184% and 178%, respectively. From 1990 to 2019, the mortality ASR and DALY ASR increased throughout the region, mostly in Equatorial and Gabon. With varying trends between countries, alcohol consumption and high fasting plasma glucose were noted to be significant contributors to breast cancer deaths between 1990 and 2019. CONCLUSION The results show the increasing burden of breast cancer in sub-Saharan Africa and provide valuable information on the trends of breast cancer and the risk factors attributable to breast cancer across sociodemographic index, region and country. These findings may inform health policies and improve the rational allocation of health resources.
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Olivos N, Banta JE, Spencer-Hwang R, Ansong D, Beane Freeman LE, Clegg-Lamptey JN, Wiafe-Addai B, Edusei L, Adjei E, Titiloye N, Dedey F, Aitpillah F, Oppong J, Vanderpuye V, Osei-Bonsu E, Ahearn TU, Biritwum R, Yarney J, Awuah B, Nyarko K, Garcia-Closas M, Abubakar M, Brinton LA, Figueroa JD, Wiafe S. Mosquito control exposures and breast cancer risk: analysis of 1071 cases and 2096 controls from the Ghana Breast Health Study. Breast Cancer Res 2023; 25:150. [PMID: 38082317 PMCID: PMC10714652 DOI: 10.1186/s13058-023-01737-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 10/30/2023] [Indexed: 12/18/2023] Open
Abstract
Epidemiologic data on insecticide exposures and breast cancer risk are inconclusive and mostly from high-income countries. Using data from 1071 invasive pathologically confirmed breast cancer cases and 2096 controls from the Ghana Breast Health Study conducted from 2013 to 2015, we investigated associations with mosquito control products to reduce the spread of mosquito-borne diseases, such as malaria. These mosquito control products were insecticide-treated nets, mosquito coils, repellent room sprays, and skin creams for personal protection against mosquitos. Multivariable and polytomous logistic regression models were used to estimate odds ratios (ORadj) and 95% confidence intervals (CI) with breast cancer risk-adjusted for potential confounders and known risk factors. Among controls, the reported use of mosquito control products were mosquito coils (65%), followed by insecticide-treated nets (56%), repellent room sprays (53%), and repellent skin creams (15%). Compared to a referent group of participants unexposed to mosquito control products, there was no significant association between breast cancer risk and mosquito coils. There was an association in breast cancer risk with reported use of insecticide-treated nets; however, that association was weak and not statistically significant. Participants who reported using repellent sprays were at elevated risks compared to women who did not use any mosquito control products, even after adjustment for all other mosquito control products (OR = 1.42, 95% CI=1.15-1.75). We had limited power to detect an association with repellent skin creams. Although only a few participants reported using repellent room sprays weekly/daily or < month-monthly, no trends were evident with increased frequency of use of repellent sprays, and there was no statistical evidence of heterogeneity by estrogen receptor (ER) status (p-het > 0.25). Our analysis was limited when determining if an association existed with repellent skin creams; therefore, we cannot conclude an association. We found limited evidence of risk associations with widely used mosquito coils and insecticide-treated nets, which are reassuring given their importance for malaria prevention. Our findings regarding specific breast cancer risk associations, specifically those observed between repellent sprays, require further study.
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Affiliation(s)
- Naomie Olivos
- School of Public Health, Loma Linda University, Loma Linda, CA, USA
| | - Jim E Banta
- School of Public Health, Loma Linda University, Loma Linda, CA, USA
| | | | | | - Laura E Beane Freeman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | | | | | | | | | | | | | | | | | | | | | - Thomas U Ahearn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | | | | | | | | | | | - Mustapha Abubakar
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Louise A Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Jonine D Figueroa
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA.
| | - Seth Wiafe
- School of Public Health, Loma Linda University, Loma Linda, CA, USA.
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Umo I, Kulai M, Umo P, James K, Ikasa R. The direct medical cost of breast cancer management in a provincial hospital of Papua New Guinea: A cost of illness study of consecutive patients from 2017 to 2022. J Cancer Policy 2023; 38:100447. [PMID: 37813161 DOI: 10.1016/j.jcpo.2023.100447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 09/29/2023] [Accepted: 10/02/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Breast cancer is a major global health, gender and socioeconomic challenge. In PNG it is the leading cause of female mortality. Understanding direct medical costs related to breast cancer management can direct resource allocation and investment in breast cancer screening, treatment, infastructure and training. METHODS A cost of illness study was conducted amongst patients with breast cancer at Alotau Provincial Hospital from the 12th of January 2017-9 th of August 2022. A bottom up approach of micro costing was applied to estimate the patient and hospital perspectives of direct medical costs. RESULTS The total cost of breast cancer management was K1,624,656.14 (US$471,150.28). 58.5 % (n = 38) of patients with breast cancer did not undergo any form of surgery. Hospital costs accounted for 99.7 % (K1,620,156.14, US$469,845.28) of the total direct medical costs. The average cost per patient was K24,994.71 (US$ 7248.47). The dollar conversion was 1 KINA = 0.29 USD. CONCLUSION Investment in screening, diagnosis and treatment is crucial in addressing the burden of breast cancer in PNG. POLICY SUMMARY Provincial hospitals (in PNG) must invest in and implement the 2015 National Cancer Control Policy strategies that aim to develop hospital based cancer registries, human resources, equip health systems, improve cancer screening, improve diagnostics, research, funding and treatment for breast cancer control.
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Affiliation(s)
- Ian Umo
- Surgical Department, Alotau Provincial Hospital, Milne Bay Provincial Health Authority, Papua New Guinea.
| | - Michealynne Kulai
- School of Medicine and Health Science, Divine Word University, Papua New Guinea
| | - Pius Umo
- Pacific International Hospital, Papua New Guinea
| | - Kennedy James
- Surgical Department, Alotau Provincial Hospital, Milne Bay Provincial Health Authority, Papua New Guinea
| | - Rodger Ikasa
- Surgical Department, Alotau Provincial Hospital, Milne Bay Provincial Health Authority, Papua New Guinea
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Anderson BO, Duggan C, Scheel JR. Resource-appropriate evidence-based strategies to improve breast cancer outcomes in low- and middle-income countries guided by the Breast Health Global Initiative and Global Breast Cancer Initiative. J Surg Oncol 2023; 128:952-958. [PMID: 37811558 DOI: 10.1002/jso.27480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/10/2023]
Affiliation(s)
- Benjamin O Anderson
- Global Breast Cancer Initiative, World Health Organization, Geneva, Switzerland
- Department of Surgery and Global Health Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
- Breast Health Global Initiative, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Program in Epidemiology, Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Catherine Duggan
- Breast Health Global Initiative, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Program in Epidemiology, Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - John R Scheel
- Breast Health Global Initiative, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Singh D, Vignat J, Lorenzoni V, Eslahi M, Ginsburg O, Lauby-Secretan B, Arbyn M, Basu P, Bray F, Vaccarella S. Global estimates of incidence and mortality of cervical cancer in 2020: a baseline analysis of the WHO Global Cervical Cancer Elimination Initiative. Lancet Glob Health 2023; 11:e197-e206. [PMID: 36528031 PMCID: PMC9848409 DOI: 10.1016/s2214-109x(22)00501-0] [Citation(s) in RCA: 332] [Impact Index Per Article: 332.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Tracking progress and providing timely evidence is a fundamental step forward for countries to remain aligned with the targets set by WHO to eliminate cervical cancer as a public health problem (ie, to reduce the incidence of the disease below a threshold of 4 cases per 100 000 women-years). We aimed to assess the extent of global inequalities in cervical cancer incidence and mortality, based on The Global Cancer Observatory (GLOBOCAN) 2020 estimates, including geographical and socioeconomic development, and temporal aspects. METHODS For this analysis, we used the GLOBOCAN 2020 database to estimate the age-specific and age-standardised incidence and mortality rates of cervical cancer per 100 000 women-years for 185 countries or territories aggregated across the 20 UN-defined world regions, and by four-tier levels of the Human Development Index (HDI). Time trends (1988-2017) in incidence were extracted from the Cancer Incidence in Five Continents (CI5) plus database. Mortality estimates were obtained using the most recent national vital registration data from WHO. FINDINGS Globally in 2020, there were an estimated 604 127 cervical cancer cases and 341 831 deaths, with a corresponding age-standardised incidence of 13·3 cases per 100 000 women-years (95% CI 13·3-13·3) and mortality rate of 7·2 deaths per 100 000 women-years (95% CI 7·2-7·3). Cervical cancer incidence ranged from 2·2 (1·9-2·4) in Iraq to 84·6 (74·8-94·3) in Eswatini. Mortality rates ranged from 1·0 (0·8-1·2) in Switzerland to 55·7 (47·7-63·7) in Eswatini. Age-standardised incidence was highest in Malawi (67·9 [95% CI 65·7 -70·1]) and Zambia (65·5 [63·0-67·9]) in Africa, Bolivia (36·6 [35·0-38·2]) and Paraguay (34·1 [32·1-36·1]) in Latin America, Maldives (24·5 [17·0-32·0]) and Indonesia (24·4 [24·2-24·7]) in Asia, and Fiji (29·8 [24·7-35·0]) and Papua New Guinea (29·2 [27·3-31·0]) in Melanesia. A clear socioeconomic gradient exists in cervical cancer, with decreasing rates as HDI increased. Incidence was three times higher in countries with low HDI than countries with very high HDI, whereas mortality rates were six times higher in low HDI countries versus very high HDI countries. In 2020 estimates, a general decline in incidence was observed in most countries of the world with representative trend data, with incidence becoming stable at relatively low levels around 2005 in several high-income countries. By contrast, in the same period incidence increased in some countries in eastern Africa and eastern Europe. We observed different patterns of age-specific incidence between countries with well developed population-based screening and treatment services (eg, Sweden, Australia, and the UK) and countries with insufficient and opportunistic services (eg, Colombia, India, and Uganda). INTERPRETATION The burden of cervical cancer remains high in many parts of the world, and in most countries, the incidence and mortality of the disease remain much higher than the threshold set by the WHO initiative on cervical cancer elimination. We identified substantial geographical and socioeconomic inequalities in cervical cancer globally, with a clear gradient of increasing rates for countries with lower levels of human development. Our study provides timely evidence and impetus for future strategies that prioritise and accelerate progress towards the WHO elimination targets and, in so doing, address the marked variations in the global cervical cancer landscape today. FUNDING French Institut National du Cancer, Horizon 2020 Framework Programme for Research and Innovation of the European Commission; and EU4Health Programme.
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Affiliation(s)
- Deependra Singh
- Cancer Surveillance Branch, International Agency for Research on Cancer, WHO, Lyon, France.
| | - Jerome Vignat
- Cancer Surveillance Branch, International Agency for Research on Cancer, WHO, Lyon, France
| | | | - Marzieh Eslahi
- Cancer Surveillance Branch, International Agency for Research on Cancer, WHO, Lyon, France
| | - Ophira Ginsburg
- Cancer Surveillance Branch, International Agency for Research on Cancer, WHO, Lyon, France; Center for Global Health, US National Cancer Institute, Bethesda, MD, USA
| | - Beatrice Lauby-Secretan
- Evidence Synthesis and Classification Branch, International Agency for Research on Cancer, WHO, Lyon, France
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Scientific Institute of Public Health, Brussels, Belgium; Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, University Ghent, Ghent, Belgium
| | - Partha Basu
- Early Detection, Prevention, and Infections Branch, International Agency for Research on Cancer, WHO, Lyon, France
| | - Freddie Bray
- Cancer Surveillance Branch, International Agency for Research on Cancer, WHO, Lyon, France
| | - Salvatore Vaccarella
- Cancer Surveillance Branch, International Agency for Research on Cancer, WHO, Lyon, France
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Fokom Domgue J, Dille I, Fry L, Mafoma R, Bouchard C, Ngom D, Ledaga N, Gnangnon F, Diop M, Traore B, Pande M, Kamgno J, Diomande MI, Tebeu PM, Lecuru F, Plante M, Dangou JM, Shete S. Enhancing cervical and breast cancer training in Africa with e-learning. Lancet Glob Health 2023; 11:e28-e29. [PMID: 36521948 DOI: 10.1016/s2214-109x(22)00499-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/02/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Joel Fokom Domgue
- Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; Department of Gynecology and Obstetrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé, Cameroon; Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé, Cameroon; Le Centre Inter-états d'Enseignement Supérieur en Santé Publique d'Afrique Centrale, Brazzaville, Congo
| | - Issimouha Dille
- The African Regional Office of the World Health Organization (WHO), Brazzaville, Congo
| | - Laura Fry
- The American Society of Colposcopy and Cervical Pathology (ASCCP), Clarksburg, MD, USA
| | - Rosine Mafoma
- Department of Obstetrics and Gynecology, Bonassama District Hospital, Douala, Cameroon
| | - Celine Bouchard
- Clinique de recherche en santé des femmes, Quebec, QC, Canada
| | - David Ngom
- Department of Obstetrics and Gynecology, Keur Massar Hospital, Dakar, Senegal
| | | | - Freddy Gnangnon
- Department of Surgical Oncology, Hubert Koutoukou Maga National Teaching Hospital, Cotonou, Benin
| | - Mamadou Diop
- Juliot-Curie Cancer Institute, Aristide Le Dantec University Hospital, Dakar, Senegal
| | - Bangaly Traore
- Surgical Oncology Unit, Donka National Hospital, Ministry of Health, Conakry, Guinea
| | - Mala Pande
- Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Joseph Kamgno
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé, Cameroon
| | | | - Pierre-Marie Tebeu
- Department of Gynecology and Obstetrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé, Cameroon; Le Centre Inter-états d'Enseignement Supérieur en Santé Publique d'Afrique Centrale, Brazzaville, Congo
| | | | - Marie Plante
- Department of Obstetrics and Gynecology, CHU de Quebec, Laval University, Quebec, QC, Canada
| | - Jean-Marie Dangou
- The African Regional Office of the World Health Organization (WHO), Brazzaville, Congo
| | - Sanjay Shete
- Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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Guida F, Kidman R, Ferlay J, Schüz J, Soerjomataram I, Kithaka B, Ginsburg O, Mailhot Vega RB, Galukande M, Parham G, Vaccarella S, Canfell K, Ilbawi AM, Anderson BO, Bray F, Dos-Santos-Silva I, McCormack V. Global and regional estimates of orphans attributed to maternal cancer mortality in 2020. Nat Med 2022; 28:2563-2572. [PMID: 36404355 PMCID: PMC9676732 DOI: 10.1038/s41591-022-02109-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 10/25/2022] [Indexed: 11/21/2022]
Abstract
Despite women being disproportionally affected by cancer deaths at young ages, there are no global estimates of the resulting maternal orphans, who experience health and education disadvantages throughout their lives. We estimated the number of children who became maternal orphans in 2020 due to their mother dying from cancer in that year, for 185 countries worldwide and by cause of cancer-related death. Female cancer deaths-by country, cancer type and age (derived from GLOBOCAN estimates)-were multiplied by each woman's estimated number of children under the age of 18 years at the time of her death (fertility data were derived from United Nations World Population Prospects for birth cohort), accounting for child mortality and parity-cancer risk associations. Globally, there were 1,047,000 such orphans. Over half of these were orphans due to maternal deaths from breast (258,000, 25%), cervix (210,000, 20%) and upper-gastrointestinal cancers (136,000, 13%), and most occurred in Asia (48%: India 15%, China 10%, rest of Asia 23%) and Africa (35%). Globally, there were 40 new maternal orphans due to cancer per 100,000 children, with a declining trend with a higher Human Development Index (range: 121 in Malawi to 15 in Malta). An estimated 7 million children were prevalent maternal orphans due to cancer in mid-2020. Accelerating the implementation of the World Health Organization's cervical and breast cancer initiatives has the potential to avert not only millions of preventable female cancer deaths but also the associated, often-overlooked, intergenerational consequences of these deaths.
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Affiliation(s)
- Florence Guida
- International Agency for Research on Cancer, Lyon, France.
| | - Rachel Kidman
- Program in Public Health and Department of Family, Population and Preventive Medicine, Stony Brook University (State University of New York), Stony Brook, NY, USA
| | - Jacques Ferlay
- International Agency for Research on Cancer, Lyon, France
| | - Joachim Schüz
- International Agency for Research on Cancer, Lyon, France
| | | | | | - Ophira Ginsburg
- Centre for Global Health, US National Cancer Institute, Rockville, MD, USA
| | | | | | - Groesbeck Parham
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | | | - Karen Canfell
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - Andre M Ilbawi
- Global Breast Cancer Initiative, Department of Non-communicable Diseases, World Health Organization (WHO), Geneva, Switzerland
| | - Benjamin O Anderson
- Global Breast Cancer Initiative, Department of Non-communicable Diseases, World Health Organization (WHO), Geneva, Switzerland
| | - Freddie Bray
- International Agency for Research on Cancer, Lyon, France
| | - Isabel Dos-Santos-Silva
- Department of Non-Communicable Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Painschab MS. Cancer care cost-effectiveness in low-income and middle-income countries: time to shift the burden of proof. THE LANCET GLOBAL HEALTH 2022; 10:e1084-e1085. [PMID: 35839803 DOI: 10.1016/s2214-109x(22)00289-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 06/21/2022] [Indexed: 10/17/2022] Open
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Wondimagegnehu A, Negash Bereded F, Assefa M, Teferra S, Zebrack B, Addissie A, Kantelhardt EJ. Burden of Cancer and Utilization of Local Surgical Treatment Services in Rural Hospitals of Ethiopia: A Retrospective Assessment from 2014 to 2019. Oncologist 2022; 27:e889-e898. [PMID: 35791963 PMCID: PMC9632304 DOI: 10.1093/oncolo/oyac127] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 05/18/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Global cancer estimations for Ethiopia announced 77 352 new cases in 2020 based on the only population-based registry in Addis Ababa. This study characterizes cancer patients in rural Ethiopia at 8 primary and secondary hospitals between 2014 and 2019. PATIENTS AND METHODS All clinically or pathologically confirmed cancer cases that were diagnosed between 1 May 2014 and 29 April 2019 were included. A structured data extraction tool was used to retrospectively review patients' charts and descriptive analysis was done. RESULTS A total of 1298 cancer cases were identified, of which three-fourths were females with a median age of 42 years. Breast (38%) and cervical (29%) cancers were the most common among females, while prostate (19%) and oesophageal cancers (16%) were the most common among males. Only 39% of tumors were pathologically confirmed. Nearly two-thirds of the cases were diagnosed at an advanced stage. Surgery was the only accessible treatment option for more than half of the cancer patients, and systemic treatment (except endocrine) was rarely available. One in 5 patients did not receive the recommended surgical procedure, half due to patient refusal or lack of the patient returning to the hospital. CONCLUSION The pattern of cancer diagnoses in rural hospitals shows an exceptionally high burden in women in their middle-ages due to breast and cervical cancers. Advanced stage presentation, lack of pathology services, and unavailability of most systemic treatment options were common. The surgery was offered to nearly 60% of the patients, showing the significant efforts of health workers to reduce sufferings.
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Affiliation(s)
- Abigiya Wondimagegnehu
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia,Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University, Halle, Saale, Germany
| | - Fekadu Negash Bereded
- Department of Surgery, St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Mathewos Assefa
- Department of Oncology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Solomon Teferra
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bradley Zebrack
- University of Michigan, School of Social Work, Ann Arbor, MI, USA
| | - Adamu Addissie
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia,Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University, Halle, Saale, Germany
| | - Eva J Kantelhardt
- Corresponding author: Eva J. Kantelhardt, MD, Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University, Halle, Germany.
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Oluyemi E, Scheel J. The Importance of Promoting Early Diagnosis of Breast Cancer in Resource-Limited Settings in Sub-Saharan Africa. J Am Coll Radiol 2022; 19:990-991. [DOI: 10.1016/j.jacr.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 04/22/2022] [Indexed: 10/18/2022]
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Breast cancer morbidity and mortality in rural Ethiopia: data from 788 verbal autopsies. BMC Womens Health 2022; 22:89. [PMID: 35331210 PMCID: PMC8951700 DOI: 10.1186/s12905-022-01672-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 03/18/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION In Ethiopia, breast cancer is the leading cause of cancer among women. Little is known about the duration of disease and symptoms of patients who died from breast cancer in rural Ethiopia. The objective of this study was to assess breast cancer mortality with a particular focus on the self-reported duration of illness including suffering of symptoms, and need for medical care. METHODS The cause of death was determined among randomly selected Ethiopian women residing in western Ethiopia. A modified standard verbal autopsy (VA) questionnaire was completed by women whose sisters had died. The questionnaires were reviewed by two independent local physicians to assign a cause of death. We analyzed pattern of cause of deaths, duration of suffering, symptoms, and treatment received. RESULT In our study, the age at death was very similar to other population-based data from Ethiopia. We found 32% of 788 deaths were caused by communicable diseases, 12.1% by neoplasms, and 9.4% by pregnancy/maternal mortality. Breast cancer was the second leading neoplasm, responsible for 21 (2.7%) of all deaths (95% CI 1.5-3.7%), and was among the top five causes of non-communicable deaths. The median age of breast cancer death was 37 years, younger than for other causes of death. The median duration of illness with breast cancer was around 1 year. This was substantially more compared to the duration of infectious diseases, but less than the duration of reproductive neoplasms, diabetes, and epilepsy. DISCUSSION/CONCLUSION Breast cancer deaths are common causes of death in women of rural Ethiopia. When assessing the total duration of illness according to specific causes of death, breast and other cancers accounted for a large share of the burden. This has practical implications and highlights the need for palliative care for cancer patients. Substantial efforts are necessary to improve early detection and treatment for breast cancer to reduce premature death in women.
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Coles CE, Anderson BO, Cameron D, Cardoso F, Horton R, Knaul FM, Mutebi M, Lee N. The Lancet Breast Cancer Commission: tackling a global health, gender, and equity challenge. Lancet 2022; 399:1101-1103. [PMID: 35189077 DOI: 10.1016/s0140-6736(22)00184-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 01/20/2022] [Indexed: 12/14/2022]
Affiliation(s)
| | - Benjamin O Anderson
- Department of Noncommunicable Diseases, WHO, Geneva; Department of Surgery, University of Washington, Seattle, WA, USA
| | | | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation and ABC Global Alliance, Lisbon, Portugal
| | | | - Felicia Marie Knaul
- Sylvester Comprehensive Cancer Center, Institute for Advanced Study of the Americas, Miller School of Medicine, University of Miami, Miami, FL, USA; Tómatelo a Pecho, Mexico City, Mexico
| | - Miriam Mutebi
- Breast Surgical Oncology, Aga Khan University, Nairobi, Kenya
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Lombe D, M'ule BC, Msadabwe SC, Chanda E. Gynecological radiation oncology in sub-Saharan Africa: status, problems and considerations for the future. Int J Gynecol Cancer 2022; 32:451-456. [DOI: 10.1136/ijgc-2021-002461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/16/2021] [Indexed: 11/04/2022] Open
Abstract
Gynecological malignancies in Africa form a significant part of the burden of disease. The high prevalence of HIV in some countries creates a heightened risk for development of human papilloma virus related cancers such as cervical, vulval and vaginal cancers. Radiotherapy is an important modality of treatment for cancer and in Africa compensates for the lack of adequate surgical services for a large proportion of cancers as well as being a cornerstone of treatment for locally advanced cancers and palliation. In this review we look at the status of radiotherapy services in sub-Saharan Africa and critical factors that influence its delivery with a focus on gynecological malignancies. This unveils that radiotherapy for gynecological cancers in sub-Saharan Africa is a significant example of the need for a holistic development approach across different sectors of the economy and different disciplines of medicine. The complexity of its management continues to expose the underdevelopment of health and financial systems and the lack of universal health coverage and social systems as we continue to see unnecessary morbidity and mortality due to the lack of organization. More systematic and scientifically robust investigations tailored to the various sub-Saharan Africa countries need to be conducted to elicit disruptive local solutions to the status quo.
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Xu S, Liu Y, Zhang T, Zheng J, Lin W, Cai J, Zou J, Chen Y, Xie Y, Chen Y, Li Z. The Global, Regional, and National Burden and Trends of Breast Cancer From 1990 to 2019: Results From the Global Burden of Disease Study 2019. Front Oncol 2021; 11:689562. [PMID: 34094989 PMCID: PMC8176863 DOI: 10.3389/fonc.2021.689562] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/28/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The burden of breast cancer has been increasing globally. The epidemiology burden and trends need to be updated. This study aimed to update the burden and trends of breast cancer incidences, deaths, and disability-adjusted life-years (DALYs) from 1990 to 2019, using the Global Burden of Disease 2019 study. METHODS The data of incidences, deaths, DALYs, and age-standardized rates were extracted. Estimated annual percentage changes were used to quantify the trends of age-standardized rates. Besides, the population attributable fractions of the risk factors of breast cancer were also estimated. RESULTS Globally, the incidences of breast cancer increased to 2,002,354 in 2019. High social-development index (SDI) quintiles had the highest incidence cases with a declining trend in age-standardized incidence rate. In 2019, the global deaths and DALYs of breast cancer increased to 700,660 and 20,625,313, respectively. From 1990 to 2019, the age-standardized mortality rates and age-standardized DALY rates declined globally, especially in high and high-middle SDI quintiles. Besides, the trends varied from different regions and countries. The proportion of the patients in the 70+ years age group increased globally. Deaths of breast cancer attributable to high fasting plasma glucose and high body mass index increased globally, and high fasting plasma glucose was the greatest contributor to the global breast cancer deaths. CONCLUSION The burden of breast cancer in higher SDI quintiles had gone down while the burden was still on the rise in lower SDI quintiles. It is necessary to appeal to the public to decrease the exposure of the risk factors.
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Affiliation(s)
- Shangbo Xu
- Department of Internal Medicine, People’s Hospital of Jieyang, Jieyang Hospital Affiliated to SunYat-sen University, Jieyang, China
| | - Yiyuan Liu
- Department of General Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
- Department of Breast Disease Research Center, The Medical Research Institute of Shantou Doctoral Association, Shantou, China
| | - Taofeng Zhang
- Department of General Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
- Department of Breast Disease Research Center, The Medical Research Institute of Shantou Doctoral Association, Shantou, China
| | - Jiehua Zheng
- Department of General Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
- Department of Breast Disease Research Center, The Medical Research Institute of Shantou Doctoral Association, Shantou, China
| | - Weixun Lin
- Department of General Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
- Department of Breast Disease Research Center, The Medical Research Institute of Shantou Doctoral Association, Shantou, China
| | - Jiehui Cai
- Department of General Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
- Department of Breast Disease Research Center, The Medical Research Institute of Shantou Doctoral Association, Shantou, China
| | - Juan Zou
- Department of General Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
- Department of Breast Disease Research Center, The Medical Research Institute of Shantou Doctoral Association, Shantou, China
| | - Yaokun Chen
- Department of General Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
- Department of Breast Disease Research Center, The Medical Research Institute of Shantou Doctoral Association, Shantou, China
| | - Yanna Xie
- Department of Breast Disease Research Center, The Medical Research Institute of Shantou Doctoral Association, Shantou, China
- Department of Internal Medicine, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Yexi Chen
- Department of General Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
- Department of Breast Disease Research Center, The Medical Research Institute of Shantou Doctoral Association, Shantou, China
| | - Zhiyang Li
- Department of General Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
- *Correspondence: Zhiyang Li,
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