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Geremew H, Golla EB, Simegn MB, Abate A, Ali MA, Kumbi H, Wondie SG, Mengstie MA, Tilahun WM. Late-stage diagnosis: The driving force behind high breast cancer mortality in Ethiopia: A systematic review and meta-analysis. PLoS One 2024; 19:e0307283. [PMID: 39028722 PMCID: PMC11259299 DOI: 10.1371/journal.pone.0307283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 07/03/2024] [Indexed: 07/21/2024] Open
Abstract
INTRODUCTION Breast cancer continues to be the most common malignancy and the leading cause of cancer-related deaths in Ethiopia. The poor prognosis and high mortality rate of breast cancer patients in the country are largely caused by late-stage diagnosis. Hence, understanding the epidemiology of late-stage diagnosis is essential to address this important problem. However, previous reports in Ethiopia indicated inconsistent findings. Therefore, this literature review was conducted to generate dependable evidence by summarizing the prevalence and determinants of late-stage diagnosis among breast cancer patients in Ethiopia. METHODS Pertinent articles were retrieved by systematically searching on major electronic databases and gray literature. Data were extracted into an Excel spreadsheet and analyzed using the STATA 17 statistical software. The pooled estimates were summarized using the random effect meta-analysis model. Heterogeneity and small study effect were evaluated using the I2 statistics and Egger's regression test in conjunction with the funnel plot, respectively. Meta-regression, sub-group analysis, and sensitivity analysis were also employed. Protocol registration number: CRD42024496237. RESULTS The pooled prevalence of late-stage diagnosis after combining reports of 24 studies with 8,677 participants was 65.85 (95% CI: 58.38, 73.32). Residence (adjusted OR: 1.92; 95% CI: 1.45, 2.53), patient delay at their first presentation (adjusted OR: 2.65; 95% CI: 1.56, 4.49), traditional medicine use (adjusted OR: 2.54; 95% CI: 1.89, 3.41), and breast self-examination practice (adjusted OR: 0.28; 95% CI: 0.09, 0.88) were significant determinants of late-stage diagnosis. CONCLUSION Two-thirds of breast cancer patients in Ethiopia were diagnosed at an advanced stage. Residence, delay in the first presentation, traditional medicine use, and breast self-examination practice were significantly associated with late-stage diagnosis. Public education about breast cancer and its early detection techniques is crucial to reduce mortality and improve the survival of patients. Besides, improving access to cancer screening services is useful to tackle the disease at its curable stages.
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Affiliation(s)
- Habtamu Geremew
- College of Health Science, Oda Bultum University, Chiro, Ethiopia
| | | | - Mulat Belay Simegn
- Department of Public Health, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Alegntaw Abate
- Department of Medical Laboratory Science, College of Health Science, Oda Bultum University, Chiro, Ethiopia
| | - Mohammed Ahmed Ali
- Department of Midwifery, College of Health Science, Oda Bultum University, Chiro, Ethiopia
| | - Hawi Kumbi
- Department of Laboratory, Adama Hospital Medical College, Adama, Ethiopia
| | - Smegnew Gichew Wondie
- Department of Human Nutrition, College of Medicine and Health Science, Mizan Tepi University, Mizan Aman, Ethiopia
| | - Misganaw Asmamaw Mengstie
- Department of Biochemistry, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Werkneh Melkie Tilahun
- Department of Public Health, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
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Tagne Simo R, Nyemb AP, Baiguerel EM, Nwabo Kamdje AH, Mohamadou A, Nangue C, Telefo PB. Assessment of breast cancer awareness and detection of asymptomatic cases in Ngaoundere, Adamawa region of Cameroon. Heliyon 2024; 10:e32995. [PMID: 38988535 PMCID: PMC11234042 DOI: 10.1016/j.heliyon.2024.e32995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/11/2024] [Accepted: 06/12/2024] [Indexed: 07/12/2024] Open
Abstract
Introduction In Cameroon and most African countries, breast cancer (BC) is mainly diagnosed at an advanced stage, leading to worse prognosis and disease consequences. This is partly due to the delayed presentation of patients, which constitutes a significant barrier to the effective management of the disease. The aim of this descriptive, cross-sectional study is to identify the level of awareness of breast cancer and screening practice among women and health professionals in the city of Ngaoundere, Cameroon. Methods Women and medical personnel were randomly recruited in two health institutions in the Adamawa region, Cameroon: the Ngaoundere Regional Hospital and the Ngaoundere Protestant Hospital. Two different questionnaires were prepared. The first was to collect sociodemographic data and assess participants' awareness of BC and related symptoms. The second was to collect information from the recommended screening methods for early detection of cases, including the frequency of screening practice among women and the daily practice of medical personnel. Results Out of the women surveyed, 88.05 % have heard of breast cancer, but the majority were unaware of its clinical signs (47.1 %) and the means of treatment (22 %). In the studied population, 66.4 % were aware of the screening, but the practice was very low, as only 1.1 % of women had ever undergone screening by mammography and only 6 % often practiced breast self-examination (BSE). The levels of screening knowledge and practice were significantly associated with the level of education and employment status (P = 0.0001). In the group of 94 health personnel surveyed, 68.1 % had no knowledge of breast cancer screening methods, and only 30 % performed breast cancer screening in their daily practice. The practice of BSE during the study allowed a detection of 2 % of screened women with some suspicious clinical signs. Conclusion This study revealed a lack of knowledge about BC and its screening methods and practice among women and health personnel in Ngaoundere. This lack of knowledge constitutes a significant barrier to early diagnosis of BC. There is a need to raise awareness and provide education and information about BC screening.
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Affiliation(s)
- Richard Tagne Simo
- Department of Biomedical Sciences, Faculty of Science, University of Ngaoundere, Cameroon
| | - Adèle Patience Nyemb
- Department of Biomedical Sciences, Faculty of Science, University of Ngaoundere, Cameroon
| | - Erika Myriam Baiguerel
- Department of Biomedical Sciences, Faculty of Science, University of Ngaoundere, Cameroon
| | | | - Ahmadou Mohamadou
- Department of Biomedical Sciences, Faculty of Science, University of Ngaoundere, Cameroon
| | - Charlette Nangue
- Department of Biomedical Sciences, Catholic University of Cameroon, Bamenda, Cameroon
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Zewdie A, Kassie TD, Anagaw TF, Mazengia EM, Gelaw SS, Fenta ET, Eshetu HB, Kebede N, Bogale EK. Advanced-stage breast cancer diagnosis and its determinants in Ethiopia: a systematic review and meta-analysis. BMC Womens Health 2024; 24:284. [PMID: 38734607 PMCID: PMC11088059 DOI: 10.1186/s12905-024-03133-9] [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: 11/03/2023] [Accepted: 05/06/2024] [Indexed: 05/13/2024] Open
Abstract
INTRODUCTION Worldwide, breast cancer is the primary cause of illness and death. Unless early detected and treated breast cancer is a life-threatening tumor. Advanced-stage presentation is greatly linked with short survival time and increased mortality rates. In Ethiopia nationally summarized evidence on the level of advanced-stage breast cancer diagnosis is scarce. Therefore, this systematic review and meta-analysis aimed to determine the pooled prevalence of advanced-stage breast cancer diagnosis and its determinants in Ethiopia. METHOD By following PRISMA guidelines, a systematic review and meta-analysis were carried out. To include relevant publications, a broad literature search was conducted in the African Online Journal, PubMed, Google Scholar, and Embase which are published until last search date; June 15, 2023. To prevent further duplication this review was registered in PROSPERO database with ID no of CRD42023435096. To determine the pooled prevalence, a weighted inverse variance random effect model was applied. I2 statistics and the Cochrane Q-test were computed to determine heterogeneity. To evaluate publication bias, a funnel plot, and Egger's regression test were used. RESULT A total of 924 articles were sought and finally 20 articles were included in this review. The pooled prevalence of advanced-stage breast cancer diagnosis in Ethiopia was 72.56% (95%CI; 68.46-76.65%). Use of traditional medicine as first choice (AOR = 1.32, 95% CI: (1.13-1.55)), delay of > 3 months in seeking care (AOR = 1.24, 95% CI: (1.09-1.41)), diagnosis or health system delay of > 2 months (AOR = 1.27, 95% CI: (1.11-1.46)), rural residence (AOR = 2.04, 95% CI: (1.42 - 2.92)), and chief complaint of a painless breast lump (AOR = 2.67, 95% CI: (1.76-4.06)) were significantly associated to advanced-stage diagnosis. CONCLUSION In Ethiopia, more than two-thirds of breast cancer cases are diagnosed at an advanced stage. Use of traditional medicine before diagnostic confirmation, delay in seeking care, health system delay, rural residence, and chief complaint of painless breast lump were positively associated with an advanced-stage diagnosis. Policymakers and program designers give great focus to those delays so as to seek and access modern diagnosis and treatment as early as possible specifically focusing on those who are rurally residing.
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Affiliation(s)
- Amare Zewdie
- Department of Public Health, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia.
| | - Tadele Derbew Kassie
- Department of Public Health, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Tadele Fentabel Anagaw
- Health Promotion and Behavioural science department, College of medicine and health science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Elyas Melaku Mazengia
- Department of Public Health, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Sintayehu Shiferaw Gelaw
- Department of Public Health, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Eneyew Talie Fenta
- Department of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Habitu Birhan Eshetu
- Department of Health Promotion and Health Behaviour, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, PO.Box.196, Gondar, Ethiopia
| | - Natnael Kebede
- Department of Health Promotion, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Eyob Ketema Bogale
- Health Promotion and Behavioural science department, College of medicine and health science, Bahir Dar University, Bahir Dar, Ethiopia
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Setiawan L, Graef K, Schmolze D, Alem A, Taylor L. Building pathology capacity in sub-Saharan Africa to improve breast cancer diagnosis and treatment: training laboratory technicians in high-quality manual immunohistochemistry. BMC Cancer 2024; 24:32. [PMID: 38172837 PMCID: PMC10763384 DOI: 10.1186/s12885-023-11756-8] [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: 10/10/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND To address the need for a skilled workforce in breast cancer (BC) pathology in sub-Saharan Africa (SSA), we implemented an education program to train laboratory technicians in manual immunohistochemistry (IHC). METHODS A quality improvement education project was developed. Interactive webinars were held every six months with didactics and presentations from African experts with experience in IHC. We conducted knowledge assessments and surveys on current practice, equipment, and human resources. A digital mentorship platform (DMP) was created for discussions, sharing SOPs, and networking. For one year (2022-2023), we followed developments in pathology capacity, practice changes, and educational needs. A paired t-test was used to calculate the significance of changes in knowledge immediately after the webinar and comfort level with topics 35 days after the webinar. RESULTS Two hundred and sixty six participants from 10 SSA countries attended the first webinar, a series of six lectures on IHC theory, methods, and practice. Ninety-five participants from nine SSA countries provided a baseline assessment of pathology capacity and feedback. Mean knowledge increased by 17.4% immediately after the webinar (from 41.8% pre-webinar to 59.2% post, p = < 0.0001). Self-reported comfort level in topics 35 days after the webinar increased by 11.3%, but this was not statistically significant (mean 3.36 pre- to 3.74 post, p = 0.1). Over six months, recordings were accessed 412 times. After six months, the second webinar had 93 participants from eight SSA countries. Membership in the DMP increased from 64 to 172; recordings were viewed 412 times in six months; and 113 participants from nine SSA countries completed surveys. Among 74 respondents who perform IHC, 43.5% reported moderate or significant positive practice changes such as improved antigen retrieval techniques and optimization of preanalytical variables. Over half (52.7%, n = 39) reported the quality of slides had moderately or significantly improved. After one year, a third webinar had 98 participants from eight SSA countries. Thirty-eight completed surveys, DMP membership increased to 199, and 1 reported launching IHC in a lab in Nigeria. CONCLUSIONS Our program 1) reached hundreds of participants and provided a baseline assessment of pathology capacity across nine SSA countries; 2) created a novel mechanism to build pathology capacity and assess progress with this cohort; and 3) improved practices and the preparation of slides for over half performing manual IHC. After one year, interest was sustained. Tracking impact on diagnosis and treatment of BC in the region is needed long-term.
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Affiliation(s)
| | - Katy Graef
- BIO Ventures for Global Health, Seattle, WA, USA
| | - Dan Schmolze
- Department of Pathology, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Alemwosen Alem
- Pathology Department, Hawassa University College of Health Science, Hawassa, Ethiopia
| | - Lesley Taylor
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
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Ginsburg O, Vanderpuye V, Beddoe AM, Bhoo-Pathy N, Bray F, Caduff C, Florez N, Fadhil I, Hammad N, Heidari S, Kataria I, Kumar S, Liebermann E, Moodley J, Mutebi M, Mukherji D, Nugent R, So WKW, Soto-Perez-de-Celis E, Unger-Saldaña K, Allman G, Bhimani J, Bourlon MT, Eala MAB, Hovmand PS, Kong YC, Menon S, Taylor CD, Soerjomataram I. Women, power, and cancer: a Lancet Commission. Lancet 2023; 402:2113-2166. [PMID: 37774725 DOI: 10.1016/s0140-6736(23)01701-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 06/27/2023] [Accepted: 08/11/2023] [Indexed: 10/01/2023]
Affiliation(s)
- Ophira Ginsburg
- Centre for Global Health, US National Cancer Institute, Rockville, MD, USA.
| | | | | | | | - Freddie Bray
- International Agency for Research on Cancer, Lyon, France
| | - Carlo Caduff
- Department of Global Health and Social Medicine, King's College London, London, UK
| | - Narjust Florez
- Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | - Nazik Hammad
- Department of Medicine, Division of Hematology-Oncology, St. Michael's Hospital, University of Toronto, Canada; Department of Oncology, Queens University, Kingston, Canada
| | - Shirin Heidari
- GENDRO, Geneva, Switzerland; Gender Centre, Geneva Graduate Institute, Geneva, Switzerland
| | - Ishu Kataria
- Center for Global Noncommunicable Diseases, RTI International, New Delhi, India
| | - Somesh Kumar
- Jhpiego India, Johns Hopkins University Affiliate, Baltimore, MD, USA
| | - Erica Liebermann
- University of Rhode Island College of Nursing, Providence, RI, USA
| | - Jennifer Moodley
- Cancer Research Initiative, Faculty of Health Sciences, School of Public Health and Family Medicine, and SAMRC Gynaecology Cancer Research Centre, University of Cape Town, Cape Town, South Africa
| | - Miriam Mutebi
- Department of Surgery, Aga Khan University, Nairobi, Kenya
| | - Deborah Mukherji
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon; Clemenceau Medical Center Dubai, Dubai, United Arab Emirates
| | - Rachel Nugent
- Center for Global Noncommunicable Diseases, RTI International, Durham, NC, USA; Department of Global Health, University of Washington, Seattle, WA, USA
| | - Winnie K W So
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong Special Administrative Region, China
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, National Institute of Medical Science and Nutrition Salvador Zubiran, Mexico City, Mexico
| | | | - Gavin Allman
- Center for Global Noncommunicable Diseases, RTI International, Durham, NC, USA
| | - Jenna Bhimani
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - María T Bourlon
- Department of Hemato-Oncology, National Institute of Medical Science and Nutrition Salvador Zubiran, Mexico City, Mexico
| | - Michelle A B Eala
- College of Medicine, University of the Philippines, Manila, Philippines; Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Yek-Ching Kong
- Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Sonia Menon
- Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
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Ketema B, Kaba M, Negash S, Addissie A, Kantelhardt EJ. Intention to Undergo Clinical Breast Examination and Its Associated Factors among Women Attending Rural Primary Healthcare Facilities in South Central Ethiopia. Breast Care (Basel) 2023; 18:464-472. [PMID: 38125918 PMCID: PMC10730096 DOI: 10.1159/000531944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 07/04/2023] [Indexed: 12/23/2023] Open
Abstract
Background Breast cancer is a global public health problem with higher mortality in developing countries. The Ethiopian National Cancer Control Plan recommends clinical breast examination (CBE) for all women aged >18 years. However, there is low breast examination practice in Ethiopia. Therefore, this study aimed to describe level of intention to undergo CBE and associated factors among women visited selected rural healthcare facilities in south central Ethiopia using Theory of Planned Behavior (TPB). Methods This study used facility-based cross-sectional study design. A total of 420 women participated in this study. Interviewer-administered structured questionnaire was adopted from previously published research works and Ajzen's TPB manual. Statistical Package for Social Sciences (SPSS), version 27, was used for analysis. Binary logistic regression model was used to determine factors associated with intention to undergo CBE. Results In this study, nine out of ten women had never had CBE. Mean score for intention to undergo CBE was 12.55 (SD ± 3.22; min 5, max 20). Intention to undergo CBE was negatively associated with being in the second and middle wealth quantiles compared to the highest wealth quantile, and with the spouse not being able to read or write compared to having attended formal education. Positive attitude and higher subjective norm had relevant association with intention to undergo CBE. Conclusion The high score for intention to undergo CBE should encourage primary healthcare facilities to offer CBE. Behavioral change communication interventions could address women's attitude, subjective norm, and spouse's education associated with intention to undergo CBE.
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Affiliation(s)
- Bezawit Ketema
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Institute for Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University, Halle, Germany
| | - Mirgissa Kaba
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Sarah Negash
- Institute for Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University, Halle, Germany
| | - Adamu Addissie
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Eva Johanna Kantelhardt
- Institute for Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University, Halle, Germany
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Fields BC, Morse RM, Ortega E, Waterfield K, Prieto BA, Oberhelman R, Paz-Soldán VA. "I wanted information": navigating breast Cancer and its treatment in Lima, Peru. BMC Womens Health 2023; 23:230. [PMID: 37143060 PMCID: PMC10161672 DOI: 10.1186/s12905-023-02321-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 03/31/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Breast cancer impacts millions of people worldwide, and in Peru, breast cancer is the most common cause of cancer related death among women. Breast cancer treatment is physically and emotionally burdensome and challenging for patients. METHODS In-depth interviews were conducted with 14 female breast cancer patients and survivors in Lima, Peru. The interviews explored four main themes: the women's emotional experiences, coping mechanisms, resources available or needed, and advice for newly diagnosed breast cancer patients. RESULTS Respondents described a tremendous lack of informational support during and after diagnosis and treatment and requested more of this support from health professionals. Social support groups were helpful to participants; however, these forms of support were not available to all participants. Emotional and esteem support seemed amply received from family and friends, faith organizations, and fellow cancer patients. Participants experienced a range of emotions upon diagnosis and during treatment including fear, anxiety, difficulty accepting bodily changes, loneliness, and denial. CONCLUSION Breast cancer and its treatment can be a long, emotional journey; more extensive forms of informational support could help patients cope with this process.
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Affiliation(s)
- Brittany C Fields
- Tulane University School of Public Health & Tropical Medicine, New Orleans, LA, USA
| | - Rachel M Morse
- Tulane University School of Public Health & Tropical Medicine, New Orleans, LA, USA
| | - Emma Ortega
- Tulane University School of Public Health & Tropical Medicine, New Orleans, LA, USA
| | - Kristen Waterfield
- Tulane University School of Public Health & Tropical Medicine, New Orleans, LA, USA
| | - Bryn A Prieto
- Tulane University School of Public Health & Tropical Medicine, New Orleans, LA, USA
| | - Richard Oberhelman
- Tulane University School of Public Health & Tropical Medicine, New Orleans, LA, USA
| | - Valerie A Paz-Soldán
- Tulane University School of Public Health & Tropical Medicine, New Orleans, LA, USA.
- Asociación Benéfica PRISMA, Lima, Peru.
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Lombe DC, Mwamba M, Msadabwe S, Bond V, Simwinga M, Ssemata AS, Muhumuza R, Seeley J, Mwaka AD, Aggarwal A. Delays in seeking, reaching and access to quality cancer care in sub-Saharan Africa: a systematic review. BMJ Open 2023; 13:e067715. [PMID: 37055211 PMCID: PMC10106057 DOI: 10.1136/bmjopen-2022-067715] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2023] Open
Abstract
OBJECTIVES Late presentation and delays in diagnosis and treatment consistently translate into poor outcomes in sub-Saharan Africa (SSA). The aim of this study was to collate and appraise the factors influencing diagnostic and treatment delays of adult solid tumours in SSA. DESIGN Systematic review with assessment of bias using Risk of Bias in Non-randomised Studies of Exposures (ROBINS-E) tool. DATA SOURCES PubMed and Embase, for publications from January 1995 to March 2021. ELIGIBILITY CRITERIA Inclusion criteria: quantitative or mixed-method research, publications in English, on solid cancers in SSA countries. EXCLUSION CRITERIA paediatric populations, haematologic malignancies, and assessments of public perceptions and awareness of cancer (since the focus was on patients with a cancer diagnosis and treatment pathways). DATA EXTRACTION AND SYNTHESIS Two reviewers extracted and validated the studies. Data included year of publication; country; demographic characteristics; country-level setting; disease subsite; study design; type of delay, reasons for delay and primary outcomes. RESULTS 57 out of 193 full-text reviews were included. 40% were from Nigeria or Ethiopia. 70% focused on breast or cervical cancer. 43 studies had a high risk of bias at preliminary stages of quality assessment. 14 studies met the criteria for full assessment and all totaled to either high or very high risk of bias across seven domains. Reasons for delays included high costs of diagnostic and treatment services; lack of coordination between primary, secondary and tertiary healthcare sectors; inadequate staffing; and continued reliance on traditional healers and complimentary medicines. CONCLUSIONS Robust research to inform policy on the barriers to quality cancer care in SSA is absent. The focus of most research is on breast and cervical cancers. Research outputs are from few countries. It is imperative that we investigate the complex interaction of these factors to build resilient and effective cancer control programmes.
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Affiliation(s)
| | | | - Susan Msadabwe
- Department of Radiation Oncology, Cancer Diseases Hospital, Lusaka, Zambia
| | - Virginia Bond
- Social Science, London School of Hygiene & Tropical Medicine and ZAMBART, Lusaka, Zambia
| | | | - Andrew Sentoogo Ssemata
- The Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Kampala, Uganda
| | - Richard Muhumuza
- The Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Kampala, Uganda
| | - Janet Seeley
- Department of Global Health & Development, London School of Hygiene and Tropical Medicine, London, UK
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Darré T, Tchandikou L, Simgban P, Bombone M, Djiwa T, N’Timon B, Sama B, Ketevi A, Douaguibe B, N’Bortche BK, Seddoh Y, Tchaou M, Napo-Koura G. Factors associated with late diagnosis of breast cancer in women in Togo, Sub-Saharan Africa. BMC Womens Health 2023; 23:106. [PMID: 36918873 PMCID: PMC10012487 DOI: 10.1186/s12905-023-02257-8] [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: 12/22/2022] [Accepted: 03/03/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Breast cancer is the most frequently diagnosed cancer in women worldwide. The objective of this study was to identify factors associated with late diagnosis of breast cancer in Togolese women. METHODS We conducted a prospective cross-sectional study with descriptive and analytical purposes on cases of breast cancer in women in 2021, in Togo. The patients included in this study were women followed in the gynecology department for stages III and IV breast cancer. RESULTS We included 62 cases of breast cancer. The average age of the patients was 38.6 ± 12.5 years with extremes of 17 and 76 years. The breast nodule was the most common reason for consultation in 75.8% of cases. The histological types diagnosed were invasive carcinoma of non-specific type (58; 93.55%), mucinous carcinoma (3; 4.84%) and lobular carcinoma (1; 1.61%). For the stage of the cancer, 43 patients were stage III (69.4%) and 19 stage IV (30.6%). In multivariate analysis, the factors associated with late diagnosis of breast cancer were: fear of diagnosis (aOR = 1.29; p = 0.0014), long delay in diagnosis (aOR = 2.62; p = 0.0001) and failure to perform breast self-examination (aOR = 1.68; p = 0.0022). CONCLUSION The fear of the diagnosis, the absence of self-examination of the breasts and the use of traditional treatment and self-medication in first intention constituted the essential factors of the late diagnosis of breast cancer. Strategies should be put in place at the national level to impact on these factors for an early diagnosis of breast cancer.
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Affiliation(s)
- Tchin Darré
- Department of Pathology, University Teaching Hospital of Lomé, Lomé, Togo
- Faculty of Health Sciences, University of Lomé, BP 1515, Lomé, Togo
| | - Lantam Tchandikou
- Department of Pathology, University Teaching Hospital of Lomé, Lomé, Togo
| | - Panakinao Simgban
- Department of Pathology, University Teaching Hospital of Lomé, Lomé, Togo
| | - Mayi Bombone
- Department of Pathology, University Teaching Hospital of Lomé, Lomé, Togo
| | - Toukilnan Djiwa
- Department of Pathology, University Teaching Hospital of Lomé, Lomé, Togo
| | - Bidamin N’Timon
- Department of Imaging, University Teaching Hospital of Lomé and Kara, Lomé, Togo
| | - Bagassam Sama
- Department of Pathology, University Teaching Hospital of Lomé, Lomé, Togo
| | - Ayoko Ketevi
- Department Obstetrics and Gynecology, University Teaching Hospital of Lomé, Lomé, Togo
| | - Baguilane Douaguibe
- Department Obstetrics and Gynecology, University Teaching Hospital of Lomé, Lomé, Togo
| | - Bingo K. N’Bortche
- Department Obstetrics and Gynecology, University Teaching Hospital of Lomé, Lomé, Togo
| | - Yao Seddoh
- Department Obstetrics and Gynecology, University Teaching Hospital of Lomé, Lomé, Togo
| | - Mazamaesso Tchaou
- Department of Imaging, University Teaching Hospital of Lomé and Kara, Lomé, Togo
| | - Gado Napo-Koura
- Department of Pathology, University Teaching Hospital of Lomé, Lomé, Togo
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Shita A, Yalew AW, Seife E, Afework T, Tesfaw A, Gufue ZH, Rabe F, Taylor L, Kantelhardt EJ, Getachew S. Survival and predictors of breast cancer mortality in South Ethiopia: A retrospective cohort study. PLoS One 2023; 18:e0282746. [PMID: 36877683 PMCID: PMC9987816 DOI: 10.1371/journal.pone.0282746] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 02/22/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death in over 100 countries. In March 2021, the World Health Organization called on the global community to decrease mortality by 2.5% per year. Despite the high burden of the disease, the survival status and the predictors for mortality are not yet fully determined in many countries in Sub-Saharan Africa, including Ethiopia. Here, we report the survival status and predictors of mortality among breast cancer patients in South Ethiopia as crucial baseline data to be used for the design and monitoring of interventions to improve early detection, diagnosis, and treatment capacity. METHODS A hospital-based retrospective cohort study was conducted among 302 female breast cancer patients diagnosed from 2013 to 2018 by reviewing their medical records and telephone interviews. The median survival time was estimated using the Kaplan-Meier survival analysis method. A log-rank test was used to compare the observed differences in survival time among different groups. The Cox proportional hazards regression model was used to identify predictors of mortality. Results are presented using the crude and adjusted as hazard ratios along with their corresponding 95% confidence intervals. Sensitivity analysis was performed with the assumption that loss to follow-up patients might die 3 months after the last hospital visit. RESULTS The study participants were followed for a total of 4,685.62 person-months. The median survival time was 50.81 months, which declined to 30.57 months in the worst-case analysis. About 83.4% of patients had advanced-stage disease at presentation. The overall survival probability of patients at two and three years was 73.2% and 63.0% respectively. Independent predictors of mortality were: patients residing in rural areas (adjusted hazard ratio = 2.71, 95% CI: 1.44, 5.09), travel time to a health facility ≥7 hours (adjusted hazard ratio = 3.42, 95% CI: 1.05, 11.10), those who presented within 7-23 months after the onset of symptoms (adjusted hazard ratio = 2.63, 95% CI: 1.22, 5.64), those who presented more than 23 months after the onset of symptoms (adjusted hazard ratio = 2.37, 95% CI: 1.00, 5.59), advanced stage at presentation (adjusted hazard ratio = 3.01, 95% CI: 1.05, 8.59), and patients who never received chemotherapy (adjusted hazard ratio = 6.69, 95% CI: 2.20, 20.30). CONCLUSION Beyond three years after diagnosis, patients from southern Ethiopia had a survival rate of less than 60% despite treatment at a tertiary health facility. It is imperative to improve the early detection, diagnosis, and treatment capacities for breast cancer patients to prevent premature death in these women.
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Affiliation(s)
- Abel Shita
- Mizan Aman College of Health Sciences, Department of Public Health, Addis Ababa, Southwest Ethiopia
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
- Global Health Working Group, Martin-Luther-University, Halle (Saale), Germany
| | - Alemayehu Worku Yalew
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Edom Seife
- Department of Medicine, Oncology Center, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tsion Afework
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
- Global Health Working Group, Martin-Luther-University, Halle (Saale), Germany
- NCD Working Group School of Public Health Addis Ababa University, Addis Ababa, Ethiopia
| | - Aragaw Tesfaw
- Department of Public Health, College of Health Science, Debre Tabor University, Debra Tabor, North West Ethiopia
| | - Zenawi Hagos Gufue
- Department of Public Health, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia
| | - Friedemann Rabe
- Global Health Working Group, Martin-Luther-University, Halle (Saale), Germany
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin Luther University, Halle, Germany
| | - Lesley Taylor
- City of Hope National Medical Center, Duarte, Los Angeles County, California, United States of America
| | - Eva Johanna Kantelhardt
- Global Health Working Group, Martin-Luther-University, Halle (Saale), Germany
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin Luther University, Halle, Germany
- Department of Gynaecology, Martin Luther University, Halle, Germany
| | - Sefonias Getachew
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
- Global Health Working Group, Martin-Luther-University, Halle (Saale), Germany
- NCD Working Group School of Public Health Addis Ababa University, Addis Ababa, Ethiopia
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin Luther University, Halle, Germany
- * E-mail:
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11
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Eid MK, Abu-Odah H, Wehedi DT, Su JJ, Abed Y. Policymakers' and patients’ perspectives on breast cancer management in the Gaza Strip-Palestine: A qualitative study. Eur J Oncol Nurs 2022; 61:102223. [DOI: 10.1016/j.ejon.2022.102223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 10/03/2022] [Accepted: 10/08/2022] [Indexed: 11/16/2022]
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12
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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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