Risk Factors Associated with Breast Cancer among Women in Addis Ababa, Ethiopia: Unmatched Case-Control Study

Determinants of breast cancer among women attending oncology units in selected health facilities of Hawassa City, Sidama Region, Southern Ethiopia, 2023: case-control study

Background

The incidence of breast cancer (BC) is rampantly increasing in developing countries particularly Ethiopia. Unfortunately, the morbidity and mortality rates are sharply increasing, and because of this, families are suffering from socioeconomic crises. Despite this, there is limited evidence on the determinants of breast cancer in Ethiopia as well as in the study area.

Objective

To identify the determinants of BC among women attending oncology units in selected hospitals in Hawassa City, Ethiopia, in 2023.

Method

A hospital-based, case-control study with 300 patients (75 cases and 225 controls) was carried out in Hawassa from June to July 2023. A simple random sampling technique was used to select cases and controls. Data were collected via pretested and structured digitally installed questionnaires with Kobo collection/smartphones. The data were exported from the server to SPSS version 27 for analysis. Descriptive analysis of univariate, bivariate, and multivariable logistic regression data was conducted to determine the associations between breast cancer incidence and independent factors.

Results

A total of 300 women participated in this study for a response rate of 100%. The mean ( ± SD) ages of the respondents were 37.2 ( ± 14.8) and 36.6 ( ± 15.1) years for the cases and controls, respectively. According to the multivariate logistic regression model, postmenopausal status [AOR: 2.49; 95% CI (1.18, 5.23)], family history of cancer [AOR: 2.33; 95% CI (1.12, 4.82)], oral contraceptives [AOR: 2.74; 95% CI (1.34, 5.99)], overweight and/or obesity [AOR: 2.29; 95% CI: (1.14, 4.59)], and consumption of solid oil [AOR: 2.36; 95% CI (1.20, 4.67)] were independently associated with BC risk.

Conclusion

This study revealed important risk factors for BC. Therefore, women should adopt healthier lifestyles through healthy nutrition and regular exercise to reduce the risk of developing BC. In addition, early detection and regular screening are proactive approaches for detecting BC.

Access to advanced healthcare services and its associated factors among patients with cervical cancer in Addis Ababa, Ethiopia

Objective

This study aimed to assess the extent of access to healthcare services, perception and associated factors among patients with cervical cancer in Addis Ababa, Ethiopia.

Methods

A facility-based cross-sectional study was conducted from 01 July through 30 August 2023 at two tertiary hospitals. Cases with histopathologic and clinical confirmation of cervical cancer were enrolled using a consecutive sampling technique. Data was collected through a validated questionnaire administered by interviewers using the KoboCollect application. Subsequently, the collected data underwent analysis using Statistical Sciences for Social Sciences (SPSS) version 26.0. Bivariable and multivariable regression models were performed at p ≤ 0.2 and p<0.05 statistical significance, respectively.

Results

A total of 391 patients were enrolled in the study. Health facilities were accessible for obtaining general medical services (56.5%), drugs (57.3%), laboratory diagnosis services (57.0%), imaging diagnosis services (56.8%), and radiotherapy services (55.8%) of the patients. Cost of services was affordable only in 11.5% of the cases. Essential anticancer medicines were out of stock for 229 (58.6%) of the patients during the past three months. About two-thirds of the patients have a good perception of access to healthcare services. In multivariable binary logistic regression, admission to the inpatient (AOR: 0.20, 95% CI: 0.06-0.67), joblessness (AOR: 0.19, 95% CI: 0.08-0.46), lower level of income to the extreme poverty line (3567ETB)(64.9 USD) (AOR: 0.19, 95% CI: 0.10-0.35), no CBHI coverage (AOR: 4.16, 95% CI: 1.76-9.85), having social support (AOR: 3.80; 95% CI: 1.96-7.41), and poor dietary practice (AOR: 2.36, 95% CI: 1.28-4.35) were found to have a statistically significant association with perceived good access to healthcare services.

Conclusion

Only close to a half of the patients with cervical cancer, in Addis Ababa, have adequate access to healthcare services. Nearly two-thirds of the patients reported perceived good access to the services. Many factors were found to show a statistically significant association with patients' perceived access to healthcare services.

Determinants of breast cancer in Ethiopia: a systematic review and meta-analysis

Background

Breast cancer (BC) is the first leading cancer sharing about 25% of the cancer burden among women globally. This study aimed to identify the determinants of BC in Ethiopia.

Methods

We comprehensively searched primary studies conducted in Ethiopia on associated factors of BC in PubMed, Cochrane Library, Hinari, Google, and Google Scholar) and available online until 2 June 2023. The necessary data were extracted from relevant studies and exported to STATA version 15 for analysis. The pooled odds ratio with its 95% confidence interval (CI) was estimated using a random effect model. The finding was reported following preferred reporting items for systematic reviews and meta-analyses guidelines.

Results

Five studies with 1,819 participants (792 cases and 1,027 controls) were included. The significant determinants of BC were age at menarche <12 years (adjusted odds ratio (AOR) = 3.36, 95% CI: 1.68-5.04), post-menopause (AOR = 2.37, 95% CI: 1.67-3.06), ever breastfeeding (AOR = 0.28, 95% CI: 0.15-0.42), and family history of cancer (AOR = 2.39, 95% CI: 1.29-3.44).

Conclusion

In Ethiopia, the significant determinants of BC among women were age at menarche <12 years, post-menopause, Ever breastfeeding, and family history of cancer. We recommend that the concerned organizations consider the aforementioned factors in addressing the problem of BC in Ethiopia by increasing community awareness, promoting breast self-examination, and developing programs to reduce the increasing burden of BC in the study setting.

Risk factors for breast cancer among women in Ekurhuleni Metropolitan Municipality, Gauteng province of South Africa, 2017‒2020: a case-control study

Introduction

Breast cancer (BC) is the most common cancer among women in South Africa (SA), with an age-standardised incidence rate of 52.6 and an age-standardised mortality rate of 16.0 per 100,000 population. There is a paucity of evidence on the risk factors for BC among women of all races in SA. Given the rising prevalence of BC in SA, literature-based evidence is critical for the appropriate dissemination of preventative measures. This study aimed to identify the risk factors associated with the development of BC among women in Ekhuruleni Metropolitan Municipality.

Methods

An unmatched case-control study was conducted from 1 January 2017 to 31 December 2020 using secondary data extracted from the Ekurhuleni Population-Based Cancer Registry. Unconditional multivariable logistic regression analysis was carried out using the adjusted odds ratio (aOR). The variables race, employment, human immunodeficiency virus (HIV), smoking and alcohol status were included in the multivariable logistic regression model while the model was adjusted for age.

Results

A total of 2,217 cases and 851 controls were enrolled in the study. The mean age (±SD) in years was 55.7 (±15.2). The White population group, being self-employed and being HIV positive was significantly associated with reduced odds of BC development. HIV-positive women were 61% less likely to have BC than women who were HIV-negative (aOR 0.39; 95% confidence interval (CI): 0.27‒0.57). White women were 65% less likely to have BC than women of other races (aOR 0.35; 95% CI: 0.29‒0.43). Self-employed women were 59% less likely to have BC than women who were formally employed (aOR 0.41; 95% CI: 0.18‒0.97). No evidence of association was observed between tobacco smoking and BC as well as alcohol consumption and BC.

Conclusion

There was a 65% reduction in BC risk among White women compared to other races. HIV-positive women demonstrated a 61% lower likelihood of BC while self-employed women showed a 59% reduced risk of developing BC. These findings suggest that being White, self-employed or HIV-positive may provide some protection against BC. However, additional research is needed to validate these results and establish the underlying reasons behind these associations.

Breast self-examination practice and associated factors among women of reproductive age in southeast Ethiopia

Regular breast self-examination is the most cost-effective method for early detection of breast cancer, especially in resource-limited countries. However, breast self-examination practice was low among reproductive-age women.

Objective

This study aims to evaluate breast self-examination practice and associated factors among women of reproductive age in southeast Ethiopia.

Methods

A convergent parallel mixed-methods study design was conducted on 836 women of reproductive age. An interviewer-administered questionnaire was used for the quantitative part of the study and supplemented by focus group discussions. A database was created using Epi-info version 3.5.3, and analyzed using SPSS version 20. Bivariate and multivariable logistic regressions were done to examine the effect of explanatory variables. Variables with p-value <0.05 during multivariable logistic regressions were considered as significantly associated with the dependent variable. Thematic data analysis was carried out for the qualitative study.

Result

Out of 836 total participants, only 20.7% had ever heard about breast self-examination practice. Also, only 13.2% of the mothers had practiced breast self-examinations. Even though the majority of the participants during focused group discussions had knowledge about breast cancer screening, most of them stated that breast self-examination was not practiced among them. Maternal age, mother's level of education, and previous history of breast examination by health professionals were significant predictors of breast self-examination practices.

Conclusion

This study reported a low prevalence of breast self-examination practice. Therefore, enhancing women's education and encouraging breast examination by health professionals are essential to increase the proportion of women performing breast self-examination.

Risk Factors Affecting Survival Time of Breast Cancer Patients: The case of Southwest Ethiopia

BACKGROUND

Breast cancer is one of the non-communicable diseases and the main origin of the loss of life in the world. In Ethiopia, breast cancer is the second common cancer health problem for women. The main objective of this study was to identify the potential risk factors affecting the survival time of breast cancer patients in Southwest Ethiopia.

STUDY DESIGN

A retrospective study design.

METHODS

The data were taken from the patients' medical records that registered from January 1, 2015, to  January 31, 2020. A retrospective study design was used in this study. Different shared frailty survival models were employed to analyze the dataset.

RESULTS

Out of 642 recorded breast cancer patients, 447(69.6%) cases died during the study period, and 195 (30.4%) patients lost follow-up for unknown reasons. The median time to death for breast cancer patients was 10 months, and hospitals were used as a cluster effect. The result revealed that women with no smoking habit had about 3.35 times higher survival time than patients who had a smoking habit, and as breast cancer patients age increased, the survival time decreased by 0.99. Moreover, breast cancer patients in rural areas had about 0.14 times lower survival time, compared to breast cancer patients who were urban residents.

CONCLUSIONS

Age, place of residence, treatment taken, stage, histologic grade, tumor size, oral contraceptives, and smoking habits led to a shorter survival time. To reduce the burden of breast cancer, awareness should be given to the community.