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Gedfew M, Getie A, Akalu TY, Ayenew T. Recurrence and associated factors of breast cancer among women in sub saharan africa, systematic review and meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108528. [PMID: 39029209 DOI: 10.1016/j.ejso.2024.108528] [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: 05/14/2024] [Revised: 06/24/2024] [Accepted: 06/30/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND Recurrence of breast cancer is a critical indicator of disease progression and survival rates. Therefore, this systematic review and meta-analysis aimed to assess the prevalence of recurrence and associated factors of breast cancer in Sub Saharan Africa. METHODS We conducted a thorough search of the following international databases between January 1 and February 7, 2024: PubMed, EMBASE, CINAHL, Google Scholar, Science Direct, and the Cochrane Library. A data extraction format was used by two authors to independently extract all required data. STATA Version 14 was used to evaluate the quantitative data and the Cochrane Q test statistics and I2 test were used to evaluate the heterogeneity among the included studies using a random effects meta-analysis model. RESULTS The overall prevalence of breast cancer recurrence is 27.44 % (95%CI: 26.41, 28.46). The highest prevalence was found in Uganda (89.927 % (87.0, 92.851)), followed by Tanzania (82.174 % (77.228, 87.120)). Involved deep surgical margin (OR: 3.62, 95 % CI: 2.11, 5.12), positive lymph node status (OR: 6.85, 95 % CI: 1.42, 12.3)), and histological grade III (OR: 7.43, 95 % CI: 3.56, 11.3)) were all significantly associated factors. CONCLUSION The pooled prevalence of breast cancer recurrence in this review was significantly high. Histological grade III, positive lymph node statuses, clinical staging III, and involved deep surgical margin were associated factors. Therefore, frequent monitoring, regular screenings, imaging tests, and consultations with oncologists, take extra care to ensure clear and deep surgical margins using advanced imaging techniques are highly recommended.
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Affiliation(s)
- Mihretie Gedfew
- Nursing Department, College of Health Science, Debre Markos University, Debre Markos, Ethiopia.
| | - Addisu Getie
- Nursing Department, College of Health Science, Debre Markos University, Debre Markos, Ethiopia.
| | - Tadesse Yirga Akalu
- Nursing Department, College of Health Science, Debre Markos University, Debre Markos, Ethiopia.
| | - Temesgen Ayenew
- Nursing Department, College of Health Science, Debre Markos University, Debre Markos, Ethiopia.
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Wondimagegnehu A, Assefa M, Teferra S, Kantelhardt EJ, Zebrack B, Addissie A. A Qualitative Study on Psychosocial Challenges of Patients With Cancer in Ethiopia Using the Social-Ecological Model. QUALITATIVE HEALTH RESEARCH 2024; 34:828-841. [PMID: 38229470 DOI: 10.1177/10497323231219409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
Cancer diagnosis and treatment can be physically arduous, disrupting patients' social and work lives. Understanding the extent of these problems is key to addressing patients' needs, but specific psychosocial challenges have not yet been well studied in resource-limited settings. A qualitative study was conducted in the capital and two regions of Ethiopia with the aim of exploring psychosocial challenges among cancer patients. A total of 14 in-depth interviews (IDIs) and 16 focus group discussions (FGDs) were done with cancer patients, health professionals, community representatives, and religious leaders. Four separate interview guides were used to facilitate the interviews and discussions. All transcribed documents, field notes, and reflexive memos were entered into NVivo 12 software, and deductive thematic analysis using the social-ecological model was applied to summarize the main findings. At an individual level, emotional distress, suicidal risk, denial, and refusal of treatment were identified immediately after diagnosis while hopelessness, feeling depressed, and fear of death were commonly reported psychosocial challenges during the course of treatment. Involvement of family members in major treatment decisions was recognized at an interpersonal level. Our result also revealed that cancer patients had strong social support from family members and close friends. In the community, traditional medicine and religious rituals were considered an alternative treatment for cancer. The findings indicate that counselling and psychoeducation are crucial for cancer patients, family members, and close friends. Awareness creation programmes should be delivered through collaboration with religious leaders and traditional healers.
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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, Biostatistics and Informatics, Martin-Luther-University, Halle, Germany
| | - 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
| | - Eva J Kantelhardt
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University, Halle, Germany
- Department of Gynecology, Martin-Luther-University, Halle, Germany
| | - Bradley Zebrack
- School of Social Work, University of Michigan, 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, Biostatistics and Informatics, Martin-Luther-University, Halle, Germany
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Kim J, Macharia PM, McCormack V, Foerster M, Galukande M, Joffe M, Cubasch H, Zietsman A, Anele A, Offiah S, Parham G, Pinder LF, Anderson BO, Schüz J, Dos Santos-Silva I, Togawa K. Geospatial disparities in survival of patients with breast cancer in sub-Saharan Africa from the African Breast Cancer-Disparities in Outcomes cohort (ABC-DO): a prospective cohort study. Lancet Glob Health 2024; 12:e1111-e1119. [PMID: 38788756 PMCID: PMC11168938 DOI: 10.1016/s2214-109x(24)00138-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 03/13/2024] [Accepted: 03/21/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND There is an urgent need to improve breast cancer survival in sub-Saharan Africa. Geospatial barriers delay diagnosis and treatment, but their effect on survival in these settings is not well understood. We examined geospatial disparities in 4-year survival in the African Breast Cancer-Disparities in Outcomes cohort. METHODS In this prospective cohort study, women (aged ≥18 years) newly diagnosed with breast cancer were recruited from eight hospitals in Namibia, Nigeria, South Africa, Uganda, and Zambia. They reported sociodemographic information in interviewer-administered questionnaires, and their clinical and treatment data were collected from medical records. Vital status was ascertained by contacting participants or their next of kin every 3 months. The primary outcome was all-cause mortality in relation to rural versus urban residence, straight-line distance, and modelled travel time to hospital, analysed using restricted mean survival time, Cox proportional hazards, and flexible parametric survival models. FINDINGS 2228 women with breast cancer were recruited between Sept 8, 2014, and Dec 31, 2017. 127 were excluded from analysis (58 had potentially recurrent cancer, had previously received treatment, or had no follow-up; 14 from minority ethnic groups with small sample sizes; and 55 with missing geocoded home addresses). Among the 2101 women included in analysis, 928 (44%) lived in a rural area. 1042 patients had died within 4 years of diagnosis; 4-year survival was 39% (95% CI 36-42) in women in rural areas versus 49% (46-52) in urban areas (unadjusted hazard ratio [HR] 1·24 [95% CI 1·09-1·40]). Among the 734 women living more than 1 h from the hospital, the crude 4-year survival was 37% (95% CI 32-42) in women in rural areas versus 54% (46-62) in women in urban areas (HR 1·35 [95% CI 1·07-1·71] after adjustment for age, stage, and treatment status). Among women in rural areas, mortality rates increased with distance (adjusted HR per 50 km 1·04, 1·01-1·07) and travel time (adjusted HR per h 1·06, 1·02-1·10). Among women with early-stage breast cancer receiving treatment, women in rural areas had a strong survival disadvantage (overall HR 1·54, 1·14-2·07 adjusted for age and stage; >1 h distance adjusted HR 2·14, 1·21-3·78). INTERPRETATION Geospatial barriers reduce survival of patients with breast cancer in sub-Saharan Africa. Specific attention is needed to support patients with early-stage breast cancer living in rural areas far from cancer treatment facilities. FUNDING US National Institutes of Health (National Cancer Institute), Susan G Komen for the Cure, and the International Agency for Research on Cancer.
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Affiliation(s)
- Joanne Kim
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer, WHO, Lyon, France
| | - Peter M Macharia
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium; Population and Health Impact Surveillance Group, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya; Centre for Health Informatics, Computing and Statistics, Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Valerie McCormack
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer, WHO, Lyon, France.
| | - Milena Foerster
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer, WHO, Lyon, France
| | - Moses Galukande
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Maureen Joffe
- Strengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Herbert Cubasch
- Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
| | - Annelle Zietsman
- AB May Cancer Centre, Windhoek Central Hospital, Windhoek, Namibia
| | | | | | - Groesbeck Parham
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Leeya F Pinder
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | | | - Joachim Schüz
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer, WHO, Lyon, France
| | - Isabel Dos Santos-Silva
- Department of Non-Communicable Diseases Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Kayo Togawa
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer, WHO, Lyon, France; Division of Surveillance and Policy Evaluation, National Cancer Center Institute for Cancer Control, Tokyo, Japan
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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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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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Mapanga W, Norris SA, Craig A, Ayeni OA, Chen WC, Jacobson JS, Neugut AI, Ruff P, Cubasch H, O’Neil DS, Buccimazza I, Čačala S, Stopforth LW, Farrow HA, Nietz S, Phakathi B, Chirwa T, McCormack VA, Joffe M. Drivers of disparities in stage at diagnosis among women with breast cancer: South African breast cancers and HIV outcomes cohort. PLoS One 2023; 18:e0281916. [PMID: 36795733 PMCID: PMC9934316 DOI: 10.1371/journal.pone.0281916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 02/05/2023] [Indexed: 02/17/2023] Open
Abstract
OBJECTIVE In low- and middle-income countries (LMICs), advanced-stage diagnosis of breast cancer (BC) is common, and this contributes to poor survival. Understanding the determinants of the stage at diagnosis will aid in designing interventions to downstage disease and improve survival from BC in LMICs. METHODS Within the South African Breast Cancers and HIV Outcomes (SABCHO) cohort, we examined factors affecting the stage at diagnosis of histologically confirmed invasive breast cancer at five tertiary hospitals in South Africa (SA). The stage was assessed clinically. To examine the associations of the modifiable health system, socio-economic/household and non-modifiable individual factors, hierarchical multivariable logistic regression with odds of late-stage at diagnosis (stage III-IV), was used. RESULTS The majority (59%) of the included 3497 women were diagnosed with late-stage BC disease. The effect of health system-level factors on late-stage BC diagnosis was consistent and significant even when adjusted for both socio-economic- and individual-level factors. Women diagnosed in a tertiary hospital that predominantly serves a rural population were 3 times (OR = 2.89 (95% CI: 1.40-5.97) as likely to be associated with late-stage BC diagnosis when compared to those diagnosed at a hospital that predominantly serves an urban population. Taking more than 3 months from identifying the BC problem to the first health system entry (OR = 1.66 (95% CI: 1.38-2.00)), and having luminal B (OR = 1.49 (95% CI: 1.19-1.87)) or HER2-enriched (OR = 1.64 (95% CI: 1.16-2.32)) molecular subtype as compared to luminal A, were associated with a late-stage diagnosis. Whilst having a higher socio-economic level (a wealth index of 5) reduced the probability of late-stage BC at diagnosis, (OR = 0.64 (95% CI: 0.47-0.85)). CONCLUSION Advanced-stage diagnosis of BC among women in SA who access health services through the public health system was associated with both modifiable health system-level factors and non-modifiable individual-level factors. These may be considered as elements in interventions to reduce the time to diagnosis of breast cancer in women.
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Affiliation(s)
- Witness Mapanga
- Strengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Paediatrics, SAMRC/Wits Developmental Pathways to Health Research Unit, Faculty of the Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Medical Oncology, Department of Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shane A. Norris
- Strengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Paediatrics, SAMRC/Wits Developmental Pathways to Health Research Unit, Faculty of the Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Global Health Research Institute, School of Health and Human Development, University of Southampton, Southampton, United Kingdom
| | - Ashleigh Craig
- Division of Medical Oncology, Department of Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Oluwatosin A. Ayeni
- Strengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Global Health Research Institute, School of Health and Human Development, University of Southampton, Southampton, United Kingdom
- South Africa Medical Research Council Common Epithelial Cancers Research Centre, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Wenlong C. Chen
- Strengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Judith S. Jacobson
- Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Alfred I. Neugut
- Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, United States of America
| | - Paul Ruff
- Strengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Medical Oncology, Department of Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- South Africa Medical Research Council Common Epithelial Cancers Research Centre, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Herbert Cubasch
- Strengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- South Africa Medical Research Council Common Epithelial Cancers Research Centre, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Daniel S. O’Neil
- Sylvester Comprehensive Cancer Center and Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - Ines Buccimazza
- Strengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sharon Čačala
- Strengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Specialized Surgery, Inkosi Albert Luthuli Central Hospital, Durban and Ngwelezane Hospital, University of KwaZulu-Natal, Empangeni, KwaZulu-Natal, South Africa
| | - Laura W. Stopforth
- Strengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Departments of Surgery and Radiation Oncology, Grey’s Hospital, University of KwaZulu-Natal, Pietermaritzburg, KwaZulu-Natal, South Africa
| | - Hayley A. Farrow
- Departments of Surgery and Radiation Oncology, Grey’s Hospital, University of KwaZulu-Natal, Pietermaritzburg, KwaZulu-Natal, South Africa
| | - Sarah Nietz
- Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Charlotte Maxeke Surgical Breast Unit, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Boitumelo Phakathi
- Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Charlotte Maxeke Surgical Breast Unit, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Tobias Chirwa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Valerie A. McCormack
- Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France
| | - Maureen Joffe
- Strengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- South Africa Medical Research Council Common Epithelial Cancers Research Centre, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Bigman G, Adebamowo SN, Yawe KDT, Yilkudi M, Olaomi O, Badejo O, Famooto A, Ezeome E, Salu IK, Miner E, Anosike I, Achusi B, Adebamowo C. Leisure-time physical activity is associated with reduced risks of breast cancer and triple negative breast cancer in Nigerian women. Cancer Epidemiol 2022; 79:102195. [PMID: 35717688 PMCID: PMC9904209 DOI: 10.1016/j.canep.2022.102195] [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: 11/04/2021] [Revised: 04/26/2022] [Accepted: 06/01/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND Leisure-time physical activity(LTPA) is associated with a reduced risk of breast cancer, but this has less been investigated by cancer subtypes in Africans living in Sub-Saharan Africa(SSA). We examined the associations between LTPA and breast cancer including its subtypes in Nigerian women and explored the effect modification of body size on such associations. METHODS The sample included 508 newly diagnosed primary invasive breast cancer cases and 892 controls from the Nigerian Integrative Epidemiology of Breast Cancer(NIBBLE) Study. Immunohistochemical(IHC) analysis was available for 294 cases. Total metabolic equivalents(METs) per hour/week of LTPA were calculated and divided by quartiles(Q1 <3.75, Q2:3.75-6.69, Q3:6.70-14.74, Q4:14.75 ≤). We applied logistic regressions to estimate the adjusted Odds Ratios(ORs) between LTPA and breast cancer and by its molecular subtypes and whether age-adjusted associations are modified by BMI. RESULTS The mean age(Mean±SD) of cases vs. controls(45.5 ± 11.1vs.40.1 ± 9.0) was higher, and the mean total METs hour/week was higher in controls vs. cases(11.9 ± 14.9vs.8.3 ± 11.1,p-value<0.001). Overall, 43.2%(N = 127/294) were classified as HRP, and 41.8%(N = 123/294) as TNBC. Women in the higher LTPA quartiles(Q3-Q4) vs. Q1 had lower odds of having breast cancer(ORQ4vs.Q1=0.51,95%CI:0.35-0.74) and TNBC(ORQ4vs.Q1=0.51, 95%CI:0.27-0.96), but not HRP(ORQ4vs.Q1=0.61,95%CI:0.34-1.09) after adjusting for age, age at first menarche, body size, breastfeeding, menopausal, parity, contraceptives, demographics, alcohol, smoking, and physical activity at home and work. Lastly, LTPA and its age-adjusted association with breast cancer was more pronounced in women with BMI< 30 vs. BMI 30 + . CONCLUSIONS LTPA may reduce the risk of breast cancer, especially TNBC, which is the more aggressive and prevalent molecular subtype of breast cancer in SSA.
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Affiliation(s)
- Galya Bigman
- Department of Epidemiology and Public Health, Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, United States,Correspondence to: 725 Lombard Street, Baltimore, MD 21201, United States. (G. Bigman), (C. Adebamowo)
| | - Sally N. Adebamowo
- Department of Epidemiology and Public Health, Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, United States
| | | | - Monday Yilkudi
- University of Abuja Teaching Hospital, Gwagwalada, Nigeria
| | | | | | - Ayo Famooto
- African Collaborative Center for Microbiome and Genomics Research(ACCME) Biorepository and Research Laboratory, Institute of Human Virology, Nigeria
| | | | | | | | | | | | - Clement Adebamowo
- Department of Epidemiology and Public Health, Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, United States,African Collaborative Center for Microbiome and Genomics Research(ACCME) Biorepository and Research Laboratory, Institute of Human Virology, Nigeria,Correspondence to: 725 Lombard Street, Baltimore, MD 21201, United States. (G. Bigman), (C. Adebamowo)
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8
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Bigman G, Adebamowo SN, Yawe KDT, Yilkudi M, Olaomi O, Badejo O, Famooto A, Ezeome E, Salu IK, Miner E, Anosike I, Achusi B, Adebamowo C. A matched case-control study of bean intake and breast cancer risk in urbanized Nigerian women. Cancer Causes Control 2022; 33:959-969. [PMID: 35511324 DOI: 10.1007/s10552-022-01584-9] [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: 11/05/2021] [Accepted: 04/11/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Bean intake has been associated with reduced risk of breast cancer, however; only a few studies considered molecular subtypes status and none in African women living in Sub-Saharan Africa (SSA). Therefore, the purpose of this study was to examine the associations between dietary intake of beans and breast cancer including its subtypes in Nigerian women. METHODS Overall, 472 newly diagnosed patients with primary invasive breast cancer were age-matched (± 5 years) with 472 controls from the Nigerian Integrative Epidemiology of Breast Cancer (NIBBLE) Study from 01/2014 to 07/2016. We collected the dietary intake of beans using a food frequency questionnaire (FFQ). Beans_alone intake was categorized into three levels never (never in the past year), low (≤ 1 portion/week), and high intake (> 1 portion/week). We used conditional and unconditional logistic regression models to estimate the Odds Ratio (OR) and 95% Confidence Intervals (CI) of beans_alone intake and the risk of breast cancer and by its molecular subtypes, respectively. RESULTS The mean (SD) age of cases was 44.4(10.0) and of controls was 43.5(9.5) years. In the case group, more than half (51.1%) have never consumed beans_alone in the past year compared to 39.0% in the control group. The multivariable models showed inverse associations between beans_alone (high vs. none) and breast cancer (OR = 0.55; 95%CI: 0.36-0.86, p-trend = 0.03), triple-negative (OR = 0.51 95%CI: 0.28-0.95, p-trend = 0.02) and marginally associated with hormone receptor-positive (OR = 0.53, 95%CI: 0.29-0.96, p-trend = 0.06). CONCLUSION Dietary intake of beans_alone may play a significant role in reducing the incidence of breast cancer, particularly of the more aggressive molecular subtype, triple-negative, in African women living in SSA.
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Affiliation(s)
- Galya Bigman
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Sally N Adebamowo
- Department of Epidemiology and Public Health and Marlene and Stewart Greenbaum, Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, USA
| | | | - Monday Yilkudi
- University of Abuja Teaching Hospital, Gwagwalada, Nigeria
| | | | | | - Ayo Famooto
- African Collaborative Center for Microbiome and Genomics Research (ACCME) Biorepository and Research Laboratory, Institute of Human Virology, Abuja, Nigeria
| | | | | | | | | | | | - Clement Adebamowo
- Department of Epidemiology and Public Health and Marlene and Stewart Greenbaum, Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, USA. .,African Collaborative Center for Microbiome and Genomics Research (ACCME) Biorepository and Research Laboratory, Institute of Human Virology, Abuja, Nigeria.
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9
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Azubuike SO, Hayes L, Sharp L, Alabi A, Oyesegun RA, McNally R. Physical activity and the risk of breast cancer among Nigerian women. Cancer Epidemiol 2022; 78:102163. [DOI: 10.1016/j.canep.2022.102163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 04/12/2022] [Accepted: 04/14/2022] [Indexed: 12/24/2022]
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10
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Behrad MS, Rashed F, Zarabi A, Saidi S. Stage at Diagnosis and Patient Delay among Breast Cancer Women in Kabul, Afghanistan. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Breast cancer is the commonest cause of mortality among women. According to WHO in 2012, about 7400 women died because of cancers in Afghanistan.
Aim: To obtain information about clinical stages of breast cancer of women at the time of diagnosis in Kabul, Afghanistan.
Patient and Method: This was a cross-sectional study of 240 women diagnosed with breast cancer from March 2016 to March 2019. The diagnosis of breast cancer was made by the surgeon on the basis of physical examination and Biopsy/Pathological reports. Clinical staging of the tumor was recorded according to the tumor, nodal, and metastasis (TNM) classification. The gap between knowing the problem and consulting a physician (Patient delay) was categorized: less than 3 months, 3-6 months and more than 6 months.
Results:
The mean age of patients was 49.31 years (SD ± 11.80) ranging from 18 to 76 years. The Patient delay was more than 6 months (65%). Infiltrating ductal carcinoma was the commonest morphological type (76.7%). Breast cancer in left breast of patients was 52.1%. Stage II was higher in left and stage III in right breast. The majority of patients were in stage II & III at the time of diagnosis. All stages were frequent in fourth decades of age group. The association between the clinical stages of breast cancer at the time of diagnosis, the age and breast R/L involvement of the patients was significant (P<0.001). The association between clinical stage and marital status was not significant (P<0.953).
Conclusion:
Late referrals, diagnosis delay and advanced stages of breast cancer are still a serious problem in Afghanistan. Cancer in right breast should be given more attention because higher stages of the disease are expected. Awareness and social education is great need.
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11
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Crosby D, Bhatia S, Brindle KM, Coussens LM, Dive C, Emberton M, Esener S, Fitzgerald RC, Gambhir SS, Kuhn P, Rebbeck TR, Balasubramanian S. Early detection of cancer. Science 2022; 375:eaay9040. [PMID: 35298272 DOI: 10.1126/science.aay9040] [Citation(s) in RCA: 267] [Impact Index Per Article: 133.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Survival improves when cancer is detected early. However, ~50% of cancers are at an advanced stage when diagnosed. Early detection of cancer or precancerous change allows early intervention to try to slow or prevent cancer development and lethality. To achieve early detection of all cancers, numerous challenges must be overcome. It is vital to better understand who is at greatest risk of developing cancer. We also need to elucidate the biology and trajectory of precancer and early cancer to identify consequential disease that requires intervention. Insights must be translated into sensitive and specific early detection technologies and be appropriately evaluated to support practical clinical implementation. Interdisciplinary collaboration is key; advances in technology and biological understanding highlight that it is time to accelerate early detection research and transform cancer survival.
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Affiliation(s)
| | - Sangeeta Bhatia
- Marble Center for Cancer Nanomedicine, Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Howard Hughes Medical Institute, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Kevin M Brindle
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
- Department of Biochemistry, University of Cambridge, Cambridge, UK
| | - Lisa M Coussens
- Cell, Developmental and Cancer Biology, Oregon Health and Science University, Portland, OR, USA
- Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
| | - Caroline Dive
- Cancer Research UK Lung Cancer Centre of Excellence at the University of Manchester and University College London, University of Manchester, Manchester, UK
- CRUK Manchester Institute Cancer Biomarker Centre, University of Manchester, Manchester, UK
| | - Mark Emberton
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Sadik Esener
- Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
- Department of Biomedical Engineering, School of Medicine, Oregon Health and Science University, Portland, OR, USA
- Cancer Early Detection Advanced Research Center, Oregon Health and Science University, Portland, OR, USA
| | - Rebecca C Fitzgerald
- Medical Research Council (MRC) Cancer Unit, Hutchison/MRC Research Centre, University of Cambridge, Cambridge, UK
| | - Sanjiv S Gambhir
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, CA, USA
| | - Peter Kuhn
- USC Michelson Center Convergent Science Institute in Cancer, University of Southern California, Los Angeles, CA, USA
| | - Timothy R Rebbeck
- Division of Population Science, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Shankar Balasubramanian
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
- Yusuf Hamied Department of Chemistry, University of Cambridge, Cambridge, UK
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12
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Okagbue HI, Oguntunde PE, Adamu PI, Adejumo AO. Unique clusters of patterns of breast cancer survivorship. HEALTH AND TECHNOLOGY 2022. [DOI: 10.1007/s12553-021-00637-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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13
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Luo Y, Carretta H, Lee I, LeBlanc G, Sinha D, Rust G. Naïve Bayesian network-based contribution analysis of tumor biology and healthcare factors to racial disparity in breast cancer stage-at-diagnosis. Health Inf Sci Syst 2021; 9:35. [PMID: 34631040 PMCID: PMC8463645 DOI: 10.1007/s13755-021-00165-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 09/04/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Variation in breast cancer stage at initial diagnosis (including racial disparities) is driven both by tumor biology and healthcare factors. METHODS We studied women age 67-74 with initial diagnosis of breast cancer from 2006 through 2014 in the SEER-Medicare database. We extracted variables related to tumor biology (histologic grade and hormone receptor status) and healthcare factors (screening mammography [SM] utilization and time delay from mammography to diagnostic biopsy). We used naïve Bayesian networks (NBNs) to illustrate the relationships among patient-specific factors and stage-at-diagnosis for African American (AA) and white patients separately. After identifying and controlling confounders, we conducted counterfactual inference through the NBN, resulting in an unbiased evaluation of the causal effects of individual factors on the expected utility of stage-at-diagnosis. An NBN-based decomposition mechanism was developed to evaluate the contributions of each patient-specific factor to an actual racial disparity in stage-at-diagnosis. 2000 bootstrap samples from our training patients were used to compute the 95% confidence intervals (CIs) of these contributions. RESULTS Using a causal-effect contribution analysis, the relative contributions of each patient-specific factor to the actual racial disparity in stage-at-diagnosis were as follows: tumor grade, 45.1% (95% CI: 44.5%, 45.8%); hormone receptor status, 5.0% (4.5%, 5.4%); mammography utilization, 23.1% (22.4%, 24.0%); and biopsy delay 26.8% (26.1%, 27.3%). CONCLUSION The modifiable mechanisms of mammography utilization and biopsy delay drive about 49.9% of racial difference in stage-at-diagnosis, potentially guiding more targeted interventions to eliminate cancer outcome disparities. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s13755-021-00165-5.
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Affiliation(s)
- Yi Luo
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, 1115 West Call Street, Tallahassee, FL USA
| | - Henry Carretta
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, 1115 West Call Street, Tallahassee, FL USA
| | - Inkoo Lee
- Department of Statistics, Florida State University, 117 N. Woodward Ave., Tallahassee, FL USA
| | - Gabrielle LeBlanc
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, 1115 West Call Street, Tallahassee, FL USA
| | - Debajyoti Sinha
- Department of Statistics, Florida State University, 117 N. Woodward Ave., Tallahassee, FL USA
| | - George Rust
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, 1115 West Call Street, Tallahassee, FL USA
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14
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Bawoke G, Kejela S, Alemayehu A, Bogale GT. Experience with modified radical mastectomy in a low-income country: a multi-center prospective observational study. BMC Surg 2021; 21:371. [PMID: 34670543 PMCID: PMC8527696 DOI: 10.1186/s12893-021-01374-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 10/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Modified radical mastectomy is the procedure of choice in centers with little to no radiotherapy services. Studying the in-hospital outcome and complications associated with the procedure is important in low-income countries. METHODS This is a multi-center prospective observational study involving all patients operated with modified radical mastectomy with curative intent. RESULTS A total of 87 patients were studied with 10.3% of which were male and 54% were between the age of 30-49 years. Clinical stage IIB and IIIA were reported in 33 (37.9%) and 25 (28.7%) respectively and 62.1% had clinically positive lymph nodes at presentation. All of the studied patients underwent curative surgery, with an average lymph node dissection of 10.2 ± 0.83. Seroma rate was 17.2% and was significantly associated with diabetes (AOR: 6.2 (CI 1.5-8.7)) and neoadjuvant chemotherapy (AOR: 8.9 (CI 1.2-14.2)). Surgical site infection occurred in 14.9% and was significantly associated with Retroviral infections (AOR: 4.2 (CI 2.1-5.8)) and neoadjuvant chemotherapy (AOR: 1.8 (CI 1.3-3.9)). No in-hospital mortality occurred during the course of the study. CONCLUSION Seroma rate was lower than published studies while surgical site infections rate was higher. Neoadjuvant chemotherapy was associated with increase in seroma and surgical site infection rates. Additionally, diabetes increased the rate of seroma. Surgical site infections were higher in patients with retroviral infections.
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Affiliation(s)
- Giziew Bawoke
- Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Segni Kejela
- Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Abebe Alemayehu
- Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Girmaye Tamirat Bogale
- Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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15
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Rick TJ, Aagard M, Erwin E, Leintz C, Danik E, Serventi F, Henke O, Yeates K. Barriers to Cancer Care in Northern Tanzania: Patient and Health-System Predictors for Delayed Presentation. JCO Glob Oncol 2021; 7:1500-1508. [PMID: 34665667 PMCID: PMC8791818 DOI: 10.1200/go.21.00253] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Cancer is a growing problem in Africa, and delays in receiving timely cancer care often results in poorer outcomes. The purpose of this study was to identify the patient and health-system factors associated with delayed cancer care in adults living in the Northern Zone of Tanzania. PATIENTS AND METHODS Between July 2018 and July 2019, we surveyed adult patients presenting to an oncology clinic in Northern Tanzania. Delayed presentation was defined as 12 weeks or longer from initial symptoms to presentation for cancer care. Multivariate logistic regression and adjusted relative risk (aRR) were used to identify factors predicting delayed presentation. RESULTS Among 244 adult patients with cancer who completed the survey, 78% (n = 191) had delayed presentation. Patient-related factors associated with delayed presentation included lower educational attainment (P = .03), increased travel time (P = .05), lack of cancer knowledge (P < .05), and fear of cancer and cancer treatments (P < .05) on multivariate analysis. On analysis of aRR, patients without private car and those with health insurance had higher risk of delayed presentation (aRR: 1.27; 95% CI, 1.02 to 1.32 and aRR: 1.15; 95% CI, 1.01 to 1.32). There was a strong association with increased number of visits before presentation at the cancer center and delayed presentation (P = .0009). CONCLUSION Cancer awareness and prevention efforts targeting patients and community-level health care workers are key to reduce delays in cancer care in Northern Tanzania. Patient and health system barriers contribute to delayed presentation of patients with cancer in Northern Tanzania.![]()
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Affiliation(s)
- Tara J Rick
- Department of Physician Assistant Studies, Saint Catherine's University, St Paul, MN.,Department of Radiotherapy, Erasmus MC, Rotterdam, the Netherlands
| | | | | | - Caara Leintz
- Department of Physician Assistant Studies, Saint Catherine's University, St Paul, MN
| | - Elizabeth Danik
- Kilimanjaro Christian Medical Center, Cancer Care Center, Moshi, Tanzania
| | - Furaha Serventi
- Kilimanjaro Christian Medical Center, Cancer Care Center, Moshi, Tanzania
| | - Oliver Henke
- Kilimanjaro Christian Medical Center, Cancer Care Center, Moshi, Tanzania.,Section Global Health, University Hospital Bonn, Bonn, Germany
| | - Karen Yeates
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
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16
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Association of Life-Course Educational Attainment and Breast Cancer Grade in the MEND Study. Ann Glob Health 2021; 87:59. [PMID: 34277361 PMCID: PMC8269775 DOI: 10.5334/aogh.3142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: Nigeria reports the highest age-standardized mortality rate for breast cancer (BC) among African countries and disproportionately high rates of high-grade cancer. Histological grade is a strong predictor of mortality, and evidence suggests that educational attainment influences cancer outcomes. Objective: We characterize the association between educational trends across the life-course and BC grade at diagnosis. Methods: Data on 224 BC patients enrolled in the Mechanisms for Established and Novel Risk Factors for Breast Cancer in Nigerian Women (MEND) study was analyzed. Participant and parental (mother and father) education was categorized as low (primary school or less) or high (secondary school or greater). Accordingly, the educational trend across the life-course was determined for each participant relative to each parent: stable high, increasing, decreasing, or stable low. BC grade was classified as high (grade 3) or low (grades 1–2). Findings: About 34% of participants, 71% of fathers, and 85% of mothers had low education. Approximately one-third of participants were diagnosed with high-grade BC. Participants with low-grade BC were more likely to have highly educated fathers (p = 0.04). After adjusting for age, comorbidities, marital status and mammogram screening, participants with highly educated fathers were 60% less likely to have high-grade BC (aOR 0.41; 95% CI 0.20 to 0.84) compared to those with less-educated fathers. Stable high life-course education relative to father was also associated with a significantly lower likelihood of having high-grade BC (aOR 0.36; 95% CI 0.15 to 0.87) compared to stable low life-course education. No significant associations were observed for the participant’s education, mother’s education, or life-course education relative to mother. Conclusions: Early-life socioeconomic status (SES) may influence BC grade. This deserves further study to inform policies that may be useful in reducing high-grade BC in Nigeria.
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17
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Khojasteh Poor F, Keivan M, Ramazii M, Ghaedrahmati F, Anbiyaiee A, Panahandeh S, Khoshnam SE, Farzaneh M. Mini review: The FDA-approved prescription drugs that target the MAPK signaling pathway in women with breast cancer. Breast Dis 2021; 40:51-62. [PMID: 33896802 DOI: 10.3233/bd-201063] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Breast cancer (BC) is the most common cancer and the prevalent type of malignancy among women. Multiple risk factors, including genetic changes, biological age, dense breast tissue, and obesity are associated with BC. The mitogen-activated protein kinases (MAPK) signaling pathway has a pivotal role in regulating biological functions such as cell proliferation, differentiation, apoptosis, and survival. It has become evident that the MAPK pathway is associated with tumorigenesis and may promote breast cancer development. The MAPK/RAS/RAF cascade is closely associated with breast cancer. RAS signaling can enhance BC cell growth and progression. B-Raf is an important kinase and a potent RAF isoform involved in breast tumor initiation and differentiation. Depending on the reasons for cancer, there are different strategies for treatment of women with BC. Till now, several FDA-approved treatments have been investigated that inhibit the MAPK pathway and reduce metastatic progression in breast cancer. The most common breast cancer drugs that regulate or inhibit the MAPK pathway may include Farnesyltransferase inhibitors (FTIs), Sorafenib, Vemurafenib, PLX8394, Dabrafenib, Ulixertinib, Simvastatin, Alisertib, and Teriflunomide. In this review, we will discuss the roles of the MAPK/RAS/RAF/MEK/ERK pathway in BC and summarize the FDA-approved prescription drugs that target the MAPK signaling pathway in women with BC.
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Affiliation(s)
- Fatemeh Khojasteh Poor
- Department of Obstetrics and Gynecology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mona Keivan
- Fertility and Infertility Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.,Fertility, Infertility and Perinatology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Ramazii
- Kerman University of Medical Sciences, University of Kerman, Kerman, Iran
| | - Farhoodeh Ghaedrahmati
- Department of Immunology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amir Anbiyaiee
- Department of Surgery, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Samira Panahandeh
- School of Health, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Seyed Esmaeil Khoshnam
- Persian Gulf Physiology Research Center, Medical Basic Sciences Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Maryam Farzaneh
- Fertility, Infertility and Perinatology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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18
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Elmore SNC, Mushonga M, Iyer HS, Kanda C, Chibonda S, Chipidza F, Makunike Mutasa R, Muchuweti D, Muguti EG, Maunganidze A, Ndlovu N, Bellon JR, Nyakabau AM. Breast cancer in Zimbabwe: patterns of care and correlates of adherence in a national referral hospital radiotherapy center cohort from 2014 to 2018. Cancer Med 2021; 10:3489-3498. [PMID: 33973399 PMCID: PMC8178482 DOI: 10.1002/cam4.3764] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/24/2020] [Accepted: 12/26/2020] [Indexed: 12/24/2022] Open
Abstract
Background Breast cancer is the second most common cancer among women in Zimbabwe. Patients face socioeconomic barriers to accessing oncology care, including radiotherapy. We sought to understand patterns of care and adherence for women with breast cancer in sub‐Saharan Africa (SSA) with radiotherapy access. Methods A retrospective cohort was created for women with breast cancer evaluated at the Parirenyatwa Hospital Radiotherapy and Oncology Center (RTC) from 2014 to 2018. Clinical data were collected to define patterns of care. Non‐adherence was modeled as a binary outcome with different criteria for patients with localized versus metastatic disease. Results In total, 351 women presented with breast cancer with median age 51 at diagnosis (IQR: 43–61). Receptor status was missing for 71% (248). 199 (57%) had non‐metastatic disease, and 152 (43%) had metastases. Of women with localized disease, 34% received post‐mastectomy radiation. Of women with metastatic disease, 9.7% received radiotherapy. Metastatic disease and missing HIV status were associated with increased odds of study‐defined non‐adherence (aOR: 1.85, 95% CI: 1.05, 3.28; aOR: 2.13, 95% CI: 1.11, 4.05), while availability of ER/PR status was associated with lower odds of non‐adherence (aOR: 0.18, 95% CI: 0.09, 0.36). Conclusions Radiotherapy is likely underutilized for women with breast cancer, even in a setting with public sector availability. Exploring patient‐level factors that influence adherence to care may provide clinicians with better tools to support adherence and improve survival. Greater investment is needed in multidisciplinary, multimodality care for breast cancer in SSA.
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Affiliation(s)
- Shekinah Nefreteri Cluff Elmore
- Harvard Radiation Oncology Program, Boston, USA.,Harvard Medical School, Boston, USA.,Department of Radiation Oncology, University of North Carolina, Chapel Hill, USA
| | - Melinda Mushonga
- Parirenyatwa Hospital Radiotherapy and Oncology Center, Harare, Zimbabwe
| | | | - Caroline Kanda
- Parirenyatwa Hospital Radiotherapy and Oncology Center, Harare, Zimbabwe
| | - Shirley Chibonda
- Parirenyatwa Hospital Radiotherapy and Oncology Center, Harare, Zimbabwe
| | - Fallon Chipidza
- Harvard Radiation Oncology Program, Boston, USA.,Harvard Medical School, Boston, USA.,Department of Radiation Oncology, Dana-Faber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Rudo Makunike Mutasa
- Department of Pathology, University of Zimbabwe, College of Health Sciences, Harare, Zimbabwe
| | - David Muchuweti
- Department of Surgery, University of Zimbabwe, College of Health Sciences, Harare, Zimbabwe
| | - Edwin G Muguti
- Department of Surgery, University of Zimbabwe, College of Health Sciences, Harare, Zimbabwe
| | - Aspect Maunganidze
- Department of Surgery, University of Zimbabwe, College of Health Sciences, Harare, Zimbabwe
| | - Ntokozo Ndlovu
- Parirenyatwa Hospital Radiotherapy and Oncology Center, Harare, Zimbabwe.,Department of Oncology, University of Zimbabwe, College of Health Sciences, Harare, Zimbabwe
| | - Jennifer Ruth Bellon
- Department of Radiation Oncology, Dana-Faber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Anna Mary Nyakabau
- Parirenyatwa Hospital Radiotherapy and Oncology Center, Harare, Zimbabwe.,Department of Pathology, University of Zimbabwe, College of Health Sciences, Harare, Zimbabwe.,Cancerserve Trust, Harare, Zimbabwe
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19
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Agodirin O, Aremu I, Rahman G, Olatoke S, Olaogun J, Akande H, Romanoff A. Determinants of Delayed Presentation and Advanced-Stage Diagnosis of Breast Cancer in Africa: A Systematic Review and Meta-Analysis. Asian Pac J Cancer Prev 2021; 22:1007-1017. [PMID: 33906291 PMCID: PMC8325140 DOI: 10.31557/apjcp.2021.22.4.1007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Indexed: 12/26/2022] Open
Abstract
Background/Objective: Breast cancer (BC) mortality is exceptionally high in Africa due to late presentation and advanced-stage diagnosis. Previous studies examining barriers to early BC presentation are markedly inconsistent, showing conflicting findings within and between African regions, making resource allocation and designing interventional campaigns challenging. Our objective was to assess the strength or magnitude of the association between determinants/risk factors and delayed presentation/advanced-stage diagnosis of BC in Africa. Methods: Electronic searches in PubMed, AJOL, Google, ResearchGate, ScienceDirect, and PubMed Central found eligible articles between 2000 and 2020. The meta-analytical procedure in Meta-XL used the quality effect model. I-squared (I2) above 75% indicated high heterogeneity. The summary effect size was the odds ratio with 95% confidence intervals. Results: The effect of socio-economic and demographic determinants on delay varies across African regions. Low level of education (1.63, 95% CI 1.01-2.63), and not performing breast self examination (BSE) (13.59, 95% CI 3.33-55.4) were significantly associated with delayed presentation. Younger patients had more significant delays in West Africa (WA, 1.41, 95%CI 1.08-1.85), and the reverse occurred in North Africa (0.68, 95%CI 0.48-0.97). Lack of BC knowledge (1.59, 95% CI 1.29-1.97), not performing BSE, or no history of undergoing clinical breast examination (CBE) (2.45, 95% CI 1.60-3.40), were associated with advanced-stage disease at diagnosis. Older patients had significantly more advanced disease in WA, and the reverse occurred in South Africa. Aggressive molecular BC subtypes [Triple negative (OR 1.62, 95% CI 1.27-2.06) or HER2 positive (1.56, 95% CI 1.10-2.23)] were significant determinants of advanced-stage diagnosis. Conclusion: Promoting early presentation and reducing advanced-stage BC throughout Africa should focus on modifiable factors, including providing quality education, improving breast health awareness and BC knowledge, and developing strategies to increase BSE and CBE. Interventions targeting socio-demographic determinants should be context-specific.
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Affiliation(s)
- Olayide Agodirin
- Department of Surgery, University of Ilorin and University of Ilorin Teaching Hospital, Ilorin, Kwara State. Nigeria
| | - Isiaka Aremu
- Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Kwara state. Nigeria
| | - Ganiyu Rahman
- Department of Surgery, University of Cape Coast and Cape Coast Teaching Hospital, Cape Coast. Ghana
| | - Samuel Olatoke
- Department of Surgery, University of Ilorin and University of Ilorin Teaching Hospital, Ilorin, Kwara State. Nigeria
| | - Julius Olaogun
- Department of Surgery, Ekiti State University, and Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti state. Nigeria
| | - Halimat Akande
- Department of Radiology, University of Ilorin and University of Ilorin Teaching Hospital, Ilorin, Kwara state. Nigeria
| | - Anya Romanoff
- Department of Global Health and Health System Design, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Global Cancer Disparities Initiatives, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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20
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Tesfaw A, Tiruneh M, Tamire T, Yosef T. Factors associated with advanced-stage diagnosis of breast cancer in north-west Ethiopia: a cross-sectional study. Ecancermedicalscience 2021; 15:1214. [PMID: 33912239 PMCID: PMC8057775 DOI: 10.3332/ecancer.2021.1214] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Indexed: 11/08/2022] Open
Abstract
Background Breast cancer tumours are the most common malignant tumours among women in Ethiopia. Although advanced-stage diagnosis of breast cancer is a common problem, evidence-based information is lacking about the magnitude and determinants of advanced-stage presentation in north-west Ethiopia. Methods An institution-based, cross-sectional study was conducted at the oncology units of the University of Gondar and Felege Hiwot specialised hospitals. Stages III and IV were considered advanced stage, whereas stages I and II were considered early stages. Data were collected prospectively on newly diagnosed breast cancer patients and entered using the EPI Info version 7.2 and analysed using Statistical Package for the Social Sciences version 23. Multivariable logistic regression was used to identify the determinants of advanced-stage diagnosis of breast cancer. A p-value < 0.05 was used as the cut-off point to select the determinants of the advanced stage. Result About 71.2% of breast cancer patients presented with advanced-stage disease. The median age of patients was 40 years. Rural residence (adjusted odds ratio (AOR) = 1.7; 95% confidence interval (CI): 1.02, 2.96), painless breast lump/wound (AOR = 2.5; 95% CI: 1.45, 4.13), travel distance ≥5 km (AOR = 3.2; 95% CI: 1.72, 5.29), not practising breast self-examination (BSE) (AOR = 2.9; 95% CI: 1.30, 6.52), time to presentation ≥3 months (AOR = 1.4; 95% CI: 1.02, 2.37) and misdiagnosed at first visit (AOR = 1.9; 95% CI: 1.09, 3.59) were determinants of advanced-stage breast cancer. Conclusion Nearly three-quarters of the patients were diagnosed with advanced-stage breast cancer. Not practising BSE, travel distance ≥5 km, rural residence, painless breast wound/lump and being misdiagnosed at first visit were important determinants of advanced-stage diagnosis of breast cancer. Focused awareness creation programmes for the public and increasing cancer diagnostic centres in the country are crucial to downstage breast cancer at presentation.
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Affiliation(s)
- Aragaw Tesfaw
- Debre Tabor University, College of Health Sciences, Department of Public Health, PO Box 272, Debre Tabor, Ethiopia
| | - Mulu Tiruneh
- Debre Tabor University, College of Health Sciences, Department of Public Health, PO Box 272, Debre Tabor, Ethiopia
| | - Tadese Tamire
- Debre Tabor University, College of Health Sciences, Department of Anesthesia, PO Box 272, Debre Tabor, Ethiopia
| | - Tewodros Yosef
- Mizan-Tepi University, Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, PO Box 260, Mizan-Aman, Ethiopia
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21
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Esiaka D, Nwakasi C, Brodie K, Philip A, Ogba K. Dying To Be Men: Masculinity and Early Cancer Detection Among Nigerian Men. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2021; 42:272684X211004938. [PMID: 33745395 DOI: 10.1177/0272684x211004938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Cancer incidence and mortality in Nigeria are increasing at an alarming rate, especially among Nigerian men. Despite the numerous public health campaigns and education on the importance of early cancer detection in Nigeria, there exist high rate of fatal/advanced stage cancer diagnoses among Nigerian men, even among affluent Nigerian men. However, there is limited information on patterns of cancer screening and psychosocial predictors of early cancer detection behaviors among Nigerian men. In this cross-sectional study, we examined demographic and psychosocial factors influencing early cancer detection behaviors among Nigerian men. Participants (N = 143; Mage = 44.73) responded to survey assessing: masculinity, attachment styles, current and future cancer detection behaviors, and sociodemographic characteristics. We found that among the participants studied, education, masculinity and anxious attachment were significantly associated with current cancer detection behaviors. Additionally, education and anxious attachment were significantly associated with future cancer detection behaviors. Our finding is best served for clinicians and public health professionals, especially those in the field of oncology in Sub-Saharan Africa. Also, the study may be used as a groundwork for future research and health intervention programs targeting men in Sub-Saharan Africa.
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Affiliation(s)
- Darlingtina Esiaka
- Department of Psychology, Union College, Schenectady, New York, United States
| | - Candidus Nwakasi
- Department of Health Policy and Management, Providence College, Rhode Island, United States
| | - Kelsey Brodie
- Department of Psychology, Union College, Schenectady, New York, United States
| | - Aaron Philip
- School of Public Health & Social Work, Queensland University of Technology, Queensland, Australia
| | - Kalu Ogba
- Department of Psychology, University of Nigeria, Nsukka, Nigeria
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22
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Knapp GC, Tansley G, Olasehinde O, Wuraola F, Adisa A, Arowolo O, Olawole MO, Romanoff AM, Quan ML, Bouchard-Fortier A, Alatise OI, Kingham TP. Geospatial access predicts cancer stage at presentation and outcomes for patients with breast cancer in southwest Nigeria: A population-based study. Cancer 2020; 127:1432-1438. [PMID: 33370458 DOI: 10.1002/cncr.33394] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/13/2020] [Accepted: 11/17/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The majority of women in Nigeria present with advanced-stage breast cancer. To address the role of geospatial access, we constructed a geographic information-system-based model to evaluate the relationship between modeled travel time, stage at presentation, and overall survival among patients with breast cancer in Nigeria. METHODS Consecutive patients were identified from a single-institution, prospective breast cancer database (May 2009-January 2019). Patients were geographically located, and travel time to the hospital was generated using a cost-distance model that utilized open-source data. The relationships between travel time, stage at presentation, and overall survival were evaluated with logistic regression and survival analyses. Models were adjusted for age, level of education, and socioeconomic status. RESULTS From 635 patients, 609 were successfully geographically located. The median age of the cohort was 49 years (interquartile range [IQR], 40-58 years); 84% presented with ≥stage III disease. Overall, 46.5% underwent surgery; 70.8% received systemic chemotherapy. The median estimated travel time for the cohort was 45 minutes (IQR, 7.9-79.3 minutes). Patients in the highest travel-time quintile had a 2.8-fold increase in the odds of presenting with stage III or IV disease relative to patients in the lowest travel-time quintile (P = .006). Travel time ≥30 minutes was associated with an increased risk of death (HR, 1.65; P = .004). CONCLUSIONS Geospatial access to a tertiary care facility is independently associated with stage at presentation and overall survival among patients with breast cancer in Nigeria. Addressing disparities in access will be essential to ensure the development of an equitable health policy.
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Affiliation(s)
- Gregory C Knapp
- Department of Surgery, Division of General Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Gavin Tansley
- Department of Medicine, Division of Critical Care, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Adewale Adisa
- Department of Surgery, Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | - M O Olawole
- Department of Geography, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Anya M Romanoff
- Breast Surgery, Dubin Breast Center, Icahn School of Medicine at The Mount Sinai Hospital, New York, New York
| | - May Lynn Quan
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | | | | | - T Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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23
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Tesfaw A, Alebachew W, Tiruneh M. Why women with breast cancer presented late to health care facility in North-west Ethiopia? A qualitative study. PLoS One 2020; 15:e0243551. [PMID: 33275642 PMCID: PMC7717512 DOI: 10.1371/journal.pone.0243551] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/24/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Although early diagnosis is a key determinant factor for breast cancer survival, delay in presentation and advanced stage diagnosis are common challenges in low and middle income countries including Ethiopia. Long patient delays in presentation to health facility and advanced stage diagnosis are common features in breast cancer care in Ethiopia but the reasons for patient delays are not well explored in the country. Therefore we aimed to explore the reasons for patient delay in seeking early medical care for breast cancer in North-west Ethiopia. METHODS A qualitative study was conducted from November to December 2019 using in-depth interviews from newly diagnosed breast cancer patients in the two comprehensive specialized hospitals in North West Ethiopia. Verbal informed consent was taken from each participant before interviews. A thematic content analysis was performed using Open Code software version 4.02. RESULTS Lack of knowledge and awareness about breast cancer, cultural and religious beliefs, economic hardships, lack of health care and transportation access, fear of surgical procedures and lack of trusts on medical care were the major reasons for late presentation of breast cancer identified from the patient's narratives. CONCLUSIONS The reasons for late presentation of patients to seek early medical care for breast cancer had multidimensional nature in Northwest Ethiopia. Health education and promotion programs about breast cancer should be designed to increase public awareness to facilitate early detection of cases before advancement on the existing health care delivery system.
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Affiliation(s)
- Aragaw Tesfaw
- Department of Public Health, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Wubet Alebachew
- Department of Nursing, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mulu Tiruneh
- Department of Public Health, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
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24
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Tesfaw A, Demis S, Munye T, Ashuro Z. Patient Delay and Contributing Factors Among Breast Cancer Patients at Two Cancer Referral Centres in Ethiopia: A Cross-Sectional Study. J Multidiscip Healthc 2020; 13:1391-1401. [PMID: 33173301 PMCID: PMC7646382 DOI: 10.2147/jmdh.s275157] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/08/2020] [Indexed: 12/19/2022] Open
Abstract
Background Unlike developed countries, there is high mortality of breast cancer in low- and middle-income countries associated with prolonged patient delays and advanced stage presentations. However, evidence-based information about patient delay in presentation and contributing factors to diagnosis of breast cancer in Ethiopia is scarce. Methods Institution-based cross-sectional study was conducted at oncology units of the University of Gondar and Felege Hiwot specialized hospitals. A total of 371 female breast cancer patients who were newly diagnosed from September 2019 to April 30, 2020 were included. Data were entered using EPI info version 7.2 and analyzed in SPSS version 23. Descriptive statistics was used to summarize socio-demographic and clinical characteristic of the patients. Multivariable logistic regression at a P-value<0.05 significance level was used to identify predictors of patient delay. Results A total of 281 (75.7%) patients had long patient delay of ≥90 days (3 months) with the average patient delay time of 8 months, and advanced stage diagnosis was found on 264 (71.2%) of patients. The median age of patients was 40 years. Rural residence (AOR=3.72; 95% CI=1.82–7.61), illiterate (AOR=3.8; 95% CI=1.71–8.64), having a painless wound (AOR=3.32; 95% CI=1.93, 5.72), travel distance ≥5 km (AOR=1.66; 95% CI=1.09–3.00), having no lump/swelling in the armpit (AOR=6.16; 95% CI=2.80–13.54), and no history of any breast problem before (AOR=2.46; 95% CI=(1.43–4.22) were predictors for long patient delay. Conclusion Long patient delay and advanced stage diagnosis of breast cancer are higher in our study. Travel distance ≥5 km, rural residence, no history of any breast problem before, having no lump/swelling in the arm pit, a painless lump in the breast, and being illiterate were important predictors for patient delay. Therefore, public awareness programs about breast cancer should be designed to prevent patient delay in presentation and to promote early detection of cases before advancement.
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Affiliation(s)
- Aragaw Tesfaw
- Department of Public Health, Debre Tabor University, College of Health Sciences, Debre Tabor, Ethiopia
| | - Solomon Demis
- Department of Pediatrics and neonatal Nursing, Debre Tabor University, College of Health Sciences, Debre Tabor, Ethiopia
| | - Tigabu Munye
- Department of Comprehensive Nursing, Debre Tabor University, College of Health Sciences, Debre Tabor, Ethiopia
| | - Zemachu Ashuro
- Dilla University, College of Health Sciences, Dilla, Southern Ethiopia
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25
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Adehin A, Kennedy MA, Soyinka JO, Alatise OI, Olasehinde O, Bolaji OO. Breast Cancer and Tamoxifen: A Nigerian Perspective to Effective Personalised Therapy. BREAST CANCER-TARGETS AND THERAPY 2020; 12:123-130. [PMID: 33116814 PMCID: PMC7548221 DOI: 10.2147/bctt.s266314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/08/2020] [Indexed: 12/24/2022]
Abstract
Estrogen-receptor positivity in tumour, often requiring long-term tamoxifen therapy, is thought to characterise between 43% and 65% of breast cancer cases in Nigeria. The patient population is further marked by late-stage diagnosis which significantly heightens the tendency for tumour relapse in the course of tamoxifen therapy. Despite tamoxifen being considered a reliable chemopreventive in high-risk individuals and an effective adjuvant therapy for hormone-sensitive tumours, mortality has remained high among breast cancer patients in the West African region where Nigeria belongs. The Nigerian breast cancer population, like other similar patient-populations in the West African region, provides a mix of intrinsic genome-diversity and perhaps unique tumour biology and evolution. These peculiarities suggest the need for a rational approach to tumour management and a personalised delivery of therapy in Nigeria's dominant estrogen-receptor-positive patient population. Herein, critical indices of tamoxifen-therapy success are discussed in the context of the Nigerian breast cancer population with emphasis on salient aspects of tamoxifen-biotransformation, host- and tumour-genomics, and epigenetics.
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Affiliation(s)
- Ayorinde Adehin
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Obafemi Awolowo University, Ile-Ife, Nigeria.,Institute of Biomedical and Pharmaceutical Sciences, Guangdong University of Technology, Guangzhou, People's Republic of China
| | - Martin Alexander Kennedy
- Department of Pathology and Biomedical Science; Carney Centre of Pharmacogenomics, University of Otago, Christchurch, New Zealand
| | - Julius Olugbenga Soyinka
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Olusegun Isaac Alatise
- Department of Surgery, Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Olalekan Olasehinde
- Department of Surgery, Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Oluseye Oladotun Bolaji
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Obafemi Awolowo University, Ile-Ife, Nigeria
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Tesfaw A, Getachew S, Addissie A, Jemal A, Wienke A, Taylor L, Kantelhardt EJ. Late-Stage Diagnosis and Associated Factors Among Breast Cancer Patients in South and Southwest Ethiopia: A Multicenter Study. Clin Breast Cancer 2020; 21:e112-e119. [PMID: 33536135 DOI: 10.1016/j.clbc.2020.08.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/19/2020] [Accepted: 08/30/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Breast cancer is a leading cause of cancer death in women in low- and middle-income countries, largely because of late-stage diagnosis. Yet studies are very limited in the Ethiopian context. Therefore, we determined the occurrence of late-stage disease and associated factors in selected public hospitals in south and southwest Ethiopia. PATIENTS AND METHODS A 5-year retrospective cross-sectional study was conducted on breast cancer patient medical records from January 2013 to December 2017 in 6 hospitals. Multivariable logistic regression was performed to identify factors associated with late-stage disease (stage III and IV). Adjusted odds ratios (AOR) with 95% confidence intervals were used. P < .05 was considered statistically significant. RESULTS Overall, 426 breast cancer patients were identified, and 72.5% were diagnosed with late-stage disease. The mean ± standard deviation patient age was 42.8 ± 13.4 years. Factors associated with late diagnosis were patient delay in seeking care (AOR = 2.50; 95% confidence interval [CI], 1.51-4.16); health system delays (AOR = 1.62; 95% CI, 1.02-2.59); female sex (AOR = 3.46; 95% CI, 1.50-7.98); rural residence (AOR = 2.37; 95% CI, 1.45-3.86); chief complaint of breast lump (AOR = 3.01; 95% CI, 1.49-6.07); and history of comorbidities (AOR = 1.72; 95% CI, 1.02-2.91). CONCLUSION The majority of patients were diagnosed with late-stage diagnosis of breast cancer. Patient delays in seeking care, health system delays, being female, rural residence, and patient comorbidities were associated factors. These findings provide evidence that efforts to increase public and health provider awareness to promote early breast cancer diagnosis, particularly in rural areas, are needed in south and southwest Ethiopia.
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Affiliation(s)
- Aragaw Tesfaw
- Department of Public Health, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Sefonias Getachew
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia; Institute of Medical Epidemiology, Biometrics, and Informatics, Martin-Luther-University Halle-Wittenberg, Germany
| | - Adamu Addissie
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ahmedin Jemal
- American Cancer Society, Surveillance & Health Services Research, Atlanta, GA
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biometrics, and Informatics, Martin-Luther-University Halle-Wittenberg, Germany
| | - Lesley Taylor
- City of Hope National Medical Center, Division of Breast Surgery, Department of Surgery, Duarte, Los Angeles County, CA
| | - Eva Johanna Kantelhardt
- Institute of Medical Epidemiology, Biometrics, and Informatics, Martin-Luther-University Halle-Wittenberg, Germany; Department of Gynaecology, Martin-Luther-University Halle-Wittenberg, Germany.
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27
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Udoh RH, Tahiru M, Ansu-Mensah M, Bawontuo V, Danquah FI, Kuupiel D. Women's knowledge, attitude, and practice of breast self- examination in sub-Saharan Africa: a scoping review. ACTA ACUST UNITED AC 2020; 78:84. [PMID: 32974016 PMCID: PMC7507650 DOI: 10.1186/s13690-020-00452-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/17/2020] [Indexed: 12/26/2022]
Abstract
Background Breast cancer (BC) is a non-communicable disease with increased morbidity and mortality. Early detection of BC contributes to prompt linkage to care and reduction of complications associated with BC. Breast self-examination (BSE) is useful for detecting breast abnormalities particularly in settings with poor access to healthcare for clinical breast examination and mammography. Therefore, we mapped evidence on women’s knowledge, attitude, and practice of BSE in sub-Sahara Africa (SSA). Methods We conducted a systematic scoping review using Arskey and O’Malleys’ framework as a guide. We searched PubMed, Google Scholar, CINAHL, and Science Direct databases for relevant studies on women’s knowledge, attitude and practice on BSE. Studies included in the review were from SSA countries as defined by the World Health Organization published from 2008 to May 2019. Two reviewers independently screened the articles at the abstract and full-text screening guided by inclusion and exclusion criteria. All relevant data were extracted, and a thematic analysis conducted. The themes were collated, and a narrative summary of the findings reported. Results Of the 264 potentially eligible articles identified from 595,144, only 21 met the inclusion criteria and were included for data extraction. These included studies were conducted in 7 countries of which 11 were conducted in Nigeria; two each in Ethiopia, Ghana, Cameroon, and Uganda; and one each in Kenya and Sudan. Of the 21 included studies, 18 studies reported evidence on BSE knowledge and practice; two on only knowledge; one on only practice only; and six presented evidence on women’s attitude towards BSE. The study findings suggest varying knowledge levels on BSE among women in SSA countries. The study findings also suggest that BSE practice is still a challenge in SSA. Conclusion There is a paucity of published literature on women’s knowledge, practice, and attitude of BSE in SSA. Hence, this study recommends further studies on knowledge, practice, and attitude of BSE, to identify contextual challenges and provide evidence-based solutions to improve women’s knowledge, practice, and attitude of BSE in SSA.
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Affiliation(s)
- Roseline H Udoh
- Faculty of Health & Allied Sciences, Catholic University College of Ghana-Fiapre, Sunyani, Ghana
| | - Mohammed Tahiru
- Faculty of Health & Allied Sciences, Catholic University College of Ghana-Fiapre, Sunyani, Ghana
| | - Monica Ansu-Mensah
- Faculty of Health & Allied Sciences, Catholic University College of Ghana-Fiapre, Sunyani, Ghana
| | - Vitalis Bawontuo
- Faculty of Health & Allied Sciences, Catholic University College of Ghana-Fiapre, Sunyani, Ghana.,Research for Sustainable Development Consult, Sunyani, Ghana
| | - Frederick Inkum Danquah
- Faculty of Health & Allied Sciences, Catholic University College of Ghana-Fiapre, Sunyani, Ghana
| | - Desmond Kuupiel
- Research for Sustainable Development Consult, Sunyani, Ghana.,Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
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28
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Bayala B, Zouré AA, Zohoncon TM, Tinguerie BL, Baron S, Bakri Y, Simpore J, Lobaccaro JMA. Effects of extracts and molecules derived from medicinal plants of West Africa in the prevention and treatment of gynecological cancers. A Review. Am J Cancer Res 2020; 10:2730-2741. [PMID: 33042613 PMCID: PMC7539771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 07/19/2019] [Indexed: 06/11/2023] Open
Abstract
Medicinal plants are a potential source of drug discovery and development of new pharmacological compounds for cancer chemoprevention. More than 80% of the West African population uses medicinal plants. It is estimated that over 60% of approved anti-cancer agents are derived from plants. The plant raw material used in African traditional medicine and particularly in West Africa can be an important source for the research of anti-tumor drugs against gynecological cancers. These tumors have a negative impact on women's general health status and causes enormous health costs as they affect all age groups. Gynecological cancers remain thus a major concern worldwide, especially in West Africa where these cancers are the leading cause of cancer deaths in women. This review reports on the contribution of West African flora to the discovery of potential antiproliferative and/or cytotoxic phytochemical compounds against gynecological cancer cells. Scientific databases such as PubMed, ScienceDirect, Scopus and GoogleScholar were used to extract publications reporting West African plants and/or isolated compounds used in cell models of gynecological cancers. Thresholds of cytotoxicity and modes of action of these phytochemicals have been summarized. This research can serve as a basis for taking medicinal plants into account in the management of these gynecological cancers in resource-limited countries such as those in West Africa.
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Affiliation(s)
- Bagora Bayala
- Laboratoire de Biologie Moléculaire et de Génétique (LABIOGENE), Université Joseph KI-ZERBO03 BP 7021, Ouagadougou 03, Burkina Faso
- Centre de Recherche Biomoléculaire Pietro Annigoni (CERBA)01 BP 216 Ouagadougou 01, Burkina Faso
- Laboratoire Génétique, Reproduction &Développement, UMR CNRS 6293, INSERM U1103, Université Clermont Auvergne, 28, Place Henri Dunant, BP38, and Centre de Recherche en Nutrition Humaine d’AuvergneF63001, Clermont-Ferrand, France
- Université Norbert ZONGOBP 376 Koudougou, Burkina Faso
| | - Abdou Azaque Zouré
- Laboratoire de Biologie Moléculaire et de Génétique (LABIOGENE), Université Joseph KI-ZERBO03 BP 7021, Ouagadougou 03, Burkina Faso
- Centre de Recherche Biomoléculaire Pietro Annigoni (CERBA)01 BP 216 Ouagadougou 01, Burkina Faso
- Laboratoire de Biologie des Pathologies Humaines-BioPatH. Faculté des Sciences, Université Mohammed VRabat, Maroc
- Institut de Recherche en Sciences de la Santé (IRSS/CNRST), Département Biomédical et Santé Publique 03 BP 7192 Ouagadougou 03Burkina Faso
| | - Théodora M Zohoncon
- Laboratoire de Biologie Moléculaire et de Génétique (LABIOGENE), Université Joseph KI-ZERBO03 BP 7021, Ouagadougou 03, Burkina Faso
- Centre de Recherche Biomoléculaire Pietro Annigoni (CERBA)01 BP 216 Ouagadougou 01, Burkina Faso
- Université Saint Thomas d’Aquin (USTA)06 BP: 10212 Ouagadougou 06, Burkina Faso
- Hôpital Saint Camille de Ouagadougou (HOSCO)09 BP 444 Ouagadougou 09, Burkina Faso
| | - Bienvenu L Tinguerie
- Hôpital Saint Camille de Ouagadougou (HOSCO)09 BP 444 Ouagadougou 09, Burkina Faso
| | - Silvère Baron
- Laboratoire Génétique, Reproduction &Développement, UMR CNRS 6293, INSERM U1103, Université Clermont Auvergne, 28, Place Henri Dunant, BP38, and Centre de Recherche en Nutrition Humaine d’AuvergneF63001, Clermont-Ferrand, France
| | - Youssef Bakri
- Université Norbert ZONGOBP 376 Koudougou, Burkina Faso
| | - Jacques Simpore
- Laboratoire de Biologie Moléculaire et de Génétique (LABIOGENE), Université Joseph KI-ZERBO03 BP 7021, Ouagadougou 03, Burkina Faso
- Centre de Recherche Biomoléculaire Pietro Annigoni (CERBA)01 BP 216 Ouagadougou 01, Burkina Faso
- Université Saint Thomas d’Aquin (USTA)06 BP: 10212 Ouagadougou 06, Burkina Faso
- Hôpital Saint Camille de Ouagadougou (HOSCO)09 BP 444 Ouagadougou 09, Burkina Faso
| | - Jean-Marc A Lobaccaro
- Laboratoire Génétique, Reproduction &Développement, UMR CNRS 6293, INSERM U1103, Université Clermont Auvergne, 28, Place Henri Dunant, BP38, and Centre de Recherche en Nutrition Humaine d’AuvergneF63001, Clermont-Ferrand, France
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Ntekim A, Ibraheem A, Adeniyi-Sofoluwe A, Adepoju T, Oluwasanu M, Aniagwu T, Awolude O, Balogun W, Kotila O, Adejumo P, Babalola CP, Arinola G, Ojengbede O, Olopade CO, Olopade OI. Implementing oncology clinical trials in Nigeria: a model for capacity building. BMC Health Serv Res 2020; 20:713. [PMID: 32746811 PMCID: PMC7397583 DOI: 10.1186/s12913-020-05561-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 07/20/2020] [Indexed: 11/10/2022] Open
Abstract
Background There is both higher mortality and morbidity from cancer in low and medium income countries (LMICs) compared with high income countries (HICs). Clinical trial activities and development of more effective and less toxic therapies have led to significant improvements in morbidity and mortality from cancer in HICs. Unfortunately, clinical trials remain low in LMICs due to poor infrastructure and paucity of experienced personnel to execute clinical trials. There is an urgent need to build local capacity for evidence-based treatment for cancer patients in LMICs. Methods We conducted a survey at facilities in four Teaching Hospitals in South West Nigeria using a checklist of information on various aspects of clinical trial activities. The gaps identified were addressed using resources sourced in partnership with investigators at HIC institutions. Results Deficits in infrastructure were in areas of patient care such as availability of oncology pharmacists, standard laboratories and diagnostic facilities, clinical equipment maintenance and regular calibrations, trained personnel for clinical trial activities, investigational products handling and disposals and lack of standard operating procedures for clinical activities. There were two GCP trained personnel, two study coordinators and one research pharmacist across the four sites. Interventions were instituted to address the observed deficits in all four sites which are now well positioned to undertake clinical trials in oncology. Training on all aspects of clinical trial was also provided. Conclusions Partnerships with institutions in HICs can successfully identify, address, and improve deficits in infrastructure for clinical trial in LMICs. The HICs should lead in providing funds, mentorship, and training for LMIC institutions to improve and expand clinical trials in LMIC countries.
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Affiliation(s)
- Atara Ntekim
- Department of Radiation Oncology, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Abiola Ibraheem
- Section of Hematology Oncology, University of Chicago, Chicago, USA
| | | | - Toyosi Adepoju
- Department of Pharmacy, University College Hospital, Ibadan, Nigeria
| | - Mojisola Oluwasanu
- Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Toyin Aniagwu
- School of Occupational Health Nursing, University College Hospital, Ibadan, Nigeria
| | - Olutosin Awolude
- Department of Obstetrics and Gynecology, Faculty of Clinical Sciences, College of Medicine, University of Ibadan /University College Hospital, Ibadan, Nigeria
| | - Williams Balogun
- Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria
| | - Olayinka Kotila
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - Prisca Adejumo
- Department of Nursing, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Chinedum Peace Babalola
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - Ganiyu Arinola
- Department of Chemical Pathology, Faculty of Basic Medical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Oladosu Ojengbede
- Department of Obstetrics and Gynecology, Faculty of Clinical Sciences, College of Medicine, University of Ibadan /University College Hospital, Ibadan, Nigeria.,Center for Population and Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Chao CA, Huang L, Visvanathan K, Mwakatobe K, Masalu N, Rositch AF. Understanding women's perspectives on breast cancer is essential for cancer control: knowledge, risk awareness, and care-seeking in Mwanza, Tanzania. BMC Public Health 2020; 20:930. [PMID: 32539723 PMCID: PMC7296642 DOI: 10.1186/s12889-020-09010-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 05/28/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Breast Cancer is the most common cancer in women worldwide. Since 2008, Mwanza, Tanzania, has worked to provide comprehensive cancer services through its Zonal consultant hospital. New national guidelines focused on clinical breast exam requires that women be aware of and seek care for breast concerns. Therefore, this study aims to understand breast cancer awareness in Mwanza and describe women-level barriers, care-seeking behavior, and perspectives on breast cancer. METHODS A community-based survey was administered to conveniently sampled women aged 30 and older to assess women's perspectives on breast cancer and care-seeking behavior. RESULTS Among 1129 women with a median age of 37 (IQR: 31-44) years, 73% have heard of cancer and 10% have received breast health education. Women self-evaluated their knowledge of breast cancer (from 1-none to 10-extremely knowledgeable) with a median response of 3 (IQR: 1-4). Only 14% felt they knew any signs or symptoms of breast cancer. Encouragingly, 56% of women were fairly-to-very confident they would notice changes in their breasts, with 24% of women practicing self-breast examination and 21% reporting they had received a past breast exam. Overall, 74% said they would be somewhat-to-very likely to seek care if they noticed breast changes, with 96% noting severity of symptoms as a motivator. However, fear of losing a breast (40%) and fear of a poor diagnosis (38%) were most frequent barriers to care seeking. In assessing knowledge of risk factors, about 50% of women did not know any risk factors for breast cancer whereas 42% of women believed long term contraceptive use a risk factor. However, 37% and 35% of women did not think that family history or being older were risk factors, respectively. CONCLUSIONS The success of efforts to improve early diagnosis in a setting without population-based screening depends on women being aware of breast cancer signs and symptoms, risks, and ultimately seeking care for breast concerns. Fortunately, most women said they would seek care if they noticed a change in their breasts, but the low levels of cancer knowledge, symptoms, and common risk factors highlight the need for targeted community education and awareness campaigns.
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Affiliation(s)
- Christina A Chao
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Liuye Huang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kala Visvanathan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Kisa Mwakatobe
- Tanzania Breast Cancer Foundation, Dar es Salaam, Tanzania
| | - Nestory Masalu
- Department of Oncology, Bugando Medical Centre, Mwanza, Tanzania
| | - Anne F Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
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Knapp GC, Tansley G, Olasehinde O, Alatise OI, Wuraola F, Olawole MO, Arije OO, Gali BM, Kingham TP. Mapping Geospatial Access to Comprehensive Cancer Care in Nigeria. J Glob Oncol 2020; 5:1-8. [PMID: 31634049 PMCID: PMC6825250 DOI: 10.1200/jgo.19.00283] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To address the increasing burden of cancer in Nigeria, the National Cancer Control Plan outlines the development of 8 public comprehensive cancer centers. We map population-level geospatial access to these eight centers and explore equity of access and the impact of future development. METHODS Geospatial methods were used to estimate population-level travel times to the 8 cancer centers. A cost distance model was built using open source road infrastructure data with verified speed limits. Geolocated population estimates were amalgamated with this model to calculate travel times to cancer centers at a national and regional level for both the entire population and the population living on < US$2 per day. RESULTS Overall, 68.9% of Nigerians have access to a comprehensive cancer center at 4 hours of continuous vehicular travel. However, there is significant variability in access between geopolitical zones (P < .001). The North East has the lowest access at 4 hours (31.4%) and the highest mean travel times (268 minutes); this is significantly lower than the proportion with 4-hour access in the South East (31.4% v 85.0%, respectively; P < .001). The addition of a second comprehensive cancer center in the North East, in either Bauchi or Gombe, would significantly improve access to this underserved region. CONCLUSION The Federal Ministry of Health endorses investment in 8 public comprehensive cancer centers. Strengthening these centers will allow the majority of Nigerians to access the full complement of multidisciplinary care within a reasonable time frame. However, geospatial access remains inequitable, and the impact on outcomes is unclear. This must be considered as the cancer control system matures and expands.
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Affiliation(s)
- Gregory C Knapp
- Memorial Sloan Kettering Cancer Center, New York, NY.,University of Calgary, Calgary, Alberta, Canada
| | | | | | - Olusegun I Alatise
- College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Funmilola Wuraola
- College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Moses O Olawole
- College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Olujide O Arije
- College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
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Pruitt LCC, Odedina S, Anetor I, Mumuni T, Oduntan H, Ademola A, Morhason-Bello IO, Ogundiran TO, Obajimi M, Ojengbede OA, Olopade OI. Breast Cancer Knowledge Assessment of Health Workers in Ibadan, Southwest Nigeria. JCO Glob Oncol 2020; 6:387-394. [PMID: 32125900 PMCID: PMC7126761 DOI: 10.1200/jgo.19.00260] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE Breast cancer is the most common cancer among women, and in low- to middle-income countries late-stage diagnosis contributes to significant mortality. Previous research at the University College Hospital, a tertiary hospital in Ibadan, Nigeria, on social factors contributing to late diagnosis revealed that many patients received inappropriate initial treatment. METHODS The level of breast cancer knowledge among health practitioners at various levels of the health system was assessed. We developed a tool tailored to local needs to assess knowledge of symptoms, risk factors, treatments, and cultural beliefs. The recruitment included doctors, nurses, and pharmacists in public hospitals, physicians and pharmacists in private practice, nurses and health care workers from primary health care centers, community birth attendants, and students in a health care field from state schools. RESULTS A total of 1,061 questionnaires were distributed, and 725 providers responded (68%). Seventy-eight percent were female, and > 90% were Yoruba, the dominant local ethnic group. The majority were Christian, and 18% were Muslim. Median knowledge score was 31 out of 56, and the differences in scores between health care worker types were statistically significant (P < .001). Nearly 60% of the participants believed breast cancer is always deadly. More than 40% of participants believed that keeping money in the bra causes breast cancer, and approximately 10% believed that breast cancer is caused by a spiritual attack. CONCLUSION Our questionnaire revealed that, even at the tertiary care level, significant gaps in knowledge exist, and knowledge of breast cancer is unacceptably low at the level of community providers. In addition to efforts aimed at strengthening health systems, greater knowledge among community health care workers has the potential to reduce delays in diagnosis for Nigerian patients with breast cancer.
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Affiliation(s)
- Liese C C Pruitt
- Center for Global Surgery, Department of Surgery, University of Utah, Salt Lake City, UT
| | - Stella Odedina
- Centre for Population and Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Imaria Anetor
- Centre for Population and Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Tolulope Mumuni
- Centre for Population and Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Helen Oduntan
- Department of Pharmacy, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Adeyinka Ademola
- Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Imran O Morhason-Bello
- Centre for Population and Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Temidayo O Ogundiran
- Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Millicent Obajimi
- Department of Radiology, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Oladosu A Ojengbede
- Centre for Population and Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Olufunmilayo I Olopade
- Center for Clinical Cancer Genetics and Global Health, Department of Medicine, University of Chicago, Chicago, IL
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Getachew S, Tesfaw A, Kaba M, Wienke A, Taylor L, Kantelhardt EJ, Addissie A. Perceived barriers to early diagnosis of breast Cancer in south and southwestern Ethiopia: a qualitative study. BMC WOMENS HEALTH 2020; 20:38. [PMID: 32103774 PMCID: PMC7045514 DOI: 10.1186/s12905-020-00909-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 02/19/2020] [Indexed: 01/27/2023]
Abstract
Background Early diagnosis is a key determinant of breast cancer prognosis and survival. More than half of breast cancer cases are diagnosed at an advanced stage in Ethiopia, and the barriers to early diagnosis in this country are not well understood. We aimed to identify the perceived barriers to early diagnosis of breast cancer from the perspective of patients and health care providers in south and southwestern Ethiopia. Methods A qualitative study was conducted from March to April 2018 using in-depth interviews of breast cancer patients and breast cancer health care providers from six public hospitals located in urban and rural areas of south and southwestern Ethiopia. All participants provided verbal consent before participating. A thematic analysis was performed using Open Code 4.02. Results Twelve breast cancer patients and thirteen health care providers were included in the study. Patient and health-system related barriers to early diagnosis of breast cancer were identified. Patient-related barriers were lack of knowledge and awareness of breast cancer, belief in traditional medicine and religious practices for treatment, and lack of social and financial support to seek care at a medical facility. Health-system related barriers were misdiagnosis of breast cancer, long distance to referral facilities, high cost of diagnostic services, long waiting time for diagnostic tests, and lack of screening and diagnostic tests in local facilities. Conclusions Early diagnosis of breast cancer is affected by multiple barriers in south and southwestern Ethiopia. Awareness campaigns and education about the disease, prevention, and early detection are needed to increase early diagnosis of breast cancer. Opportunities exist to improve early diagnosis and timely treatment in rural areas.
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Affiliation(s)
- Sefonias Getachew
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.,Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University, Halle, Germany
| | - Aragaw Tesfaw
- Department Public Health, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mirgissa Kaba
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University, Halle, Germany
| | - Lesley Taylor
- City of Hope National Medical Center, Duarte, Los Angeles, California, USA
| | - Eva J Kantelhardt
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University, Halle, Germany.,Department of Gynaecology, Martin-Luther-University, Halle, Germany
| | - Adamu Addissie
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia. .,Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University, Halle, Germany.
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Gakunga R, Kinyanjui A, Ali Z, Ochieng' E, Gikaara N, Maluni F, Wata D, Kyeng' M, Korir A, Subramanian S. Identifying Barriers and Facilitators to Breast Cancer Early Detection and Subsequent Treatment Engagement in Kenya: A Qualitative Approach. Oncologist 2019; 24:1549-1556. [PMID: 31601730 PMCID: PMC6975962 DOI: 10.1634/theoncologist.2019-0257] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 08/23/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Early detection and prompt access to quality treatment and palliative care are critical for good breast cancer outcomes. Interventions require understanding of identified barriers and facilitators to care. A hermeneutic phenomenological approach, whose purpose is to describe feelings and lived experiences of participants, can expand the existing scope of understanding of barriers and facilitators in accessing breast cancer care in Kenya. METHODS This is qualitative research applying focus groups and a hermeneutic phenomenological approach to identify barriers and facilitators to breast cancer care from the knowledge, perceptions, and lived experiences of women with and without a diagnosis of breast cancer in Kenya. We conducted four focus group discussions with 6-11 women aged 30-60 years in each. Groups were classified according to breast cancer diagnosis and socioeconomic status. The transcribed discussions were coded independently by two investigators. Together they reviewed the codes and identified themes. RESULTS The key barriers were costs, inadequate knowledge, distance to health facilities, communication with health providers, medicines stockouts, long waiting periods, limited or no counseling at diagnosis, patient vulnerability, and limited access to rehabilitation items. Facilitators were dependable social support, periodical access to subsidized awareness, and early detection services and friendly caregivers. We found no marked differences in perceptions between groups by socioeconomic status. CONCLUSION There is need for targeted awareness and education for health providers and the public, early detection services with onsite counseling and cost mitigation. Support from the society and religious organizations and persons may be leveraged as adjuncts to conventional management. Further interpretations are encouraged. IMPLICATIONS FOR PRACTICE Continuing cancer education for health providers in technical skills for early detection, treatment, and survivorship care, as well as nontechnical skills like communication, and an understanding of their patients' preferences and socioeconomic status may guide individualized management plans and positively affect patient experiences. Patients and the general public also need education on cancer to avoid misconceptions and inaccuracies that perpetuate fear, confusion, delayed presentation for treatment, and stigma. Critical analysis of the cancer care value chain and processes, development, and implementation of interventions to reduce costs while streamlining processes may improve client experiences.
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Affiliation(s)
| | - Asaph Kinyanjui
- Kenya Hospices and Palliative Care Association (KEHPCA), Nairobi, Kenya
| | - Zipporah Ali
- Kenya Hospices and Palliative Care Association (KEHPCA), Nairobi, Kenya
| | | | - Nancy Gikaara
- Kenya Hospices and Palliative Care Association (KEHPCA), Nairobi, Kenya
| | | | - David Wata
- Kenyatta National Hospital, Nairobi, Kenya
| | - Mercy Kyeng'
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Anne Korir
- Kenya Medical Research Institute, Nairobi, Kenya
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Allo TA, Imhonopi D, Amoo EO, Iruonagbe TC, Jegede AE, Ajayi LA, Olanrewaju FO, Ajayi PM, Olawole-Isaac A. Moderating Role of Demographic Characteristics in Breast Cancer Awareness and the Behavioural Disposition of Women in Ogun State, Nigeria. Open Access Maced J Med Sci 2019; 7:3281-3286. [PMID: 31949531 PMCID: PMC6953945 DOI: 10.3889/oamjms.2019.671] [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: 05/26/2019] [Revised: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Breast cancer incidence is fast increasing, posing a significant threat to the health of women of all races globally. In Nigeria, breast cancer causes the most cancer-related deaths among women each year as a result of inadequate awareness. AIM This study is aimed at examining the moderating role of demographic characteristics in facilitating breast cancer awareness among women, and how it relates to their behavioural disposition to the disease. METHODS The study adopted the descriptive (survey) and cross-sectional research designs to elicit information from women of adult age selected across five Local Government Areas in Ogun state. The data, collected through questionnaire were analysed through the use of a variance-based SEM Partial Least Square (PLS). RESULTS The result shows that demographic characteristics (age and education) has a significant positive effect and jointly explain 74.9% of the variance in the breast cancer awareness and behavioural disposition among women in the study area. The findings revealed that a significant number of women with breast cancer had not acquired useful knowledge that could potentially be used to diagnose, prevent, and manage the disease. Unfortunately, the practice of Breast Self-Examination is grossly low among Nigerian women, as a consequence, only 20-30% of the women in study areas, including professionals, are aware of the benefits of BSE and only a smaller percentage practice BSE. CONCLUSION There is, therefore, a need to educate women on the benefits of this simple life-saving procedure through the consistent use of media platforms.
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Affiliation(s)
| | - David Imhonopi
- Department of Sociology, Covenant University, Ota, Nigeria
| | - Emmanuel O. Amoo
- Demography and Social Statistics, Covenant University, Ota, Nigeria
| | | | | | - Lady A. Ajayi
- Department of Political Science and International relations, Covenant University, Ota, Nigeria
| | - Faith O. Olanrewaju
- Department of Political Science and International relations, Covenant University, Ota, Nigeria
| | - Paula M. Ajayi
- Department of Sociology, Covenant University, Ota, Nigeria
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Iyer HS, Kohler RE, Ramogola-Masire D, Brown C, Molebatsi K, Grover S, Kablay I, Bvochora-Nsingo M, Efstathiou JA, Lockman S, Tapela N, Dryden-Peterson SL. Explaining disparities in oncology health systems delays and stage at diagnosis between men and women in Botswana: A cohort study. PLoS One 2019; 14:e0218094. [PMID: 31170274 PMCID: PMC6553768 DOI: 10.1371/journal.pone.0218094] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 05/24/2019] [Indexed: 01/04/2023] Open
Abstract
Purpose Men in Botswana present with more advanced cancer than women, leading to poorer outcomes. We sought to explain sex-specific differences in time to and stage at treatment initiation. Methods Cancer patients who initiated oncology treatment between October 2010 and June 2017 were recruited at four oncology centers in Botswana. Primary outcomes were time from first visit with cancer symptom to treatment initiation, and advanced cancer (stage III/IV). Sociodemographic and clinical covariates were obtained retrospectively through interviews and medical record review. We used accelerated failure time and logistic models to estimate standardized sex differences in treatment initiation time and risk differences for presentation with advanced stage. Results were stratified by cancer type (breast, cervix, non-Hodgkin’s lymphoma, anogenital, head and neck, esophageal, other). Results 1886 participants (70% female) were included. After covariate adjustment, men experienced longer excess time from first presentation to treatment initiation (8.4 months) than women (7.0 months) for all cancers combined (1.4 months, 95% CI: 0.30, 2.5). In analysis stratified by cancer type, we only found evidence of a sex disparity (Men: 8.2; Women: 6.8 months) among patients with other, non-common cancers (1.4 months, 95% CI: 0.01, 2.8). Men experienced an increased risk of advanced stage (Men: 67%; Women: 60%; aRD: 6.7%, 95% CI: -1.7%, 15.1%) for all cancers combined, but this disparity was only statistically significant among patients with anogenital cancers (Men: 72%; Women: 50%; aRD: 22.0%, 95% CI: 0.5%, 43.5%). Conclusions Accounting for the types of cancers experienced by men and women strongly attenuated disparities in time to treatment initiation and stage. Higher incidence of rarer cancers among men could explain these disparities.
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Affiliation(s)
- Hari S. Iyer
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
| | - Racquel E. Kohler
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Dana-Farber Cancer Institute, Boston, Massachusetts, United States of America
| | - Doreen Ramogola-Masire
- Botswana University of Pennsylvania Partnership, Gaborone, Botswana
- School of Medicine, University of Botswana, Gaborone, Botswana
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Carolyn Brown
- Department of Epidemiology, Emory Rollins School of Public Health, Atlanta, GA, United States of America
| | | | - Surbhi Grover
- Botswana University of Pennsylvania Partnership, Gaborone, Botswana
- School of Medicine, University of Botswana, Gaborone, Botswana
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Princess Marina Hospital, Gaborone, Botswana
| | | | | | - Jason A. Efstathiou
- Dana-Farber Cancer Institute, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Shahin Lockman
- Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Infectious Diseases, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Botswana Ministry of Health and Wellness, Gaborone, Botswana
| | - Neo Tapela
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Botswana Ministry of Health and Wellness, Gaborone, Botswana
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Scott L. Dryden-Peterson
- Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Infectious Diseases, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
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Traoré B, Koulibaly M, Diallo A, Bah M. Molecular profile of breast cancers in Guinean oncological settings. Pan Afr Med J 2019; 33:22. [PMID: 31312338 PMCID: PMC6615767 DOI: 10.11604/pamj.2019.33.22.18189] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 05/02/2019] [Indexed: 12/12/2022] Open
Abstract
Breast cancer is a complex disease characterized by the accumulation of multiple molecular alterations giving each tumor phenotype and an own evolutionary potential. This study aimed to describe the distribution of the profile and molecular subtypes of breast cancers followed at Surgical Oncology Unit of Donka National Hospital. This was retrospective and descriptive study on cases of breast cancer in which the hormone receptor status and expression of the Her2 oncogene have been performed from 2007 to 2016. We recorded 58 cases including 56 (96.6%) women and 2 (3.4%) men. The average age was 48.2 ± 10.9. Invasive ductal carcinoma accounted for 50 (86.2%) cases. The SBR grade was II in 31(53.4%) cases, III in 21 (36.2%) cases and I in 6 (10.3%) cases. The tumor was classified as T4 in 36 (62.1%) cases; it was metastatic in 11(19.0%) cases. Estrogen receptors were positive in 29 (50.0%) cases, progesterone receptors positive in 25 (43.1%) cases, the Her2 oncogene was positive in 22 (39.3%) cases. The distribution of molecular sub-types was: 20 (34.5%) luminal A, 15 (25.9%) triple negative, 13 (22.4%) Her2 overexpressed, 8 (13.8%) luminal B and 2 (3.2%) undetermined. This preliminary study showed the poor accessibility of immunohistochemistry for the molecular diagnosis of breast cancer in our country. Luminal A subtypes and triple negatives were more common. The determination of molecular subtypes is a rational basis for hormone therapy and targeted therapy, thus personalizing the treatment of breast cancer.
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Affiliation(s)
- Bangaly Traoré
- Surgical Oncology Unit, Donka National Hospital, Faculty of Medical Sciences and Technics, University Gamal Abdel Nasser of Conakry, Conakry, Guinea
| | - Moussa Koulibaly
- Laboratory of Anatomo-Pathology, Donka National Hospital, Faculty of Medical Sciences and Technics, University Gamal Abdel Nasser of Conakry, Conakry, Guinea
| | - Aissatou Diallo
- Surgical Oncology Unit, Donka National Hospital, Faculty of Medical Sciences and Technics, University Gamal Abdel Nasser of Conakry, Conakry, Guinea
| | - Malick Bah
- Surgical Oncology Unit, Donka National Hospital, Faculty of Medical Sciences and Technics, University Gamal Abdel Nasser of Conakry, Conakry, Guinea
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Rayne S, Schnippel K, Grover S, Fearnhead K, Kruger D, Benn C, Firnhaber C. Unraveling the South African Breast Cancer Story: The Relationship of Patients, Delay to Diagnosis, and Tumor Biology With Stage at Presentation in an Urban Setting. J Surg Res 2018; 235:181-189. [PMID: 30691793 DOI: 10.1016/j.jss.2018.09.087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/13/2018] [Accepted: 09/28/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Adverse outcomes from breast cancer disproportionately affect women in sub-Saharan Africa, with delay the most studied contribution to advanced stage at presentation. However, tumor molecular biology and its contribution to advanced stage are yet to be explored. MATERIALS AND METHODS Patients newly diagnosed with breast cancer in a South African tertiary breast center completed a questionnaire and file review concerning socioeconomics, delay to care, stage at presentation, and molecular characteristics. Logistic regression was done to determine the relative risk of advanced stage presentation. RESULTS Advanced stage was present in 70.1% (n = 162) of the 231 participants, with 55.8% stage III (n = 129) and 32% (n = 72) having a T4 tumor. The median age was 56 y with 21.6% (n = 47) aged <45 y. Most common subtype was luminal B (57.7%, n = 128) followed by luminal A (21.6%, n = 48), triple negative (13.9%, n = 31), and HER2 positive (6.7%, n = 15). Lobular cancer (incidence risk ratio [IRR], 1.29; 95% confidence interval [CI], 1.03-1.62), high grade and intermediate grade tumors (IRR, 1.90; 95% CI, 1.15-3.13 and IRR, 1.95; 95% CI, 1.18-3.22, respectively), high Ki67 proliferation index (IRR, 1.30; 95% CI, 1.02-1.66), and HER2 overexpression (IRR, 1.32; 95% CI, 1.12-1.55) were more likely to present with advanced disease, as were luminal B (HER2+) cancers (adjusted IRR [aIRR], 1.46; 95% CI, 1.10-1.95). Although on univariate analysis Black and young participants were both more likely to have advanced stage (IRR, 1.23; 95% CI, 1.01-1.49 and IRR, 1.25; 95% CI, 1.04-1.51, respectively), in multivariate analysis controlling for tumor biology and delay, these were no longer significant (aIRR, 1.12; 95% CI, 0.91-1.37 and aIRR, 1.17; 95% CI, 0.94-1.48, respectively). CONCLUSIONS Tumor biology has a compelling role in the etiology of advanced-stage disease irrespective of socioeconomic factors. Accurate pathologic assessment is important in planning breast cancer care in Africa.
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Affiliation(s)
- Sarah Rayne
- Department of Surgery, Helen Joseph Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Kathryn Schnippel
- Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Princess Marina Hospital, Gaborone, Botswana, Botswana-UPENN Partnership, Gaborone, Botswana
| | - Kirstin Fearnhead
- Department of Anatomical Pathology, National Health Laboratory Services, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Deirdre Kruger
- Department of Surgery, Helen Joseph Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Carol Benn
- Department of Surgery, Helen Joseph Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Cynthia Firnhaber
- Clinical HIV Research Unit, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Oguntunde PE, Adejumo AO, Okagbue HI. Breast cancer patients in Nigeria: Data exploration approach. Data Brief 2017; 15:47-57. [PMID: 28971122 PMCID: PMC5612794 DOI: 10.1016/j.dib.2017.08.038] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 08/08/2017] [Accepted: 08/28/2017] [Indexed: 12/04/2022] Open
Abstract
Breast cancer is the type of cancer that develops from breast tissue; it is mostly common in women and it is one of the most studied diseases, largely because of its high mortality (second to lung cancer). However, it occurs in males also. This article presents a statistical study of the distribution of age, gender, length of stay, mode of diagnosis, status (dead or alive) after treatment and the location of breast cancer among 300 patients admitted in the University of Ilorin teaching hospital, Ilorin, Nigeria. The study covers a period of five (5) years; from 2011 to 2016 and logistic regression was used to perform the basic analysis in this study. It was discovered that the age of patients and the location of the breast cancer (right or left) contributes significantly to the survival of the patients. However, early detection and treatment of the disease is highly encouraged. This study also recommends that awareness should be taken to the grassroots and males should not be excluded from this discussion.
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Affiliation(s)
- Pelumi E Oguntunde
- Department of Mathematics, Covenant University, Ota, Ogun State, Nigeria
| | - Adebowale O Adejumo
- Department of Statistics, University of Ilorin, Ilorin, Kwara State, Nigeria
| | - Hilary I Okagbue
- Department of Mathematics, Covenant University, Ota, Ogun State, Nigeria
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