Determinants Of Late Stage Breast Cancer Diagnosis In The Multi-Country African Breast Cancer - Disparities In Outcome (ABC-DO) Study

Fiona MCKENZIE, International Agency for Research on Cancer, France
SCHUZ J. 1 , ANDERSON B. 7 , HERBERT C. 6 , ADISA C. 5 , ANELE A. 4 , GALUKANDE M. 3 , ZIETSMAN A. 2 , DOS SANTOS SILVA I. 8 , MCCORMACK V. 1

1 Section of Environment, International Agency for Research on Cancer, Lyon, France
2 Windhoek Central Hospital, Windhoek, Namibia
3 Department of Surgery, Makerere University, Kampala, Uganda
4 Federal Medical Centre, Owerri, Imo State, Nigeria
5 Abia State University Teaching Hospital, Aba, Nigeria
6 Department of Surgery, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Soweto, Johannesburg, South Africa
7 Fred Hutchinson Cancer Research Center, Seattle, USA
8 Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, UK

Purpose: Breast cancer (BC) survival rates in sub-Saharan Africa (SSA) are low, in part due to advanced stage at diagnosis. The African Breast Cancer – Disparities in Outcomes (ABC-DO) study is an m-Health technology-implemented study of breast cancer survival in multiple SSA settings and includes a detailed assessment of the pre-diagnostic journey. This journey and determinants of late stage at diagnosis are examined.

Methods: Newly diagnosed women with BC presenting at ABC-DO hospitals are being enrolled since September 2014. Face-to-face baseline interviews were conducted at first hospital visit to obtain data on socio-economic and cultural factors, healthcare access and beliefs. Clinical data were extracted from medical records. Logistic regression was used to estimate odds ratios (OR) of late stage at diagnosis (stage III/IV vs 0/I/II), adjusted for country and age.

Results: From a total of 756 women enrolled in Namibia, Nigeria and Uganda, information on stage at diagnosis has so far been extracted for 626 women. Median age at diagnosis was 49 years (IQR: 41-61) and time from first symptom to diagnosis was 7.8 months (IQR: 3.5-21.1). Over half of the cohort was diagnosed at late stage (60% overall; Namibia 55%; Nigeria 75%; Uganda 62%). Late stage at presentation was strongly associated with time from first symptom to diagnosis (5.3, 8.9 and 14.7 months for stage 0/I/II, III, and IV, respectively), living in rural areas (OR 1.68, 95% CI: 1.17-2.40), not having tertiary education (OR 2.67, 1.75-4.08), and being uninsured (OR 4.76, 2.89-7.83).

Conclusions: Long delays from symptoms to breast cancer diagnosis are present in these SSA settings, and were correlated with advanced diagnostic stage. This lengthy period, and its determinants, indicate windows of time and opportunity to target improvements in early presentation and diagnosis using context-specific and culturally-appropriate strategies.

Funding source: Susan G. Komen.