Abstract
ObjectiveTo analyse patient and healthcare system related factors influencing the time to first healthcare visit, diagnosis and treatment of breast cancer patients in sub-Saharan Africa and the impact on survival in order to advise on early detection strategies.MethodsA prospective hospital cohort study was conducted at the only pathology department in Mali, at the University Hospital in Bamako. All the female patients with a breast cancer diagnosis between January and April 2016 were interviewed with a structured questionnaire (N = 64) to gather information about breast symptom recognition and first healthcare visit. Information on beginning of treatment and survival were collected at 18-months follow-up. Simple Cox regression analyses were performed.ResultsThe median time to first healthcare visit was 4.8 months, from first healthcare visit to diagnosis was 0.9 months and for the patients who started treatment (N = 46) the time from diagnosis to treatment was 1.3 months. Knowledge of breast-self-examination and correct symptom interpretation increased the chance of an earlier healthcare visit. Prolonged time to diagnosis was found with shorter duration to first healthcare visit, for working women compared to housewives and for those living within Bamako. Living outside Bamako and smaller tumour size (T1/T2) prolonged time to treatment. Visit of a traditional healer and larger tumour size (T3/T4) shortened survival time, whereas time to first healthcare visit and subsequent time to diagnosis had no influence on survival.ConclusionsDown-staging strategies are only useful if the continuum of breast cancer care is warranted for the majority of patients.
Highlights
Breast cancer is one of the most common cancers among women in sub-Saharan Africa in terms of prevalence and incidence [1]
Knowledge of breast-self-examination and correct symptom interpretation increased the chance of an earlier healthcare visit
Prolonged time to diagnosis was found with shorter duration to first healthcare visit, for working women compared to housewives and for those living within Bamako
Summary
Breast cancer is one of the most common cancers among women in sub-Saharan Africa in terms of prevalence and incidence [1]. A 5-year survival rate of 13.6% for breast cancer patients in Mali (not age standardised) [3] and a 5-year age-standardised relative survival of 12% in Gambia have been reported [4]. Those survival estimates are considered less reliable and probably ignore a significant number of patients not being registered and dying without a diagnosis and treatment [3]. Clinical factors such as stage at diagnosis were reported as important determinants of survival. While no association was found between time to diagnosis and late stage breast cancers on the study level, the authors still reasoned that “most advanced stage cancers might be a result of delayed diagnosis” [6] and that the large time frame leaves space for improvements
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