Abstract
The presence of preexisting morbidities poses a challenge to cancer patient care. There is little information on the profile and prevalence of multi‐morbidities in breast cancer patients across middle income countries (MIC) to lower income countries (LIC) in sub‐Saharan Africa (SSA). The African Breast Cancer–Disparities in Outcomes (ABC‐DO) breast cancer cohort spans upper MICs South Africa and Namibia, lower MICs Zambia and Nigeria and LIC Uganda. At cancer diagnosis, seven morbidities were assessed: obesity, hypertension, diabetes, asthma/chronic obstructive pulmonary disease, heart disease, tuberculosis and HIV. Logistic regression models were used to assess determinants of morbidities and the influence of morbidities on advanced stage (stage III/IV) breast cancer diagnosis. Among 2189 women, morbidity prevalence was the highest for obesity (35%, country‐specific range 15‐57%), hypertension (32%, 15‐51%) and HIV (16%, 2‐26%) then for diabetes (7%, 4%‐10%), asthma (4%, 2%‐10%), tuberculosis (4%, 0%‐8%) and heart disease (3%, 1%‐7%). Obesity and hypertension were more common in upper MICs and in higher socioeconomic groups. Overall, 27% of women had at least two preexisting morbidities. Older women were more likely to have obesity (odds ratio: 1.09 per 10 years, 95% CI 1.01‐1.18), hypertension (1.98, 1.81‐2.17), diabetes (1.51, 1.32‐1.74) and heart disease (1.69, 1.37‐2.09) and were less likely to be HIV positive (0.64, 0.58‐0.71). Multi‐morbidity was not associated with stage at diagnosis, with the exception of earlier stage in obese and hypertensive women. Breast cancer patients in higher income countries and higher social groups in SSA face the additional burden of preexisting non‐communicable diseases, particularly obesity and hypertension, exacerbated by HIV in Southern/Eastern Africa.
Highlights
Breast cancer is the most common malignancy and the leading cause of cancer mortality in women worldwide
In addition to these factors, studies mostly originating from high-income countries (HICs) have shown that several preexisting morbidities are associated with lower breast cancer survival, poorer overall outcomes and they impact on treatment recommendations and tolerance
We examined associations of sociodemographic factors with each chronic condition and with multimorbidity (≥2 of these chronic conditions in addition to the breast cancer) using logistic regression analysis
Summary
Breast cancer is the most common malignancy and the leading cause of cancer mortality in women worldwide. It is the most common cancer among women in sub-Saharan Africa (SSA), where the incidence of this cancer is on the rise These temporal changes form part of an epidemiological transition occurring in SSA, characterised by improved control of infectious diseases, ageing populations and increasing prevalence of risk factors for non-communicable diseases (NCD) due to economic advancement, urbanisation and lifestyle modifications.. Survival after breast cancer diagnosis is determined by patient characteristics and disease-related factors such as stage at diagnosis and breast cancer subtypes.4 In addition to these factors, studies mostly originating from high-income countries (HICs) have shown that several preexisting morbidities are associated with lower breast cancer survival, poorer overall outcomes and they impact on treatment recommendations and tolerance.. Survival after breast cancer diagnosis is determined by patient characteristics and disease-related factors such as stage at diagnosis and breast cancer subtypes. In addition to these factors, studies mostly originating from high-income countries (HICs) have shown that several preexisting morbidities are associated with lower breast cancer survival, poorer overall outcomes and they impact on treatment recommendations and tolerance. These morbidities include obesity, diabetes and insulin resistance, stroke, body composition and mental health illnesses, that is, conditions that tend to be more common in older breast cancer patients.
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