Elima Jedy-Agba1, Valerie McCormack2, Oluwole Olaomi3, Wunmi Badejo3, Monday Yilkudi4, Terna Yawe4, Emmanuel Ezeome5, Iliya Salu6, Elijah Miner7, Ikechukwu Anosike8, Sally N Adebamowo9, Benjamin Achusi10, Isabel Dos-Santos-Silva11, Clement Adebamowo12. 1. Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK. elima.jedy-agba@lshtm.ac.uk. 2. Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France. 3. National Hospital Abuja, Nigeria, Abuja, Nigeria. 4. University of Abuja Teaching Hospital, Gwagwalada, Nigeria. 5. University of Nigeria Teaching Hospital, Enugu, Nigeria. 6. Asokoro District Hospital, Abuja, Nigeria. 7. Garki Hospital, Abuja, Nigeria. 8. Wuse General Hospital, Abuja, Nigeria. 9. Center for Research on Genomics and Global Health, National Human Genome Research Institute, Bethesda, MD, USA. 10. Federal Staff Hospital, Abuja, Nigeria. 11. Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK. 12. Institute of Human Virology, University of Maryland and Marlene and Stewart Greenebaum Comprehensive Cancer Centre, Baltimore, MD, USA.
Abstract
PURPOSE: Advanced stage at diagnosis is a common feature of breast cancer in Sub-Saharan Africa (SSA), contributing to poor survival rates. Understanding its determinants is key to preventing deaths from this cancer in SSA. METHODS: Within the Nigerian Integrative Epidemiology of Breast Cancer Study, a multicentred case-control study on breast cancer, we studied factors affecting stage at diagnosis of cases, i.e. women diagnosed with histologically confirmed invasive breast cancer between January 2014 and July 2016 at six secondary and tertiary hospitals in Nigeria. Stage was assessed using clinical and imaging methods. Ordinal logistic regression was used to examine associations of sociodemographic, breast cancer awareness, health care access and clinical factors with odds of later stage (I, II, III or IV) at diagnosis. RESULTS: A total of 316 women were included, with a mean age (SD) of 45.4 (11.4) years. Of these, 94.9% had stage information: 5 (1.7%), 92 (30.7%), 157 (52.4%) and 46 (15.3%) were diagnosed at stages I, II, III and IV, respectively. In multivariate analyses, lower educational level (odds ratio (OR) 2.35, 95% confidence interval: 1.04, 5.29), not believing in a cure for breast cancer (1.81: 1.09, 3.01), and living in a rural area (2.18: 1.05, 4.51) were strongly associated with later stage, whilst age at diagnosis, tumour grade and oestrogen receptor status were not. Being Muslim (vs. Christian) was associated with lower odds of later stage disease (0.46: 0.22, 0.94). CONCLUSION: Our findings suggest that factors that are amenable to intervention concerning breast cancer awareness and health care access, rather than intrinsic tumour characteristics, are the strongest determinants of stage at diagnosis in Nigerian women.
PURPOSE: Advanced stage at diagnosis is a common feature of breast cancer in Sub-Saharan Africa (SSA), contributing to poor survival rates. Understanding its determinants is key to preventing deaths from this cancer in SSA. METHODS: Within the Nigerian Integrative Epidemiology of Breast Cancer Study, a multicentred case-control study on breast cancer, we studied factors affecting stage at diagnosis of cases, i.e. women diagnosed with histologically confirmed invasive breast cancer between January 2014 and July 2016 at six secondary and tertiary hospitals in Nigeria. Stage was assessed using clinical and imaging methods. Ordinal logistic regression was used to examine associations of sociodemographic, breast cancer awareness, health care access and clinical factors with odds of later stage (I, II, III or IV) at diagnosis. RESULTS: A total of 316 women were included, with a mean age (SD) of 45.4 (11.4) years. Of these, 94.9% had stage information: 5 (1.7%), 92 (30.7%), 157 (52.4%) and 46 (15.3%) were diagnosed at stages I, II, III and IV, respectively. In multivariate analyses, lower educational level (odds ratio (OR) 2.35, 95% confidence interval: 1.04, 5.29), not believing in a cure for breast cancer (1.81: 1.09, 3.01), and living in a rural area (2.18: 1.05, 4.51) were strongly associated with later stage, whilst age at diagnosis, tumour grade and oestrogen receptor status were not. Being Muslim (vs. Christian) was associated with lower odds of later stage disease (0.46: 0.22, 0.94). CONCLUSION: Our findings suggest that factors that are amenable to intervention concerning breast cancer awareness and health care access, rather than intrinsic tumour characteristics, are the strongest determinants of stage at diagnosis in Nigerian women.
Entities:
Keywords:
Awareness; Breast cancer; Nigeria; Stage; Stage at diagnosis
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