Valerie McCormack1, Fiona McKenzie2, Milena Foerster2, Annelle Zietsman3, Moses Galukande4, Charles Adisa5, Angelica Anele6, Groesbeck Parham7, Leeya F Pinder8, Herbert Cubasch9, Maureen Joffe10, Thomas Beaney11, Manuela Quaresma12, Kayo Togawa2, Behnoush Abedi-Ardekani13, Benjamin O Anderson14, Joachim Schüz2, Isabel Dos-Santos-Silva12. 1. Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France. Electronic address: mccormackv@iarc.fr. 2. Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France. 3. AB May Cancer Centre, Windhoek Central Hospital, Windhoek, Namibia. 4. College of Health Sciences, Makerere University, Kampala, Uganda. 5. Department of Surgery, Abia State University Teaching Hospital, Aba, Nigeria. 6. Breast Oncology Unit, Federal Medical Centre, Owerri, Nigeria. 7. Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina, Chapel Hill, NC, USA. 8. Department of Obstetrics and Gynecology, Women and Newborn Hospital, Lusaka, Zambia; Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA. 9. Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa; Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa; Non-Communicable Diseases Research Division, Wits Health Consortium, Johannesburg, South Africa. 10. Non-Communicable Diseases Research Division, University of the Witwatersrand, Johannesburg, South Africa; Noncommunicable Diseases Research Division, Wits Health Consortium, Johannesburg, South Africa; MRC Developmental Pathways to Health Research Unit, Department of Pediatrics, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa. 11. Department of Primary Care and Public Health, Imperial College London, UK. 12. Department of Non-Communicable Diseases Epidemiology, London School of Hygiene & Tropical Medicine, London, UK. 13. Section of Genetics, International Agency for Research on Cancer, Lyon, France. 14. Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USA.
Abstract
BACKGROUND: Breast cancer is the second leading cause of death from cancer in women in sub-Saharan Africa, yet there are few well characterised large-scale survival studies with complete follow-up data. We aimed to provide robust survival estimates in women in this setting and apportion the survival gaps. METHODS: The African Breast Cancer-Disparities in Outcomes (ABC-DO) prospective cohort study was done at eight hospitals across five sub-Saharan African countries (Namibia, Nigeria, South Africa, Uganda, and Zambia). We prospectively recruited women (aged ≥18 years) who attended these hospitals with suspected breast cancer. Women were actively followed up by use of a telephone call once every 3 months, and a mobile health application was used to keep a dynamic record of follow-up calls due. We collected detailed sociodemographic, clinical, and treatment data. The primary outcome was 3-year overall survival, analysed by use of flexible proportional mortality models, and we predicted survival under scenarios of modified distributions of risk factors. FINDINGS: Between Sept 8, 2014, and Dec 31, 2017, 2313 women were recruited from these eight hospitals, of whom 85 did not have breast cancer. Of the remaining 2228 women with breast cancer, 58 women with previous treatment or recurrence, and 14 women from small racial groups (white and Asian women in South Africa), were excluded. Of the 2156 women analysed, 1840 (85%) were histologically confirmed, 129 (6%) were cytologically confirmed, and 187 (9%) were clinically confirmed to have breast cancer. 2156 (97%) women were followed up for up to 3 years or up to Jan 1, 2019, whichever was earlier. Up to this date, 879 (41%) of these women had died, 1118 (52%) were alive, and 159 (7%) were censored early. 3-year overall survival was 50% (95% CI 48-53), but we observed variations in 3-year survival between different races in Namibia (from 90% in white women to 56% in Black women) and in South Africa (from 76% in mixed-race women to 59% in Black women), and between different countries (44-47% in Uganda and Zambia vs 36% in Nigeria). 215 (10%) of all women had died within 6 months of diagnosis, but 3-year overall survival remained low in women who survived to this timepoint (58%). Among survival determinants, improvements in early diagnosis and treatment were predicted to contribute to the largest increases in survival, with a combined absolute increase in survival of up to 22% in Nigeria, Zambia, and Uganda, when compared with the contributions of other factors (such as HIV or aggressive subtypes). INTERPRETATION: Large variations in breast cancer survival in sub-Saharan African countries indicate that improvements are possible. At least a third of the projected 416 000 breast cancer deaths that will occur in this region in the next decade could be prevented through achievable downstaging and improvements in treatment. Improving survival in socially disadvantaged women warrants special attention. FUNDING: Susan G Komen and the International Agency for Research on Cancer.
BACKGROUND:Breast cancer is the second leading cause of death from cancer in women in sub-Saharan Africa, yet there are few well characterised large-scale survival studies with complete follow-up data. We aimed to provide robust survival estimates in women in this setting and apportion the survival gaps. METHODS: The African Breast Cancer-Disparities in Outcomes (ABC-DO) prospective cohort study was done at eight hospitals across five sub-Saharan African countries (Namibia, Nigeria, South Africa, Uganda, and Zambia). We prospectively recruited women (aged ≥18 years) who attended these hospitals with suspected breast cancer. Women were actively followed up by use of a telephone call once every 3 months, and a mobile health application was used to keep a dynamic record of follow-up calls due. We collected detailed sociodemographic, clinical, and treatment data. The primary outcome was 3-year overall survival, analysed by use of flexible proportional mortality models, and we predicted survival under scenarios of modified distributions of risk factors. FINDINGS: Between Sept 8, 2014, and Dec 31, 2017, 2313 women were recruited from these eight hospitals, of whom 85 did not have breast cancer. Of the remaining 2228 women with breast cancer, 58 women with previous treatment or recurrence, and 14 women from small racial groups (white and Asian women in South Africa), were excluded. Of the 2156 women analysed, 1840 (85%) were histologically confirmed, 129 (6%) were cytologically confirmed, and 187 (9%) were clinically confirmed to have breast cancer. 2156 (97%) women were followed up for up to 3 years or up to Jan 1, 2019, whichever was earlier. Up to this date, 879 (41%) of these women had died, 1118 (52%) were alive, and 159 (7%) were censored early. 3-year overall survival was 50% (95% CI 48-53), but we observed variations in 3-year survival between different races in Namibia (from 90% in white women to 56% in Black women) and in South Africa (from 76% in mixed-race women to 59% in Black women), and between different countries (44-47% in Uganda and Zambia vs 36% in Nigeria). 215 (10%) of all women had died within 6 months of diagnosis, but 3-year overall survival remained low in women who survived to this timepoint (58%). Among survival determinants, improvements in early diagnosis and treatment were predicted to contribute to the largest increases in survival, with a combined absolute increase in survival of up to 22% in Nigeria, Zambia, and Uganda, when compared with the contributions of other factors (such as HIV or aggressive subtypes). INTERPRETATION: Large variations in breast cancer survival in sub-Saharan African countries indicate that improvements are possible. At least a third of the projected 416 000 breast cancer deaths that will occur in this region in the next decade could be prevented through achievable downstaging and improvements in treatment. Improving survival in socially disadvantaged women warrants special attention. FUNDING: Susan G Komen and the International Agency for Research on Cancer.
Authors: A O J Agboola; H O Ebili; V O Iyawe; A A F Banjo; B S Salami; E A Rakha; C Nolan; I O Ellis; A R Green Journal: Malays J Pathol Date: 2016-08 Impact factor: 0.656
Authors: Benjamin O Anderson; Eduardo Cazap; Nagi S El Saghir; Cheng-Har Yip; Hussein M Khaled; Isabel V Otero; Clement A Adebamowo; Rajendra A Badwe; Joe B Harford Journal: Lancet Oncol Date: 2011-04 Impact factor: 41.316
Authors: Caroline Dickens; Ruth M Pfeiffer; William F Anderson; Raquel Duarte; Patricia Kellett; Joachim Schüz; Danuta Kielkowski; Valerie A McCormack Journal: Breast Cancer Res Treat Date: 2016-10-18 Impact factor: 4.872
Authors: Anna E Coghill; Polly A Newcomb; Margaret M Madeleine; Barbra A Richardson; Innocent Mutyaba; Fred Okuku; Warren Phipps; Henry Wabinga; Jackson Orem; Corey Casper Journal: AIDS Date: 2013-11-28 Impact factor: 4.177
Authors: Yoanna S Pumpalova; Oluwatosin A Ayeni; Wenlong Carl Chen; Ines Buccimazza; Sharon Cačala; Laura W Stopforth; Hayley A Farrow; Witness Mapanga; Sarah Nietz; Boitumelo Phakathi; Maureen Joffe; Valerie McCormack; Judith S Jacobson; Katherine D Crew; Alfred I Neugut; Paul Ruff; Herbert Cubasch; Daniel S O'Neil Journal: Oncologist Date: 2022-03-11
Authors: Anna J Dare; Gregory C Knapp; Anya Romanoff; Olalekan Olasehinde; Olusola C Famurewa; Akinwumi O Komolafe; Samuel Olatoke; Aba Katung; Olusegun I Alatise; T Peter Kingham Journal: Cancer Prev Res (Phila) Date: 2021-09-10
Authors: Oluwatosin A Ayeni; Shane A Norris; Maureen Joffe; Herbert Cubasch; Moses Galukande; Annelle Zietsman; Groesbeck Parham; Charles Adisa; Angelica Anele; Joachim Schüz; Benjamin O Anderson; Milena Foerster; Isabel Dos Santos Silva; Valerie A McCormack Journal: Int J Cancer Date: 2020-11-25 Impact factor: 7.316
Authors: Kayo Togawa; Benjamin O Anderson; Milena Foerster; Moses Galukande; Annelle Zietsman; Johanna Pontac; Angelica Anele; Charles Adisa; Groesbeck Parham; Leeya F Pinder; Fiona McKenzie; Joachim Schüz; Isabel Dos Santos-Silva; Valerie McCormack Journal: Int J Cancer Date: 2020-12-08 Impact factor: 7.396
Authors: Dhirendra Govender; Xiaohong R Yang; Shahin Sayed; Shaoqi Fan; Zahir Moloo; Ronald Wasike; Peter Bird; Mansoor Saleh; Asim Jamal Shaikh; Jonine D Figueroa; Richard Naidoo; Francis W Makokha; Kevin Gardner; Raymond Oigara; Faith Wambui Njoroge; Pumza Magangane; Miriam Mutebi; Rajendra Chauhan; Sitna Mwanzi Journal: Breast Cancer Res Date: 2021-06-26 Impact factor: 6.466