Abstract
While more than 90% of breast cancer patients in western countries survive for at least 5 years, the survival rate in Tanzania is less than 45% because of late stage at presentation. The aim of this study was to identify patient and health system factors related to early or late stages of a breast cancer diagnosis. The study was conducted at the Ocean Road Cancer Institute (ORCI) in Dar es Salaam, Tanzania, and included interviews with 196 breast cancer patients diagnosed with early (stage I/II, n = 44) or late (stage III/IV, n = 152) stage who were referred to ORCI from January 2016 to August 2018. The questionnaire elicited information regarding disease history, sociodemographics, barriers to navigating the health system, and patient attitudes towards breast cancer. More early-stage patients (54.5%) stated history of previous breast examinations before their initial diagnosis compared to late-stage patients (19.7%) (p = < 0.001). Financial restraints were cited more often as barriers to diagnosis among late-stage presentation patients (55.7%) compared to early-stage patients (35.5%) (p = 0.047). Patients who were diagnosed at late-stage (47.5%) were also more likely to state time restraints as significant barriers to their diagnosis than early-stage patients (25.8%) (p = 0.041). Although the late diagnosis of breast cancer will take immense efforts of policy workers to resolve, this study offers significant opportunities for making immediate health system changes through patient and physician education that can aid in reducing diagnosis delay in Tanzania other low-income developing countries, and low-income communities within the USA.
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12 September 2019
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References
Azubuike SO, Muirhead C, Hayes L, McNally R (2018) Rising global burden of breast cancer: the case of sub-Saharan Africa (with emphasis on Nigeria) and implications for regional development: a review. World J Surg Oncol 16(1):63
Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F (2015) Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 136(5):E359–E386
Jedy-Agba E, McCormack V, Adebamowo C, dos-Santos-Silva I (2016) Stage at diagnosis of breast cancer in sub-Saharan Africa: a systematic review and meta-analysis. Lancet Glob Health 4(12):e923–e935
Shin HR, Joubert C, Boniol M, Hery C, Ahn SH, Won YJ, … & Mirasol-Lumague MR (2010) Recent trends and patterns in breast cancer incidence among eastern and southeastern Asian women. Cancer Causes Control 21(11):1777–1785
Howlader N, Noone AM, Krapcho M, Miller D, Bishop K, Kosary CL, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2014, National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/csr/1975_2014/, based on November 2016 SEER data submission, posted to the SEER web site, April 2017
Scheel JR, Anderson S, Foerster M, Galukande M, McCormack V (2018) Factors contributing to late-stage breast Cancer presentation in sub-Saharan Africa. Curr Breast Cancer Rep 10(3):142–147
DeSantis CE, Bray F, Ferlay J, Lortet-Tieulent J, Anderson BO, Jemal A (2015) International variation in female breast cancer incidence and mortality rates. Cancer Epidemiology and Prevention Biomarkers
Pace LE, Mpunga T, Hategekimana V, Dusengimana JMV, Habineza H, Bigirimana JB, … & Amoroso C (2015) Delays in breast cancer presentation and diagnosis at two rural cancer referral centers in Rwanda. Oncologist 20(7):780–788
Kisiangani J, Baliddawa J, Marinda P, Mabeya H, Choge JK, Adino EO, Khayeka-Wandabwa C (2018) Determinants of breast cancer early detection for cues to expanded control and care: the lived experiences among women from Western Kenya. BMC Womens Health 18(1):81
McKenzie F, Zietsman A, Galukande M, Anele A, Adisa C, Parham G, … Lukande R (2018) Drivers of advanced stage at breast cancer diagnosis in the multicountry a frican breast cancer–disparities in outcomes (ABC-DO) study. Int J Cancer 142(8):1568–1579
“Tanzania Breast Health Care Assessment 2017: An Assessment of Breast Cancer Early Detection, Diagnosis and Treatment in Tanzania.”Https://ww5.Komen.org/UploadedFiles/_Komen/Content/Grants_Central/International_Grants/Grantee_Resources/Full_Tanzania_Assessment_report.Pdf, 2017, www.bing.com/cr?IG=652A6FB674604C0C884AC70984EEEFDB&CID=0E74DCD73FBC6D6D3727D7693E136C7D&rd=1&h=U3i7DgXKFJI-uDxzJrw7olAZZ9aSfCRhDD3TUojg1rE&v=1&r=https%3a%2f%2fww5.komen.org%2fuploadedFiles%2f_Komen%2fContent%2fWhat_We_Do%2fAround_the_World%2fAfrica%2fTanzania-BHCA-2017.pdf&p=DevEx,5066.1
Burson AM, Soliman AS, Ngoma TA, Mwaiselage J, Ogweyo P, Eissa MS, Dey S, Merajver SD (2010) Clinical and epidemiologic profile of breast cancer in Tanzania. Breast Dis 31(1):33–41
Morse EP, Maegga B, Joseph G, Miesfeldt S (2014) Breast Cancer knowledge, beliefs, and screening practices among women seeking Care at District Hospitals in Dar Es Salaam, Tanzania. Breast Cancer: Basic Clin Res 8:73–79. https://doi.org/10.4137/bcbcr.s13745
Mutebi M, Olasehinde O, Kingham P, Boutin-Foster C, Pusic A (2018) Understanding the breast Cancer experience of women in East Africa: a qualitative study
Mayor S (2017) Service review: improving breast cancer care in Tanzania. Lancet Oncol 18(4):430
Mabula JB, Mchembe MD, Chalya PL, Giiti G, Chandika AB, Rambau PF, … Gilyoma JM (2012) Stage at diagnosis, clinicopathological and treatment patterns of breast cancer at Bugando Medical Centre in North-Western Tanzania. Tanzan J Health Res 14(4)
Mwakigonja AR, Rabiel H, Mbembati NA, Lema LE (2016) The pattern of prognostic and risk indicators among women with breast cancer undergoing modified radical mastectomy in Dar es Salaam, Tanzania. Infect Agents Cancer 11(1):28
Hosmer DW, Lemeshow S (2000) Applied logistic regression. Wiley, New York
Hosmer DW, Lemeshow S (1999) Applied Survival Analysis: Regression Modeling of Time to Event data. Wiley, New York
Bursac Z, Gauss CH, Williams DK, Hosmer DW (2007) A purposeful selection of variables macro for logistic regression. SAS Global Forum Proc Pap 173:1–5
Ngoma T, Mandeli J, Holland JF (2015) Downstaging cancer in rural Africa. Int J Cancer 136(12):2875–2879
Ibrahim NA, Oludara MA (2012) Socio-demographic factors and reasons associated with delay in breast cancer presentation: a study in Nigerian women. Breast 21(3):416–418
Stapleton JM, Mullan PB, Dey S, Hablas A, Gaafar R, Seifeldin IA, Banerjee M, Soliman AS (2011) Patient-mediated factors predicting early-and late-stage presentation of breast cancer in Egypt. Psycho-Oncology 20(5):532–537
Pace LE, Shulman LN (2016) Breast cancer in sub-Saharan Africa: challenges and opportunities to reduce mortality. Oncologist 21(6):739–744
Lee TYWJ (2019) Promoting breast cancer awareness and screening practices for early detection in low-resource settings. Eur J Breast Health 15(1):18–25
Dey S (2014) Preventing breast cancer in LMICs via screening and/or early detection: the real and the surreal. World J Clin Oncol 5(3):509–519
Dye TD, Bogale S, Hobden C, Tilahun Y, Deressa T, Reeler A (2012) Experience of initial symptoms of breast cancer and triggers for action in Ethiopia. Int J Breast Cancer
Brown CA, Kohler RE, John O, Motswetla G, Mmalane M, Tapela N, Grover S, Dryden-Peterson S, Lockman S, Dryden-Peterson SL (2018) Multilevel factors affecting time to cancer diagnosis and care quality in Botswana. Oncologist 23(12):1453–1460
Acknowledgements
We would like to thank the healthcare team at the Ocean Road Cancer Institute for assistance during data collection. Kristen Yang was funded by the Department of Community Health and Social Medicine and the Cancer Epidemiology Education in Special Populations Program of the City University of New York School of Medicine.
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Informed consent was received by all participants of the study in compliance with the Ocean Road Cancer Institute’s Bioethics Committee and the City College of New York’s Institutional Review Board.
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Yang, K., Msami, K., Calixte, R. et al. Educational Opportunities for Down-Staging Breast Cancer in Low-Income Countries: an Example from Tanzania. J Canc Educ 34, 1225–1230 (2019). https://doi.org/10.1007/s13187-019-01587-2
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DOI: https://doi.org/10.1007/s13187-019-01587-2