Journal Article

Inequities in breast cancer treatment in sub-Saharan Africa: findings from a prospective multi-country observational study

McKenzie, Fiona, McCormack, Valerie, Anderson, Benjamin O., Galukande, Moses, Adisa, Charles, dos Santos Silva, Isabel, Anele, Angelica, Zietsman, Annelle, Foerster, Milena, Schuz, Joachim

2019

Overview

Background Improving breast cancer survival in sub-Saharan Africa (SSA) is urgently needed, requiring early diagnosis and improved access to treatment. However, data on the types of and barriers to receiving breast cancer therapy in this region are limited and have not been compared between different SSA countries and treatment settings. Methods In different health care settings across Uganda, Nigeria and Namibian sites of the prospective African Breast Cancer - Disparities in Outcomes cohort study, we assessed the percentage of newly diagnosed breast cancer patients who received treatment (systemic, surgery and/or radiotherapy) for cancer and their socio-demographic and clinical determinants. Treatment data were systematically extracted from medical records, as well as self-reported by women during 6-month follow-up interviews, and were used to generate a binary indicator of treatment received within 12 months of diagnosis (yes/no), which was analysed via logistic regression. Results Of 1325 women, cancer treatment had not been initiated treatment within 1 year of diagnosis for 227 (17%) women and 185 (14%) of women with stage I–III disease. Untreated percentages were highest in two Nigerian regional hospitals where 38% of 314 women were not treated (32% among stage I–III). At a national referral hospital in Uganda, 18% of 430 women were not treated (15% among stage I–III). In contrast, at a cancer care centre in Windhoek, Namibia, where treatment is provided free to the patient, all non-black (100%) and almost all (98.7%) black women had initiated treatment. Percentages of untreated women were higher in women from lower socio-economic groups, women who believed in traditional medicine and, in Uganda, in HIV+ women. Self-reported treatment barriers confirmed treatment costs and treatment refusal as contributors to not receiving treatment. Conclusions Financial support to ensure treatment access and education of treatment benefits are needed to improve treatment access for breast cancer patients across sub-Saharan Africa, especially at regional treatment centres, for lower socio-economic groups, and for the HIV-positive woman with breast cancer.

• Publisher: BioMed Central,BioMed Central Ltd,BMC
• Subject: Africa / Africa South of the Sahara - epidemiology / Age Factors / Aged / Biomedical and Life Sciences / Biomedicine / Black women / Breast cancer / Breast cancer treatment / Breast Neoplasms - diagnosis / Breast Neoplasms - epidemiology / Breast Neoplasms - therapy / Cancer / Cancer patients / Cancer Research / Cancer treatment / Care and treatment / Chemotherapy / Comorbidity / Diagnosis / Disease Management / Female / Health aspects / Health Expenditures / Healthcare Disparities / HIV / HIV patients / Humans / Medical records / Middle Aged / Neoplasm Staging / Observational studies / Odds Ratio / Oncology / Outcome Assessment, Health Care / Patients' rights / Prognosis / Prospective Studies / Radiotherapy / Research Article / Retirement benefits / Socioeconomic Factors / Surgery / Surgical Oncology