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Late-Stage Diagnosis and Associated Factors Among Breast Cancer Patients in South and Southwest Ethiopia: A Multicenter Study

Published:October 01, 2020DOI:https://doi.org/10.1016/j.clbc.2020.08.011

      Abstract

      Background

      Breast cancer is a leading cause of cancer death in women in low- and middle-income countries, largely because of late-stage diagnosis. Yet studies are very limited in the Ethiopian context. Therefore, we determined the occurrence of late-stage disease and associated factors in selected public hospitals in south and southwest Ethiopia.

      Patients and Methods

      A 5-year retrospective cross-sectional study was conducted on breast cancer patient medical records from January 2013 to December 2017 in 6 hospitals. Multivariable logistic regression was performed to identify factors associated with late-stage disease (stage III and IV). Adjusted odds ratios (AOR) with 95% confidence intervals were used. P < .05 was considered statistically significant.

      Results

      Overall, 426 breast cancer patients were identified, and 72.5% were diagnosed with late-stage disease. The mean ± standard deviation patient age was 42.8 ± 13.4 years. Factors associated with late diagnosis were patient delay in seeking care (AOR = 2.50; 95% confidence interval [CI], 1.51-4.16); health system delays (AOR = 1.62; 95% CI, 1.02-2.59); female sex (AOR = 3.46; 95% CI, 1.50-7.98); rural residence (AOR = 2.37; 95% CI, 1.45-3.86); chief complaint of breast lump (AOR = 3.01; 95% CI, 1.49-6.07); and history of comorbidities (AOR = 1.72; 95% CI, 1.02-2.91).

      Conclusion

      The majority of patients were diagnosed with late-stage diagnosis of breast cancer. Patient delays in seeking care, health system delays, being female, rural residence, and patient comorbidities were associated factors. These findings provide evidence that efforts to increase public and health provider awareness to promote early breast cancer diagnosis, particularly in rural areas, are needed in south and southwest Ethiopia.

      Keywords

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      References

        • Ferlay J.
        • Colombet M.
        • Soerjomataram I.
        • et al.
        Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods.
        Int J Cancer. 2019; 144: 1941-1953
        • Boyle P.
        • Autier P.
        • Adebamowo C.
        • et al.
        World Breast Cancer Report.
        International Prevention Research Institute, Lyon2012
      1. Edge S.B. Byrd D.R. Compton C.C. Fritz A.G. Greene F.L. Trotti A. AJCC Cancer Staging Manual. 7th ed. Springer, New York, NY2010
        • Jedy-Agba E.
        • McCormack V.
        • Adebamowo C.
        • dos-Santos-Silva I.
        Stage at diagnosis of breast cancer in sub-Saharan Africa: a systematic review and meta-analysis.
        Lancet Glob Health. 2016; 4: e923-e935
        • Ermiah E.
        • Abdalla F.
        • Buhmeida A.
        • Larbesh E.
        • Pyrhönen S.
        • Collan Y.
        Diagnosis delay in Libyan female breast cancer.
        BMC Res Notes. 2012; 5: 452
        • Muchuweti D.
        • Nyandoro G.
        • Muguti E.G.
        • Muchaziwepi T.
        Factors contributing to delayed breast cancer presentation: a prospective study at Parirenyatwa group of hospitals, Harare, Zimbabwe, 2010-2013.
        J Cancer Tumor Int. 2017; 5: 1-10
        • Pace L.E.
        • Mpunga T.
        • Hategekimana V.
        • et al.
        Delays in breast cancer presentation and diagnosis at two rural cancer referral centers in Rwanda.
        Oncologist. 2015; 20: 780-788
        • Benbakhta B.
        • Tazi M.
        • Benjaafar N.
        • Khattabi A.
        • Maaroufi A.
        [Determinants of patient and health system delays for women with breast cancer in Morocco, 2013].
        Rev Epidemiol Sante Publique. 2015; 63: 191-201
        • Walters S.
        • Maringe C.
        • Butler J.
        • et al.
        Breast cancer survival and stage at diagnosis in Australia, Canada, Denmark, Norway, Sweden and the UK, 2000-2007: a population-based study.
        Br J Cancer. 2013; 108: 1195
        • Yip C.
        • Smith R.A.
        • Anderson B.O.
        • et al.
        Guideline implementation for breast healthcare in low-and middle-income countries: early detection resource allocation.
        Cancer. 2008; 113: 2244-2256
        • Unger-Saldaña K.
        Challenges to the early diagnosis and treatment of breast cancer in developing countries.
        World J Clin Oncol. 2014; 5: 465
        • Seneviratne S.
        • Lawrenson R.
        • Harvey V.
        • et al.
        Stage of breast cancer at diagnosis in New Zealand: impacts of socio-demographic factors, breast cancer screening and biology.
        BMC Cancer. 2016; 16: 129
        • Price A.J.
        • Ndom P.
        • Atenguena E.
        • Mambou Nouemssi J.P.
        • Ryder R.W.
        Cancer care challenges in developing countries.
        Cancer. 2012; 118: 3627-3635
        • Kohler R.E.
        • Gopal S.
        • Miller A.R.
        • et al.
        A framework for improving early detection of breast cancer in sub-Saharan Africa: a qualitative study of help-seeking behaviors among Malawian women.
        Patient Educ Counsel. 2017; 100: 167-173
        • Macleod U.
        • Mitchell E.D.
        • Burgess C.
        • Macdonald S.
        • Ramirez A.J.
        Risk factors for delayed presentation and referral of symptomatic cancer: evidence for common cancers.
        Br J Cancer. 2009; 101: S92
        • Stapleton J.M.
        • Mullan P.B.
        • Dey S.
        • et al.
        Patient-mediated factors predicting early- and late-stage presentation of breast cancer in Egypt.
        Psychooncology. 2011; 20: 532-537
        • Gonçalves L.L.
        • Travassos G.L.
        • Maria de Almeida A.
        • Guimarães A.M.
        • Gois C.F.
        [Barriers in health care to breast cancer: perception of women].
        Rev Esc Enferm USP. 2014; 48: 394-400
        • Shieh S.
        • Hsieh V.C.
        • Liu S.
        • Chien C.
        • Lin C.
        • Wu T.
        Delayed time from first medical visit to diagnosis for breast cancer patients in Taiwan.
        J Formos Med Assn. 2014; 113: 696-703
        • Poum A.
        • Promthet S.
        • Duffy S.W.
        • Parkin D.M.
        Factors associated with delayed diagnosis of breast cancer in northeast Thailand.
        J Epidemiol. 2014; 24: 102-108
        • Timotewos G.
        • Solomon A.
        • Mathewos A.
        • et al.
        First data from a population based cancer registry in Ethiopia.
        Cancer Epidemiol. 2018; 53: 93-98
        • Kantelhardt E.J.
        • Zerche P.
        • Mathewos A.
        • et al.
        Breast cancer survival in Ethiopia: a cohort study of 1,070 women.
        Int J Cancer. 2014; 135: 702-709
        • Federal Ministry of Health
        National Cancer Control Plan of Ethiopia (2016-2020). Disease prevention and control directorate. Addis Ababa, Ethiopia: Federal Ministry of Health..
        (Available at)
        • Jedy-Agba E.
        • McCormack V.
        • Olaomi O.
        • et al.
        Determinants of stage at diagnosis of breast cancer in Nigerian women: sociodemographic, breast cancer awareness, health care access and clinical factors.
        Cancer Causes Control. 2017; 28: 685-697
        • Howlader N.
        • Noone A.M.
        • Krapcho M.
        • et al.
        SEER Cancer Statistics Review, 1975-2012.
        National Cancer Institute, Bethesda, MD2015
        • Mousa S.M.
        • Seifeldin I.A.
        • Hablas A.
        • Elbana E.S.
        • Soliman A.S.
        Patterns of seeking medical care among Egyptian breast cancer patients: relationship to late-stage presentation.
        Breast. 2011; 20: 555-561
        • Unger-Saldaña K.
        • Miranda A.
        • Zarco-Espinosa G.
        • Mainero-Ratchelous F.
        • Bargalló-Rocha E.
        • Miguel Lázaro-León J.
        Health system delay and its effect on clinical stage of breast cancer: multicenter study.
        Cancer. 2015; 121: 2198-2206
        • Frie K.G.
        • Kamaté B.
        • Traoré C.B.
        • et al.
        Factors associated with time to first healthcare visit, diagnosis and treatment, and their impact on survival among breast cancer patients in Mali.
        PLoS One. 2018; 13: e0207928
        • Abate Y.
        • Yilma Z.
        • Assefa M.
        • Tigeneh W.
        Trends of breast cancer in Ethiopia.
        Int J Cancer Res Mol Mech. 2016; 2: 1
        • Wabinga H.R.
        • Nambooze S.
        • Amulen P.M.
        • Okello C.
        • Mbus L.
        • Parkin D.M.
        Trends in the incidence of cancer in Kampala, Uganda, 1991-2010.
        Int J Cancer. 2014; 135: 432-439
        • Chokunonga E.
        • Borok M.Z.
        • Chirenje Z.M.
        • Nyakabau A.M.
        • Parkin D.M.
        Trends in the incidence of cancer in the black population of Harare, Zimbabwe, 1991-2010.
        Int J Cancer. 2013; 133: 721-729