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Erschienen in: Current Breast Cancer Reports 3/2018

03.07.2018 | Global Breast Cancer (BO Anderson and C Duggan, Section Editors)

Factors Contributing to Late-Stage Breast Cancer Presentation in sub-Saharan Africa

verfasst von: John R. Scheel, Sarah Anderson, Milena Foerster, Moses Galukande, Valerie McCormack

Erschienen in: Current Breast Cancer Reports | Ausgabe 3/2018

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Abstract

Purpose of Review

Late stage at breast cancer diagnosis is a major contributor to poor survival from breast cancer in many sub-Saharan African countries. Using Ugandan as an example, we discuss barriers along the journey to diagnosis and highlight areas where improvements are needed.

Recent Findings

In Uganda, the majority of breast cancer patients noticed symptoms of their cancer for at least 9 months prior to diagnosis, which is typical of many African countries. For most women, the health provider delay is extensive, owing to barriers related to cost, transport, stigma, provider knowledge, and difficult-to-navigate referral systems.

Summary

Downstaging efforts should focus on reducing health system delay and target low community awareness. Implementation research to strengthen women’s breast cancer knowledge, access to breast health services, and referral pathways provide clear opportunities for downstaging.
Literatur
3.
Zurück zum Zitat Jones-Hepler B, Moran K, Griffin J, McClure EM, Rouse D, Barbosa C, et al. Maternal and Neonatal Directed Assessment of Technologies (MANDATE): methods and assumptions for a predictive model for maternal, fetal, and neonatal mortality interventions. Glob Health Sci Pract. 2017;5(4):571–80.CrossRefPubMedPubMedCentral Jones-Hepler B, Moran K, Griffin J, McClure EM, Rouse D, Barbosa C, et al. Maternal and Neonatal Directed Assessment of Technologies (MANDATE): methods and assumptions for a predictive model for maternal, fetal, and neonatal mortality interventions. Glob Health Sci Pract. 2017;5(4):571–80.CrossRefPubMedPubMedCentral
4.
Zurück zum Zitat Kawooya MG, Nathan RO, Swanson J, Swanson DL, Namulema E, Ankunda R, et al. Impact of introducing routine antenatal ultrasound services on reproductive health indicators in Mpigi District, Central Uganda. Ultrasound Q. 2015;31(4):285–9.CrossRefPubMed Kawooya MG, Nathan RO, Swanson J, Swanson DL, Namulema E, Ankunda R, et al. Impact of introducing routine antenatal ultrasound services on reproductive health indicators in Mpigi District, Central Uganda. Ultrasound Q. 2015;31(4):285–9.CrossRefPubMed
5.
Zurück zum Zitat Nathan R, Swanson JO, Marks W, Goldsmith N, Vance C, Sserwanga NB, et al. Screening obstetric ultrasound training for a 5-country cluster randomized controlled trial. Ultrasound Q. 2014;30(4):262–6.CrossRefPubMedPubMedCentral Nathan R, Swanson JO, Marks W, Goldsmith N, Vance C, Sserwanga NB, et al. Screening obstetric ultrasound training for a 5-country cluster randomized controlled trial. Ultrasound Q. 2014;30(4):262–6.CrossRefPubMedPubMedCentral
6.
Zurück zum Zitat Swanson JO, Kawooya MG, Swanson DL, Hippe DS, Dungu-Matovu P, Nathan R. The diagnostic impact of limited, screening obstetric ultrasound when performed by midwives in rural Uganda. J Perinatol. 2014;34(7):508–12.CrossRefPubMed Swanson JO, Kawooya MG, Swanson DL, Hippe DS, Dungu-Matovu P, Nathan R. The diagnostic impact of limited, screening obstetric ultrasound when performed by midwives in rural Uganda. J Perinatol. 2014;34(7):508–12.CrossRefPubMed
7.
Zurück zum Zitat Rice B, Boulle A, Baral S, Egger M, Mee P, Fearon E, et al. Strengthening routine data systems to track the HIV epidemic and guide the response in sub-Saharan Africa. JMIR Public Health Surveill. 2018;4(2):e36.CrossRefPubMedPubMedCentral Rice B, Boulle A, Baral S, Egger M, Mee P, Fearon E, et al. Strengthening routine data systems to track the HIV epidemic and guide the response in sub-Saharan Africa. JMIR Public Health Surveill. 2018;4(2):e36.CrossRefPubMedPubMedCentral
8.
Zurück zum Zitat Lessler J, Moore SM, Luquero FJ, McKay HS, Grais R, Henkens M, et al. Mapping the burden of cholera in sub-Saharan Africa and implications for control: an analysis of data across geographical scales. Lancet. 2018;391:1908–15.CrossRefPubMedPubMedCentral Lessler J, Moore SM, Luquero FJ, McKay HS, Grais R, Henkens M, et al. Mapping the burden of cholera in sub-Saharan Africa and implications for control: an analysis of data across geographical scales. Lancet. 2018;391:1908–15.CrossRefPubMedPubMedCentral
9.
Zurück zum Zitat Bor J, Herbst AJ, Newell ML, Barnighausen T. Increases in adult life expectancy in rural South Africa: valuing the scale-up of HIV treatment. Science. 2013;339(6122):961–5.CrossRefPubMed Bor J, Herbst AJ, Newell ML, Barnighausen T. Increases in adult life expectancy in rural South Africa: valuing the scale-up of HIV treatment. Science. 2013;339(6122):961–5.CrossRefPubMed
10.
Zurück zum Zitat Espina C, McKenzie F, Dos-Santos-Silva I. Delayed presentation and diagnosis of breast cancer in African women: a systematic review. Ann Epidemiol. 2017;27(10):659–71 e7.CrossRefPubMedPubMedCentral Espina C, McKenzie F, Dos-Santos-Silva I. Delayed presentation and diagnosis of breast cancer in African women: a systematic review. Ann Epidemiol. 2017;27(10):659–71 e7.CrossRefPubMedPubMedCentral
11.
Zurück zum Zitat Ginsburg O, Bray F, Coleman MP, Vanderpuye V, Eniu A, Kotha SR, et al. The global burden of women’s cancers: a grand challenge in global health. Lancet. 2017;389(10071):847–60.CrossRefPubMed Ginsburg O, Bray F, Coleman MP, Vanderpuye V, Eniu A, Kotha SR, et al. The global burden of women’s cancers: a grand challenge in global health. Lancet. 2017;389(10071):847–60.CrossRefPubMed
12.
Zurück zum Zitat Global Burden of Disease Cancer C, Fitzmaurice C, Dicker D, et al. The global burden of cancer 2013. JAMA Oncol. 2015;1(4):505–27.CrossRef Global Burden of Disease Cancer C, Fitzmaurice C, Dicker D, et al. The global burden of cancer 2013. JAMA Oncol. 2015;1(4):505–27.CrossRef
14.
Zurück zum Zitat Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65(2):87–108.CrossRefPubMed Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65(2):87–108.CrossRefPubMed
15.
Zurück zum Zitat Allemani C, Matsuda T, Di Carlo V, et al. Global surveillance of trends in cancer survival 2000–14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet. 2018;391(10125):1023–75.CrossRefPubMed Allemani C, Matsuda T, Di Carlo V, et al. Global surveillance of trends in cancer survival 2000–14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet. 2018;391(10125):1023–75.CrossRefPubMed
16.
Zurück zum Zitat Allemani C, Weir HK, Carreira H, Harewood R, Spika D, Wang XS, et al. Global surveillance of cancer survival 1995–2009: analysis of individual data for 25,676,887 patients from 279 population-based registries in 67 countries (CONCORD-2). Lancet. 2015;385(9972):977–1010.CrossRefPubMed Allemani C, Weir HK, Carreira H, Harewood R, Spika D, Wang XS, et al. Global surveillance of cancer survival 1995–2009: analysis of individual data for 25,676,887 patients from 279 population-based registries in 67 countries (CONCORD-2). Lancet. 2015;385(9972):977–1010.CrossRefPubMed
17.
Zurück zum Zitat Kingham TP, Alatise OI, Vanderpuye V, Casper C, Abantanga FA, Kamara TB, et al. Treatment of cancer in sub-Saharan Africa. Lancet Oncol. 2013;14(4):e158–67.CrossRefPubMed Kingham TP, Alatise OI, Vanderpuye V, Casper C, Abantanga FA, Kamara TB, et al. Treatment of cancer in sub-Saharan Africa. Lancet Oncol. 2013;14(4):e158–67.CrossRefPubMed
18.
Zurück zum Zitat Meacham E, Orem J, Nakigudde G, Zujewski JA, Rao D. Exploring stigma as a barrier to cancer service engagement with breast cancer survivors in Kampala, Uganda. Psychooncology. 2016;25(10):1206–11.CrossRefPubMed Meacham E, Orem J, Nakigudde G, Zujewski JA, Rao D. Exploring stigma as a barrier to cancer service engagement with breast cancer survivors in Kampala, Uganda. Psychooncology. 2016;25(10):1206–11.CrossRefPubMed
19.
Zurück zum Zitat Hayes Constant TK, Winkler JL, Bishop A, Taboada Palomino LG. Perilous uncertainty: situating women’s breast-health seeking in northern Peru. Qual Health Res. 2014;24(6):811–23.CrossRefPubMed Hayes Constant TK, Winkler JL, Bishop A, Taboada Palomino LG. Perilous uncertainty: situating women’s breast-health seeking in northern Peru. Qual Health Res. 2014;24(6):811–23.CrossRefPubMed
20.
Zurück zum Zitat McKenzie F, Zietsman A, Galukande M, Anele A, Adisa C, Parham G, et al. Drivers of advanced stage at breast cancer diagnosis in the multicountry African breast cancer—disparities in outcomes (ABC-DO) study. Int J Cancer. 2018;142(8):1568–79.CrossRefPubMed McKenzie F, Zietsman A, Galukande M, Anele A, Adisa C, Parham G, et al. Drivers of advanced stage at breast cancer diagnosis in the multicountry African breast cancer—disparities in outcomes (ABC-DO) study. Int J Cancer. 2018;142(8):1568–79.CrossRefPubMed
21.
Zurück zum Zitat 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(12):e923–e35.CrossRefPubMedPubMedCentral 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(12):e923–e35.CrossRefPubMedPubMedCentral
22.
Zurück zum Zitat Wabinga HR, Nambooze S, Amulen PM, Okello C, Mbus L, Parkin DM. Trends in the incidence of cancer in Kampala, Uganda 1991-2010. Int J Cancer. 2014;135(2):432–9.CrossRefPubMed Wabinga HR, Nambooze S, Amulen PM, Okello C, Mbus L, Parkin DM. Trends in the incidence of cancer in Kampala, Uganda 1991-2010. Int J Cancer. 2014;135(2):432–9.CrossRefPubMed
23.
Zurück zum Zitat Galukande M, Kiguli-Malwadde E. Rethinking breast cancer screening strategies in resource-limited settings. Afr Health Sci. 2010;10(1):89–92.PubMedPubMedCentral Galukande M, Kiguli-Malwadde E. Rethinking breast cancer screening strategies in resource-limited settings. Afr Health Sci. 2010;10(1):89–92.PubMedPubMedCentral
24.
Zurück zum Zitat Monu JU, Muyinda Z, Taljanovic M. ISS outreach sub-Saharan Africa insight: Uganda 2011. Skelet Radiol. 2012;41(11):1347–8.CrossRef Monu JU, Muyinda Z, Taljanovic M. ISS outreach sub-Saharan Africa insight: Uganda 2011. Skelet Radiol. 2012;41(11):1347–8.CrossRef
26.
Zurück zum Zitat Weedon-Fekjaer H, Lindqvist BH, Vatten LJ, Aalen OO, Tretli S. Breast cancer tumor growth estimated through mammography screening data. Breast Cancer Res. 2008;10(3):R41.CrossRefPubMedPubMedCentral Weedon-Fekjaer H, Lindqvist BH, Vatten LJ, Aalen OO, Tretli S. Breast cancer tumor growth estimated through mammography screening data. Breast Cancer Res. 2008;10(3):R41.CrossRefPubMedPubMedCentral
27.
Zurück zum Zitat Galukande M, Mirembe F, Wabinga H. Patient delay in accessing breast cancer care in a sub Saharan African country: Uganda. Br J Med Med Res. 2014;4(13):2599–610.CrossRefPubMedPubMedCentral Galukande M, Mirembe F, Wabinga H. Patient delay in accessing breast cancer care in a sub Saharan African country: Uganda. Br J Med Med Res. 2014;4(13):2599–610.CrossRefPubMedPubMedCentral
28.
Zurück zum Zitat Atuhairwe C, Amongin D, Agaba E, Mugarura S, Taremwa IM. The effect of knowledge on uptake of breast cancer prevention modalities among women in Kyadondo County, Uganda. BMC Public Health. 2018;18(1):279.CrossRefPubMedPubMedCentral Atuhairwe C, Amongin D, Agaba E, Mugarura S, Taremwa IM. The effect of knowledge on uptake of breast cancer prevention modalities among women in Kyadondo County, Uganda. BMC Public Health. 2018;18(1):279.CrossRefPubMedPubMedCentral
29.
Zurück zum Zitat Muthoni A, Miller AN. An exploration of rural and urban Kenyan women’s knowledge and attitudes regarding breast cancer and breast cancer early detection measures. Health Care Women Int. 2010;31(9):801–16.CrossRefPubMed Muthoni A, Miller AN. An exploration of rural and urban Kenyan women’s knowledge and attitudes regarding breast cancer and breast cancer early detection measures. Health Care Women Int. 2010;31(9):801–16.CrossRefPubMed
30.
Zurück zum Zitat Scheel JR, Molina Y, Anderson BO, Patrick DL, Nakigudde G, Gralow JR, et al. Breast cancer beliefs as potential targets for breast cancer awareness efforts to decrease late-stage presentation in Uganda. Journal of Global Oncology. 2018; https://doi.org/10.1200/JGO.2016.008748. Scheel JR, Molina Y, Anderson BO, Patrick DL, Nakigudde G, Gralow JR, et al. Breast cancer beliefs as potential targets for breast cancer awareness efforts to decrease late-stage presentation in Uganda. Journal of Global Oncology. 2018; https://​doi.​org/​10.​1200/​JGO.​2016.​008748.
31.
Zurück zum Zitat Koon KP, Lehman CD, Gralow JR. The importance of survivors and partners in improving breast cancer outcomes in Uganda. Breast. 2013;22(2):138–41.CrossRefPubMed Koon KP, Lehman CD, Gralow JR. The importance of survivors and partners in improving breast cancer outcomes in Uganda. Breast. 2013;22(2):138–41.CrossRefPubMed
32.
Zurück zum Zitat Scheel JR, Nealey EM, Orem J, Bugeza S, Muyinda Z, Nathan RO, et al. ACR BI-RADS use in low-income countries: an analysis of diagnostic breast ultrasound practice in Uganda. J Am Coll Radiol. 2016;13(2):163–9.CrossRefPubMed Scheel JR, Nealey EM, Orem J, Bugeza S, Muyinda Z, Nathan RO, et al. ACR BI-RADS use in low-income countries: an analysis of diagnostic breast ultrasound practice in Uganda. J Am Coll Radiol. 2016;13(2):163–9.CrossRefPubMed
33.
Zurück zum Zitat Gakwaya A, Galukande M, Luwaga A, Jombwe J, Fualal J, Kiguli-Malwadde E, et al. Breast cancer guidelines for Uganda (2nd edition 2008). Afr Health Sci. 2008;8(2):126–32.PubMedPubMedCentral Gakwaya A, Galukande M, Luwaga A, Jombwe J, Fualal J, Kiguli-Malwadde E, et al. Breast cancer guidelines for Uganda (2nd edition 2008). Afr Health Sci. 2008;8(2):126–32.PubMedPubMedCentral
34.
Zurück zum Zitat Scheel JR, Molina Y, Patrick DL, Anderson BO, Nakigudde G, Lehman CD, et al. Breast cancer downstaging practices and breast health messaging preferences among a community sample of urban and rural Ugandan women. J Glob Oncol. 2017;3(2):105–13.CrossRefPubMed Scheel JR, Molina Y, Patrick DL, Anderson BO, Nakigudde G, Lehman CD, et al. Breast cancer downstaging practices and breast health messaging preferences among a community sample of urban and rural Ugandan women. J Glob Oncol. 2017;3(2):105–13.CrossRefPubMed
35.
Zurück zum Zitat Scheel JR, Peacock S, Orem J, Bugeza S, Muyinda Z, Porter PL, et al. Improving breast ultrasound interpretation in Uganda using a condensed breast imaging reporting and data system. Acad Radiol. 2016;23(10):1271–7.CrossRefPubMed Scheel JR, Peacock S, Orem J, Bugeza S, Muyinda Z, Porter PL, et al. Improving breast ultrasound interpretation in Uganda using a condensed breast imaging reporting and data system. Acad Radiol. 2016;23(10):1271–7.CrossRefPubMed
36.
Zurück zum Zitat Lauby-Secretan B, Scoccianti C, Loomis D, Benbrahim-Tallaa L, Bouvard V, Bianchini F, et al. Breast-cancer screening—viewpoint of the IARC Working Group. N Engl J Med. 2015;372(24):2353–8.CrossRefPubMed Lauby-Secretan B, Scoccianti C, Loomis D, Benbrahim-Tallaa L, Bouvard V, Bianchini F, et al. Breast-cancer screening—viewpoint of the IARC Working Group. N Engl J Med. 2015;372(24):2353–8.CrossRefPubMed
37.
Zurück zum Zitat Romanoff A, Constant TH, Johnson KM, Guadiamos MC, Vega AMB, Zunt J, et al. Association of previous clinical breast examination with reduced delays and earlier-stage breast cancer diagnosis among women in Peru. JAMA Oncol. 2017;3(11):1563–7.CrossRefPubMedPubMedCentral Romanoff A, Constant TH, Johnson KM, Guadiamos MC, Vega AMB, Zunt J, et al. Association of previous clinical breast examination with reduced delays and earlier-stage breast cancer diagnosis among women in Peru. JAMA Oncol. 2017;3(11):1563–7.CrossRefPubMedPubMedCentral
38.
Zurück zum Zitat Scheel JR, Molina Y, Coronado G, Bishop S, Doty S, Jimenez R, et al. Healthcare factors for obtaining a mammogram in Latinas with a variable mammography history. Oncol Nurs Forum. 2017;44(1):66–76.CrossRefPubMedPubMedCentral Scheel JR, Molina Y, Coronado G, Bishop S, Doty S, Jimenez R, et al. Healthcare factors for obtaining a mammogram in Latinas with a variable mammography history. Oncol Nurs Forum. 2017;44(1):66–76.CrossRefPubMedPubMedCentral
39.
Zurück zum Zitat International Agency for Research on Cancer. Breast cancer screening. Lyon: IARC; 2014. International Agency for Research on Cancer. Breast cancer screening. Lyon: IARC; 2014.
40.
Zurück zum Zitat Yip CH, Smith RA, Anderson BO, Miller AB, Thomas DB, Ang E, et al. Guideline implementation for breast healthcare in low- and middle-income countries: early detection resource allocation. Cancer. 2009;113(8 Suppl):2244–56. Yip CH, Smith RA, Anderson BO, Miller AB, Thomas DB, Ang E, et al. Guideline implementation for breast healthcare in low- and middle-income countries: early detection resource allocation. Cancer. 2009;113(8 Suppl):2244–56.
41.
Zurück zum Zitat McTiernan A. Guideline implementation for breast healthcare in low- and middle-income countries. Cancer. 2008;113(S8):2244–56.CrossRefPubMed McTiernan A. Guideline implementation for breast healthcare in low- and middle-income countries. Cancer. 2008;113(S8):2244–56.CrossRefPubMed
44.
Zurück zum Zitat Schwartz JI, Guwatudde D, Nugent R, Kiiza CM. Looking at non-communicable diseases in Uganda through a local lens: an analysis using locally derived data. Glob Health. 2014;10:77.CrossRef Schwartz JI, Guwatudde D, Nugent R, Kiiza CM. Looking at non-communicable diseases in Uganda through a local lens: an analysis using locally derived data. Glob Health. 2014;10:77.CrossRef
45.
Zurück zum Zitat Essue BM, Kapiriri L. The unfunded priorities: an evaluation of priority setting for noncommunicable disease control in Uganda. Glob Health. 2018;14(1):22.CrossRef Essue BM, Kapiriri L. The unfunded priorities: an evaluation of priority setting for noncommunicable disease control in Uganda. Glob Health. 2018;14(1):22.CrossRef
47.
Zurück zum Zitat Ali N, Njeri A, Ssembatya R, Matovu A, Streeter M, DeStigter K. Using village health teams to disseminate ultrasound education in rural Uganda. JGR. 2015;1(2) Ali N, Njeri A, Ssembatya R, Matovu A, Streeter M, DeStigter K. Using village health teams to disseminate ultrasound education in rural Uganda. JGR. 2015;1(2)
48.
Zurück zum Zitat Lukong KE, Ogunbolude Y, Kamdem JP. Breast cancer in Africa: prevalence, treatment options, herbal medicines, and socioeconomic determinants. Breast Cancer Res Treat. 2017;166(2):351–65.CrossRefPubMed Lukong KE, Ogunbolude Y, Kamdem JP. Breast cancer in Africa: prevalence, treatment options, herbal medicines, and socioeconomic determinants. Breast Cancer Res Treat. 2017;166(2):351–65.CrossRefPubMed
49.
Zurück zum Zitat Hulett JM, Armer JM, Stewart BR, Wanchai A. Perspectives of the breast cancer survivorship continuum: diagnosis through 30 months post-treatment. J Pers Med. 2015;5(2):174–90.CrossRefPubMedPubMedCentral Hulett JM, Armer JM, Stewart BR, Wanchai A. Perspectives of the breast cancer survivorship continuum: diagnosis through 30 months post-treatment. J Pers Med. 2015;5(2):174–90.CrossRefPubMedPubMedCentral
50.
Zurück zum Zitat Matovu A, Scheel JR, Galukande M, DeStigter KK. Implementation of a resource-appropriate strategy for downstaging breast cancer in rural Uganda. JGR. 2016;2(1):1–6.CrossRef Matovu A, Scheel JR, Galukande M, DeStigter KK. Implementation of a resource-appropriate strategy for downstaging breast cancer in rural Uganda. JGR. 2016;2(1):1–6.CrossRef
51.
Zurück zum Zitat Vanderpuye V, Grover S, Hammad N, PoojaPrabhakar, Simonds H, Olopade F, et al. An update on the management of breast cancer in Africa. Infect Agent Cancer. 2017;12:13.CrossRefPubMedPubMedCentral Vanderpuye V, Grover S, Hammad N, PoojaPrabhakar, Simonds H, Olopade F, et al. An update on the management of breast cancer in Africa. Infect Agent Cancer. 2017;12:13.CrossRefPubMedPubMedCentral
Metadaten
Titel
Factors Contributing to Late-Stage Breast Cancer Presentation in sub-Saharan Africa
verfasst von
John R. Scheel
Sarah Anderson
Milena Foerster
Moses Galukande
Valerie McCormack
Publikationsdatum
03.07.2018
Verlag
Springer US
Erschienen in
Current Breast Cancer Reports / Ausgabe 3/2018
Print ISSN: 1943-4588
Elektronische ISSN: 1943-4596
DOI
https://doi.org/10.1007/s12609-018-0278-7

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