Below are two linked articles on this subject from The Lancet Global Health (open access).

CITATION: Elima Jedy-Agba, MD, Valerie McCormack, PhD, Prof Clement Adebamowo, MD, Prof Isabel dos-Santos-Silva, PhD

Stage at diagnosis of breast cancer in sub-Saharan Africa: a systematic review and meta-analysis

Lancet Global Health, Volume 4, No. 12, e923–e935, December 2016

DOI: http://dx.doi.org/10.1016/S2214-109X(16)30259-5

SUMMARY

Background: The incidence of breast cancer in sub-Saharan Africa is relatively low, but as survival from the disease in the region is poor, mortality rates are as high as in high-income countries. Stage at diagnosis is a major contributing factor to poor survival from breast cancer. We aimed to do a systematic review and meta-analysis on stage at diagnosis of breast cancer in sub-Saharan Africa to examine trends over time, and investigate sources of variations across the region.

Methods: We searched MEDLINE, Embase, Web of Knowledge, and Africa-Wide Information to identify studies on breast cancer stage at diagnosis in sub-Saharan African women published before Jan 1, 2014, and in any language. Random-effects meta-analyses were done to investigate between-study heterogeneity in percentage of late-stage breast cancer (stage III/IV), and meta-regression analyses to identify potential sources of variation. Percentages of women with late-stage breast cancer at diagnosis in sub-Saharan Africa were compared with similar estimates for black and white women in the USA from the Surveillance, Epidemiology, and End Results database.

Findings: 83 studies were included, which consisted of 26?788 women from 17 sub-Saharan African countries. There was wide between-study heterogeneity in the percentage of late-stage disease at diagnosis (median 74·7%, range 30·3–100%, I2=93·3%, p<0·0001). The percentage of patients with late-stage disease at diagnosis did not vary by region in black women, but was lower in non-black women from southern Africa than in black women in any region (absolute difference [AD] from black women in western Africa [reference group] -18·1%, 95% CI -28·2 to -8·0), and higher for populations from mixed (urban and rural) settings rather than urban settings (13·2%, 5·7 to 20·7, in analyses restricted to black women). The percentage of patients with late-stage disease at diagnosis in black Africans decreased over time (–10·5%, -19·3 to -1·6; for 2000 or later vs 1980 or before), but it was still higher around 2010 than it was in white and black women in the USA 40 years previously.

Interpretation: Strategies for early diagnosis of breast cancer should be regarded as a major priority by cancer control programmes in sub-Saharan Africa.

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CITATION: How advanced is breast cancer in Africa?

Eva Johanna Kantel, Kirstin Grosse Frie

Lancet Global Health, Volume 4, No. 12, e875–e876, December 2016

http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(16)30283-2/fulltext?elsca1=etoc

Breast cancer is a growing problem in low-resource settings. According to the GLOBOCAN database, an estimated 94,378 new cases of breast cancer are diagnosed in sub-Saharan Africa annually…

Jedy-Agba and colleagues also report that the average age at diagnosis in sub-Saharan Africa (35–49 years) is lower than in high-income countries, which is due to the high proportion of young people in these countries…

A debate about whether the advanced stages are due to a unique aggressive biology of the disease or a delay in presentation is ongoing…

Trained volunteers and health-care workers have been shown to be able to do simplified screening to find advanced breast cancer at a village level. The need for patient advocates, such as survivors, and education of health-care workers to correctly help women with symptoms of breast cancer is evident. Their success will depend on the assurance of diagnosis and the availability of appropriate treatment…

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Best wishes, Neil

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