Study finds high proportion of advanced breast cancers in sub-Saharan Africa

In one of the first studies of its kind, a new report finds a large majority of breast cancers in Cote d'Ivoire and Republic of Congo are detected only after they've become advanced. The study, by American Cancer Society researchers and the African Cancer Registry Network, appears early online in the medical journal The Breast.

Although breast cancer is far less common in Cote d'Ivoire and Republic of Congo (33.7 per 100,000 females and 31.7 per 100,000 females, respectively) than in high-income countries (e.g. 122.8 per 100,000 in U.S. women), breast cancer is the leading cancer among females in sub-Saharan Africa, estimated to constitute one in three female cancers in these two countries in 2012.

Still, there is relatively little information on breast cancer characteristics in this region. To find out more, researchers led by Farhad Islami Gomeshtapeh, M.D., Ph.D., American Cancer Society epidemiologist, studied the size and stage of female breast cancer at diagnosis in Cote d'Ivoire and Republic of Congo. Data on tumor size and stage at diagnosis are among the best indicators for prognosis of breast cancer, and can be useful tools to help direct allocation of available resources.

The researchers used population-based cancer registry data to analyze records from a group of randomly chosen female breast cancer cases diagnosed in 2008-2009 in both countries, the first such study in sub-Saharan Africa.

They found in Cote d'Ivoire, more than two in three (68%) tumors were 5 cm or larger in diameter and nearly three in four (74%) were stage III or IV at diagnosis. The corresponding proportions for Republic of Congo were 63% and 81%. The corresponding rates for breast cancer stages III and IV combined in the US is 24% for African American women and 16% in non-Hispanic white women.

"Mass screening with mammography is not considered a viable cancer control intervention in sub-Saharan African countries at this moment, due to limited resources," said Dr. Islami. "Instead, raising public awareness may be one of the most important factors. That approach has reduced the stage of breast cancer at diagnosis in low- and middle-income countries, where it is among the highest priority strategies for early detection of breast cancer. That said, in order to improve the outcome of breast cancer, access to appropriate diagnosis and treatment should also be improved."