Breast cancer survival in rural sub-Saharan Africa

Abstract INTRODUCTION: Five-year overall survival rate of breast cancer in low-income countries (LICs) is significantly lower than in high-resource countries. In this study, we explored clinical and pathological factors influencing mortality in a rural community setting in sub-Saharan Africa. METHODS: We performed a retrospective medical review of patients undergoing surgery and chemotherapy for breast cancer at a regional hospital in Ghana from January 2014 through January 2017. Descriptive and survival analysis was done. RESULTS: One hundred and twenty-nine patients were included in the study. The median age at presentation was 51 years. 60.0% of patients presented with poorly differential histological grade III. The most common histological type was invasive ductal carcinoma (83%). Based on assessment of stage using only tumor size and lymph node status, 60% presented at stage 3. Only 25% were tested for hormone receptor proteins and HER2 status. Of these, 57% had triple-negative breast cancer (TNBC). The 3-year overall survival rate was only 52%. A significant proportion of the patients (46%) were lost to follow-up. CONCLUSIONS: The cumulative 3-year survival was 52 %. Despite success in the reduction of cancer mortality in southern and northern Africa, survival in the rural communities of sub-Saharan Africa remains poor. A significantly higher percentage of GIII and TNBC is found in breast cancers seen in Ghana. Late-stage presentation, when combined with limited capacity for accurate diagnosis, cancer subtype analysis, adequate therapy and follow-up, leads to poor outcomes. Future studies should emphasize identification of barriers to care and opportunities for cost-effective and sustainable improvements in the diagnosis and treatment of breast cancer in LICs.