Breast cancer survival in sub-Saharan Africa by age, stage at diagnosis and human development index: A population-based registry study.

Breast cancer is the leading cancer diagnosis and second most common cause of cancer deaths in sub-Saharan Africa (SSA). Yet, there are few population-level survival data from Africa and none on the survival differences by stage at diagnosis. Here, we estimate breast cancer survival within SSA by area, stage and country-level human development index (HDI). We obtained data on a random sample of 2,588 breast cancer incident cases, diagnosed in 2008-2015 from 14 population-based cancer registries in 12 countries (Benin, Cote d'Ivoire, Ethiopia, Kenya, Mali, Mauritius, Mozambique, Namibia, Seychelles, South Africa, Uganda and Zimbabwe) through the African Cancer Registry Network. Of these, 2,311 were included for survival analyses. The 1-, 3- and 5-year observed and relative survival (RS) were estimated by registry, stage and country-level HDI. We equally estimated the excess hazards adjusting for potential confounders. Among patients with known stage, 64.9% were diagnosed in late stages, with 18.4% being metastatic at diagnosis. The RS varied by registry, ranging from 21.6%(8.2-39.8) at Year 3 in Bulawayo to 84.5% (70.6-93.5) in Namibia. Patients diagnosed at early stages had a 3-year RS of 78% (71.6-83.3) in contrast to 40.3% (34.9-45.7) at advanced stages (III and IV). The overall RS at Year 1 was 86.1% (84.4-87.6), 65.8% (63.5-68.1) at Year 3 and 59.0% (56.3-61.6) at Year 5. Age at diagnosis was not independently associated with increased mortality risk after adjusting for the effect of stage and country-level HDI. In conclusion, downstaging breast cancer at diagnosis and improving access to quality care could be pivotal in improving breast cancer survival outcomes in Africa.

Trends in cancer incidence in rural Eastern Cape Province; South Africa, 1998-2012.

There are few cancer trend data reported in sub-Saharan Africa notably due to the scarcity of population-based cancer registries (PBCRs). The Eastern Cape Province PBCR is amongst the few registries in sub-Saharan Africa that reports data for a rural population. Trends in cancer incidence are reported for the period 1998-2012. Registered cases, age-standardized rates (ASRs) and standardized rate ratios are presented for the most common cancers in both males and females in three periods (1998-2002, 2003-2007 and 2008-2012). In males, the most commonly diagnosed cancer during the 15 year period was cancer of the oesophagus; incidence rates showed a significant decline over the 15 year period, entirely due to a 30% decrease between 2003-2007 and 2008-2012, to an ASR of 23.2 per 100,000 population. This was followed by prostate cancer, the incidence of which was more than doubled to a level of 9.9/100,000. In women, cancer of the cervix uteri has become the most common malignancy, with a significant increase in incidence during the period to 29.0/100,000. Oesophageal cancer is second in frequency, with (as in males) a significant decline in the final 10 years to an incidence of 14.5/100,000 in 2008-2012. The incidence of breast cancer increased by 61%, although the absolute rate remains low (12.2/100,000). The incidence rates of colorectal cancer are low, and the increases in incidence, although relatively large (35% in men, 63% in women) were not statistically significant. Kaposi sarcoma showed a dramatic increase in incidence in both sexes (3.5-fold in men, 11-fold in women) although the incidence remains relatively low by southern African standards. Cancer prevention and control activities in the area need to be informed by these data and strengthened.