As reported in The Lancet Oncology by Foerster et al, the African Breast Cancer–Disparities in Outcomes prospective cohort study has shown that a high proportion of women with newly diagnosed nonmetastatic breast cancer in sub-Saharan Africa did not initiate, did not fully complete, or abandoned guideline-recommended treatment.
The study involved a total of 1,176 women with nonmetastatic invasive breast cancer diagnosed between September 2014 and December 2017 at eight hospitals in Namibia, Nigeria, Uganda, South Africa, and Zambia. Treatments received were compared with those recommended by the National Comprehensive Cancer Network® (NCCN®) Harmonized Guidelines for Sub-Saharan Africa.
A high proportion of patients with nonmetastatic breast cancer did not initiate, did not fully complete, or abandoned treatment with surgery, systemic therapy, radiotherapy, or an appropriate combination of these, highlighting the need for improved treatment access and completion in sub-Saharan Africa to potentially prevent premature breast cancer deaths.— Foerster et al
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Key Findings
After a median follow-up of 5.2 years (interquartile range = 4.6–5.9 years), 1,163 (68%) of the 1,716 women had undergone breast cancer surgery. Among 255 women receiving breast-conserving surgery, subsequent radiotherapy was initiated by 107 (42%).
Surgery and systemic therapy (ie, multimodality treatment) with radiotherapy was initiated in 370 (36%) of 1,028 women with localized tumors vs 156 (23%) of 688 women with locally advanced tumors. Multimodality treatment without radiotherapy was initiated in 386 (38%) vs 167 (24%) women.
Among 1,530 women requiring chemotherapy (excluding 105 who died within 6 months after baseline), 1,013 (66%) initiated treatment within 3 months after baseline; of these, treatment was adequately completed by 359 (35%), marginally completed by 284 (28%), and abandoned by 200 (20%). Status of treatment was unknown for 151 (15%), and 19 women (2%) died within 6 months after chemotherapy initiation.
Among 1,375 women with an indication for endocrine therapy, treatment was initiated in 920 (67%), and lasted ≥ 3 years in 367 (40%). Among 259 patients with known HER2-positive tumors, 42 (16%) received trastuzumab.
The investigators concluded, “A high proportion of patients with nonmetastatic breast cancer did not initiate, did not fully complete, or abandoned treatment with surgery, systemic therapy, radiotherapy, or an appropriate combination of these, highlighting the need for improved treatment access and completion in sub-Saharan Africa to potentially prevent premature breast cancer deaths.”
Milena Foerster, PhD, of the Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer, Lyon, France, is the corresponding author for The Lancet Oncology article.
Disclosure: The study was funded by the U.S. National Institutes of Health (National Cancer Institute), Susan G. Komen, and International Agency for Research on Cancer. For full disclosures of the study authors, visit thelancet.com.
