Drivers of disparities in stage at diagnosis among women with breast cancer: South African breast cancers and HIV outcomes cohort.
<h4>Objective</h4>In low- and middle-income countries (LMICs), advanced-stage diagnosis of breast cancer (BC) is common, and this contributes to poor survival. Understanding the determinants of the stage at diagnosis will aid in designing interventions to downstage disease and improve su...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2023-01-01
|
| Series: | PLoS ONE |
| Online Access: | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0281916&type=printable |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849332126880628736 |
|---|---|
| author | Witness Mapanga Shane A Norris Ashleigh Craig Oluwatosin A Ayeni Wenlong C Chen Judith S Jacobson Alfred I Neugut Paul Ruff Herbert Cubasch Daniel S O'Neil Ines Buccimazza Sharon Čačala Laura W Stopforth Hayley A Farrow Sarah Nietz Boitumelo Phakathi Tobias Chirwa Valerie A McCormack Maureen Joffe |
| author_facet | Witness Mapanga Shane A Norris Ashleigh Craig Oluwatosin A Ayeni Wenlong C Chen Judith S Jacobson Alfred I Neugut Paul Ruff Herbert Cubasch Daniel S O'Neil Ines Buccimazza Sharon Čačala Laura W Stopforth Hayley A Farrow Sarah Nietz Boitumelo Phakathi Tobias Chirwa Valerie A McCormack Maureen Joffe |
| author_sort | Witness Mapanga |
| collection | DOAJ |
| description | <h4>Objective</h4>In low- and middle-income countries (LMICs), advanced-stage diagnosis of breast cancer (BC) is common, and this contributes to poor survival. Understanding the determinants of the stage at diagnosis will aid in designing interventions to downstage disease and improve survival from BC in LMICs.<h4>Methods</h4>Within the South African Breast Cancers and HIV Outcomes (SABCHO) cohort, we examined factors affecting the stage at diagnosis of histologically confirmed invasive breast cancer at five tertiary hospitals in South Africa (SA). The stage was assessed clinically. To examine the associations of the modifiable health system, socio-economic/household and non-modifiable individual factors, hierarchical multivariable logistic regression with odds of late-stage at diagnosis (stage III-IV), was used.<h4>Results</h4>The majority (59%) of the included 3497 women were diagnosed with late-stage BC disease. The effect of health system-level factors on late-stage BC diagnosis was consistent and significant even when adjusted for both socio-economic- and individual-level factors. Women diagnosed in a tertiary hospital that predominantly serves a rural population were 3 times (OR = 2.89 (95% CI: 1.40-5.97) as likely to be associated with late-stage BC diagnosis when compared to those diagnosed at a hospital that predominantly serves an urban population. Taking more than 3 months from identifying the BC problem to the first health system entry (OR = 1.66 (95% CI: 1.38-2.00)), and having luminal B (OR = 1.49 (95% CI: 1.19-1.87)) or HER2-enriched (OR = 1.64 (95% CI: 1.16-2.32)) molecular subtype as compared to luminal A, were associated with a late-stage diagnosis. Whilst having a higher socio-economic level (a wealth index of 5) reduced the probability of late-stage BC at diagnosis, (OR = 0.64 (95% CI: 0.47-0.85)).<h4>Conclusion</h4>Advanced-stage diagnosis of BC among women in SA who access health services through the public health system was associated with both modifiable health system-level factors and non-modifiable individual-level factors. These may be considered as elements in interventions to reduce the time to diagnosis of breast cancer in women. |
| format | Article |
| id | doaj-art-873c8824eae248fbae8fd94b7f871cfe |
| institution | Kabale University |
| issn | 1932-6203 |
| language | English |
| publishDate | 2023-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj-art-873c8824eae248fbae8fd94b7f871cfe2025-08-20T03:46:19ZengPublic Library of Science (PLoS)PLoS ONE1932-62032023-01-01182e028191610.1371/journal.pone.0281916Drivers of disparities in stage at diagnosis among women with breast cancer: South African breast cancers and HIV outcomes cohort.Witness MapangaShane A NorrisAshleigh CraigOluwatosin A AyeniWenlong C ChenJudith S JacobsonAlfred I NeugutPaul RuffHerbert CubaschDaniel S O'NeilInes BuccimazzaSharon ČačalaLaura W StopforthHayley A FarrowSarah NietzBoitumelo PhakathiTobias ChirwaValerie A McCormackMaureen Joffe<h4>Objective</h4>In low- and middle-income countries (LMICs), advanced-stage diagnosis of breast cancer (BC) is common, and this contributes to poor survival. Understanding the determinants of the stage at diagnosis will aid in designing interventions to downstage disease and improve survival from BC in LMICs.<h4>Methods</h4>Within the South African Breast Cancers and HIV Outcomes (SABCHO) cohort, we examined factors affecting the stage at diagnosis of histologically confirmed invasive breast cancer at five tertiary hospitals in South Africa (SA). The stage was assessed clinically. To examine the associations of the modifiable health system, socio-economic/household and non-modifiable individual factors, hierarchical multivariable logistic regression with odds of late-stage at diagnosis (stage III-IV), was used.<h4>Results</h4>The majority (59%) of the included 3497 women were diagnosed with late-stage BC disease. The effect of health system-level factors on late-stage BC diagnosis was consistent and significant even when adjusted for both socio-economic- and individual-level factors. Women diagnosed in a tertiary hospital that predominantly serves a rural population were 3 times (OR = 2.89 (95% CI: 1.40-5.97) as likely to be associated with late-stage BC diagnosis when compared to those diagnosed at a hospital that predominantly serves an urban population. Taking more than 3 months from identifying the BC problem to the first health system entry (OR = 1.66 (95% CI: 1.38-2.00)), and having luminal B (OR = 1.49 (95% CI: 1.19-1.87)) or HER2-enriched (OR = 1.64 (95% CI: 1.16-2.32)) molecular subtype as compared to luminal A, were associated with a late-stage diagnosis. Whilst having a higher socio-economic level (a wealth index of 5) reduced the probability of late-stage BC at diagnosis, (OR = 0.64 (95% CI: 0.47-0.85)).<h4>Conclusion</h4>Advanced-stage diagnosis of BC among women in SA who access health services through the public health system was associated with both modifiable health system-level factors and non-modifiable individual-level factors. These may be considered as elements in interventions to reduce the time to diagnosis of breast cancer in women.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0281916&type=printable |
| spellingShingle | Witness Mapanga Shane A Norris Ashleigh Craig Oluwatosin A Ayeni Wenlong C Chen Judith S Jacobson Alfred I Neugut Paul Ruff Herbert Cubasch Daniel S O'Neil Ines Buccimazza Sharon Čačala Laura W Stopforth Hayley A Farrow Sarah Nietz Boitumelo Phakathi Tobias Chirwa Valerie A McCormack Maureen Joffe Drivers of disparities in stage at diagnosis among women with breast cancer: South African breast cancers and HIV outcomes cohort. PLoS ONE |
| title | Drivers of disparities in stage at diagnosis among women with breast cancer: South African breast cancers and HIV outcomes cohort. |
| title_full | Drivers of disparities in stage at diagnosis among women with breast cancer: South African breast cancers and HIV outcomes cohort. |
| title_fullStr | Drivers of disparities in stage at diagnosis among women with breast cancer: South African breast cancers and HIV outcomes cohort. |
| title_full_unstemmed | Drivers of disparities in stage at diagnosis among women with breast cancer: South African breast cancers and HIV outcomes cohort. |
| title_short | Drivers of disparities in stage at diagnosis among women with breast cancer: South African breast cancers and HIV outcomes cohort. |
| title_sort | drivers of disparities in stage at diagnosis among women with breast cancer south african breast cancers and hiv outcomes cohort |
| url | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0281916&type=printable |
| work_keys_str_mv | AT witnessmapanga driversofdisparitiesinstageatdiagnosisamongwomenwithbreastcancersouthafricanbreastcancersandhivoutcomescohort AT shaneanorris driversofdisparitiesinstageatdiagnosisamongwomenwithbreastcancersouthafricanbreastcancersandhivoutcomescohort AT ashleighcraig driversofdisparitiesinstageatdiagnosisamongwomenwithbreastcancersouthafricanbreastcancersandhivoutcomescohort AT oluwatosinaayeni driversofdisparitiesinstageatdiagnosisamongwomenwithbreastcancersouthafricanbreastcancersandhivoutcomescohort AT wenlongcchen driversofdisparitiesinstageatdiagnosisamongwomenwithbreastcancersouthafricanbreastcancersandhivoutcomescohort AT judithsjacobson driversofdisparitiesinstageatdiagnosisamongwomenwithbreastcancersouthafricanbreastcancersandhivoutcomescohort AT alfredineugut driversofdisparitiesinstageatdiagnosisamongwomenwithbreastcancersouthafricanbreastcancersandhivoutcomescohort AT paulruff driversofdisparitiesinstageatdiagnosisamongwomenwithbreastcancersouthafricanbreastcancersandhivoutcomescohort AT herbertcubasch driversofdisparitiesinstageatdiagnosisamongwomenwithbreastcancersouthafricanbreastcancersandhivoutcomescohort AT danielsoneil driversofdisparitiesinstageatdiagnosisamongwomenwithbreastcancersouthafricanbreastcancersandhivoutcomescohort AT inesbuccimazza driversofdisparitiesinstageatdiagnosisamongwomenwithbreastcancersouthafricanbreastcancersandhivoutcomescohort AT sharoncacala driversofdisparitiesinstageatdiagnosisamongwomenwithbreastcancersouthafricanbreastcancersandhivoutcomescohort AT laurawstopforth driversofdisparitiesinstageatdiagnosisamongwomenwithbreastcancersouthafricanbreastcancersandhivoutcomescohort AT hayleyafarrow driversofdisparitiesinstageatdiagnosisamongwomenwithbreastcancersouthafricanbreastcancersandhivoutcomescohort AT sarahnietz driversofdisparitiesinstageatdiagnosisamongwomenwithbreastcancersouthafricanbreastcancersandhivoutcomescohort AT boitumelophakathi driversofdisparitiesinstageatdiagnosisamongwomenwithbreastcancersouthafricanbreastcancersandhivoutcomescohort AT tobiaschirwa driversofdisparitiesinstageatdiagnosisamongwomenwithbreastcancersouthafricanbreastcancersandhivoutcomescohort AT valerieamccormack driversofdisparitiesinstageatdiagnosisamongwomenwithbreastcancersouthafricanbreastcancersandhivoutcomescohort AT maureenjoffe driversofdisparitiesinstageatdiagnosisamongwomenwithbreastcancersouthafricanbreastcancersandhivoutcomescohort |