Survival status and predictors of mortality among patients with breast cancer in Ethiopia: a systematic review and meta-analysis
Objectives This study aimed to evaluate survival outcomes and identify key mortality predictors among patients with breast cancer in Ethiopia.Study design A systematic review and meta-analysis.Study participants The study used 11 primary studies, involving a total of 4131 participants.Data sources W...
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BMJ Publishing Group
2025-05-01
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| Series: | BMJ Open |
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| author | Hailu Aragie Lemlemu Maru Dagnew Getnet Adugna Habtu Kifle Negash Nega Dagnew Baye |
| author_facet | Hailu Aragie Lemlemu Maru Dagnew Getnet Adugna Habtu Kifle Negash Nega Dagnew Baye |
| author_sort | Hailu Aragie |
| collection | DOAJ |
| description | Objectives This study aimed to evaluate survival outcomes and identify key mortality predictors among patients with breast cancer in Ethiopia.Study design A systematic review and meta-analysis.Study participants The study used 11 primary studies, involving a total of 4131 participants.Data sources We searched PubMed, Embase, Web of Science, Scopus and Google Scholar until 7 March 2025, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Eligibility criteria for selecting studies All observational studies that had reported the survival status and/or at least one predictor of mortality of women patients with breast cancer were considered.Data extraction and synthesis Three independent reviewers (HA, HKN and DGA) used a structured data extraction form to extract the data. To compute the pooled survival and mortality rates, the survival rates at different observation periods and the mortality rates reported in the included studies were extracted.Results Eleven studies were analysed. All studies were of good quality based on Newcastle-Ottawa Scale. However, heterogeneity was high (I² = 98.2%, p=0.00). Funnel plots showed significant publication bias. The Grading of Recommendations, Assessment, Development, and Evaluations assessment indicated moderate certainty for mortality rates and predictors, limited by heterogeneity and regional data gaps. The pooled mortality rate was 36% (95% CI: 25% to 46%). The survival rates at 1, 3 and 5 years were 85% (95% CI: 75% to 96%), 66% (95% CI: 48% to 84%) and 22% (95% CI: 1% to 43%), respectively. Key mortality predictors included advanced clinical stage (Adjusted Hazard Ratio (AHR): 4.14; CI: 2.53 to 6.78), rural residence (AHR: 1.65; 95% CI: 1.27 to 2.14), positive lymph node status (AHR: 2.85; 95% CI: 1.50 to 5.44), no hormonal therapy (AHR: 2.02; 95% CI: 1.59 to 2.56), histologic grade III (AHR: 1.76; 95% CI: 1.29 to 2.41), hormone receptor negativity (AHR: 1.54; 95% CI: 1.05 to 2.25) and comorbidities (AHR: 2.24; 95% CI: 1.41 to 3.56).Conclusion Breast cancer in Ethiopia poses a high mortality rate primarily due to late-stage diagnosis, rural residency, histologic grade III, positive lymph node status and comorbidities. To improve survival outcomes, it is crucial to expand access to early screening, particularly in rural areas, implement comprehensive treatment protocols and strengthen healthcare infrastructure to address these critical factors.PROSPERO registration number CRD42024575074. |
| format | Article |
| id | doaj-art-cd62f094e9f44b40ac0bc63921e67af7 |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2025-05-01 |
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| spelling | doaj-art-cd62f094e9f44b40ac0bc63921e67af72025-08-20T02:16:22ZengBMJ Publishing GroupBMJ Open2044-60552025-05-0115510.1136/bmjopen-2024-092725Survival status and predictors of mortality among patients with breast cancer in Ethiopia: a systematic review and meta-analysisHailu Aragie0Lemlemu Maru1Dagnew Getnet Adugna2Habtu Kifle Negash3Nega Dagnew Baye4Department of Human Anatomy, University of Gondar, Gondar, EthiopiaDepartment of Human Physiology, University of Gondar, Gondar, EthiopiaDepartment of Human Anatomy, University of Gondar, Gondar, EthiopiaDepartment of Human Anatomy, University of Gondar, Gondar, EthiopiaDepartment of Human Anatomy, University of Gondar, Gondar, EthiopiaObjectives This study aimed to evaluate survival outcomes and identify key mortality predictors among patients with breast cancer in Ethiopia.Study design A systematic review and meta-analysis.Study participants The study used 11 primary studies, involving a total of 4131 participants.Data sources We searched PubMed, Embase, Web of Science, Scopus and Google Scholar until 7 March 2025, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Eligibility criteria for selecting studies All observational studies that had reported the survival status and/or at least one predictor of mortality of women patients with breast cancer were considered.Data extraction and synthesis Three independent reviewers (HA, HKN and DGA) used a structured data extraction form to extract the data. To compute the pooled survival and mortality rates, the survival rates at different observation periods and the mortality rates reported in the included studies were extracted.Results Eleven studies were analysed. All studies were of good quality based on Newcastle-Ottawa Scale. However, heterogeneity was high (I² = 98.2%, p=0.00). Funnel plots showed significant publication bias. The Grading of Recommendations, Assessment, Development, and Evaluations assessment indicated moderate certainty for mortality rates and predictors, limited by heterogeneity and regional data gaps. The pooled mortality rate was 36% (95% CI: 25% to 46%). The survival rates at 1, 3 and 5 years were 85% (95% CI: 75% to 96%), 66% (95% CI: 48% to 84%) and 22% (95% CI: 1% to 43%), respectively. Key mortality predictors included advanced clinical stage (Adjusted Hazard Ratio (AHR): 4.14; CI: 2.53 to 6.78), rural residence (AHR: 1.65; 95% CI: 1.27 to 2.14), positive lymph node status (AHR: 2.85; 95% CI: 1.50 to 5.44), no hormonal therapy (AHR: 2.02; 95% CI: 1.59 to 2.56), histologic grade III (AHR: 1.76; 95% CI: 1.29 to 2.41), hormone receptor negativity (AHR: 1.54; 95% CI: 1.05 to 2.25) and comorbidities (AHR: 2.24; 95% CI: 1.41 to 3.56).Conclusion Breast cancer in Ethiopia poses a high mortality rate primarily due to late-stage diagnosis, rural residency, histologic grade III, positive lymph node status and comorbidities. To improve survival outcomes, it is crucial to expand access to early screening, particularly in rural areas, implement comprehensive treatment protocols and strengthen healthcare infrastructure to address these critical factors.PROSPERO registration number CRD42024575074.https://bmjopen.bmj.com/content/15/5/e092725.full |
| spellingShingle | Hailu Aragie Lemlemu Maru Dagnew Getnet Adugna Habtu Kifle Negash Nega Dagnew Baye Survival status and predictors of mortality among patients with breast cancer in Ethiopia: a systematic review and meta-analysis BMJ Open |
| title | Survival status and predictors of mortality among patients with breast cancer in Ethiopia: a systematic review and meta-analysis |
| title_full | Survival status and predictors of mortality among patients with breast cancer in Ethiopia: a systematic review and meta-analysis |
| title_fullStr | Survival status and predictors of mortality among patients with breast cancer in Ethiopia: a systematic review and meta-analysis |
| title_full_unstemmed | Survival status and predictors of mortality among patients with breast cancer in Ethiopia: a systematic review and meta-analysis |
| title_short | Survival status and predictors of mortality among patients with breast cancer in Ethiopia: a systematic review and meta-analysis |
| title_sort | survival status and predictors of mortality among patients with breast cancer in ethiopia a systematic review and meta analysis |
| url | https://bmjopen.bmj.com/content/15/5/e092725.full |
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