Geospatial barriers to healthcare access for breast cancer diagnosis in sub‐Saharan African settings: The African Breast Cancer—Disparities in Outcomes Cohort Study. Issue 9 (8th December 2020)

• Record Type: Journal Article
• Authors: Togawa, Kayo; Anderson, Benjamin O.; Foerster, Milena; Galukande, Moses; Zietsman, Annelle; Pontac, Johanna; Anele, Angelica; Adisa, Charles; Parham, Groesbeck; Pinder, Leeya F.; McKenzie, Fiona; Schüz, Joachim; dos Santos‐Silva, Isabel; McCormack, Valerie
• Is Part Of: International journal of cancer. Volume 148:Issue 9(2021)
• Page Start: 2212
• Page End: 2226
• Publication Date: 2020-12-08
• Subjects: breast cancer -- cohort study -- early diagnosis -- geospatial barrier -- sub‐Saharan Africa; Cancer -- Periodicals; Cancer -- Prevention -- Periodicals; 616.994
• DOI: 10.1002/ijc.33400
• Languages: English
• ISSNs: 0020-7136

Abstract

Abstract: We examined the geospatial dimension of delays to diagnosis of breast cancer in a prospective study of 1541 women newly diagnosed in the African Breast Cancer—Disparities in Outcomes (ABC‐DO) Study. Women were recruited at cancer treatment facilities in Namibia, Nigeria, Uganda and Zambia. The baseline interview included information used to generate the geospatial features: urban/rural residence, travel mode to treatment facility and straight‐line distances from home to first‐care provider and to diagnostic/treatment facility, categorized into country/ethnicity (population)‐specific quartiles. These factors were investigated in relation to delay in diagnosis (≥3 months since first symptom) and late stage at diagnosis (TNM: III, IV) using logistic regression, adjusted for population group and sociodemographic characteristics. The median (interquartile range) distances to first provider and diagnostic and treatment facilities were 5 (1‐37), 17 (3‐105) and 62 (5‐289) km, respectively. The majority had a delay in diagnosis (74%) and diagnosis at late stage (64%). Distance to first provider was not associated with delay in diagnosis or late stage at diagnosis. Rural residence was associated with delay, but the association did not persist after adjustment for sociodemographic characteristics. Distance to the diagnostic/treatment facility was associated with delay (highest vs lowest quartile: odds ratio (OR) = 1.56, 95% confidence interval (CI) = 1.08‐2.27) and late stage (overall: OR = 1.47, CI = 1.05‐2.06; without Nigerian hospitals where mostly local residents were treated: OR = 1.73, CI = 1.18‐2.54). These findings underscore the need for measures addressing the geospatial barriers to early diagnosis in sub‐Saharan African settings, including providing transport or travel allowance and decentralizing diagnostic services. Abstract : What's new? Survival from breast cancer is poor in sub‐Saharan Africa, due largely to the high proportion of women who are diagnosed at advanced stages. In this study, the authors examined geospatial information to assess women's prediagnostic journey to breast cancer diagnosis, with special attention to delays in diagnosis, in the regions of Namibia, Nigeria, Uganda, and Zambia. Geospatial factors particularly long travel distances to diagnostic and treatment facilities were identified as major barriers to early diagnosis. The findings underscore the need for policies to address these barriers to ensure breast cancer diagnosis at a curable stage.