Survival of breast cancer patients in rural Ethiopia

• Published in: Breast cancer research and treatment Vol. 170; no. 1; pp. 111 - 118
• Main Authors: Eber-Schulz, Pia, Tariku, Wakuma, Reibold, Christian, Addissie, Adamu, Wickenhauser, Claudia, Fathke, Christine, Hauptmann, Steffen, Jemal, Ahmedin, Thomssen, Christoph, Kantelhardt, Eva Johanna
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.07.2018; Springer; Springer Nature B.V
• Subjects: Adjuvant chemotherapy; Adult; Aged; Analysis; Breast cancer; Breast Neoplasms - drug therapy; Breast Neoplasms - epidemiology; Breast Neoplasms - genetics; Breast Neoplasms - pathology; Cancer patients; Cancer research; Care and treatment; Disease-Free Survival; Epidemiology; ErbB-2 protein; Estrogens; Ethiopia - epidemiology; Female; Gene Expression Regulation, Neoplastic; Humans; Lymph nodes; Lymphatic Metastasis; Lymphatic system; Medical research; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Recurrence, Local - epidemiology; Neoplasm Recurrence, Local - genetics; Neoplasm Recurrence, Local - pathology; Oncology; Patient outcomes; Progesterone; Receptor, ErbB-2 - genetics; Receptors, Estrogen - genetics; Receptors, Progesterone - genetics; Rural Population; Surgery; Survival; Survival Rate; Tumors; Ethiopia; Breast cancer; Survival; Prognostic factors; Ethiopia; Africa
• ISSN: 0167-6806; 1573-7217
• DOI: 10.1007/s10549-018-4724-z

Purpose To describe the histopathological characteristics and survival of female breast cancer (BC) patients in a rural setting with limited access to adjuvant treatment. Methods A prospective study of 107 histologically confirmed BC patients treated with surgery from 2010 to 2016 from rural parts of western Ethiopia. Referral pathology was performed, and active follow-up was conducted. Adjusted cox regression analysis (hazard ratio [HR]) was performed. Results The median age at diagnosis was 45 (16–83) years; 57% of the patients presented with cT3/4 tumors, 71% with clinically positive lymph nodes, 21% with HER2-overexpression (Dako3+) and 68% with grade 3 tumors. Estrogen and/or progesterone receptor expressions were present in 66% and triple-negative disease in 25%. The estimated 1- and 2-year overall survival probability rates were 78 and 53%, respectively. The 2-year survival for patients with clinically positive lymph nodes was 44% compared to 73% for patients with lymph node-negative disease (HR 2.44; 95% confidence interval [95% CI] 1.19–5.02). The corresponding 2-year survival for patients with cT4 tumors was 25% versus 68% for patients with cT1–2 tumors (cT1–3 vs. cT4 HR 3.86; 95% CI 1.82–13.63). The 2-year survival for patients with hormone receptor-negative disease was 40% compared to 59% for patients with hormone receptor-positive disease (HR 1.92; 95% CI 1.06–3.47). Conclusion The majority of breast cancer patients treated with surgery in rural parts of western Ethiopia are diagnosed at advanced stage and have hormone receptor-positive disease. Nearly half of the patients die within 2 years. These findings underscore the need for provision of adjuvant hormonal therapy and for the establishment of pathology service including hormone receptor testing.