撒哈拉以南非洲地区乳腺癌诊断时的分期：系统评价和荟萃分析。
Stage at diagnosis of breast cancer in sub-Saharan Africa: a systematic review and meta-analysis.
机构信息
Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Institute of Human Virology, Abuja, Nigeria.
Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France.
出版信息
Lancet Glob Health. 2016 Dec;4(12):e923-e935. doi: 10.1016/S2214-109X(16)30259-5.
BACKGROUND
The incidence of breast cancer in sub-Saharan Africa is relatively low, but as survival from the disease in the region is poor, mortality rates are as high as in high-income countries. Stage at diagnosis is a major contributing factor to poor survival from breast cancer. We aimed to do a systematic review and meta-analysis on stage at diagnosis of breast cancer in sub-Saharan Africa to examine trends over time, and investigate sources of variations across the region.
METHODS
We searched MEDLINE, Embase, Web of Knowledge, and Africa-Wide Information to identify studies on breast cancer stage at diagnosis in sub-Saharan African women published before Jan 1, 2014, and in any language. Random-effects meta-analyses were done to investigate between-study heterogeneity in percentage of late-stage breast cancer (stage III/IV), and meta-regression analyses to identify potential sources of variation. Percentages of women with late-stage breast cancer at diagnosis in sub-Saharan Africa were compared with similar estimates for black and white women in the USA from the Surveillance, Epidemiology, and End Results database.
FINDINGS
83 studies were included, which consisted of 26 788 women from 17 sub-Saharan African countries. There was wide between-study heterogeneity in the percentage of late-stage disease at diagnosis (median 74·7%, range 30·3-100%, I=93·3%, p<0·0001). The percentage of patients with late-stage disease at diagnosis did not vary by region in black women, but was lower in non-black women from southern Africa than in black women in any region (absolute difference [AD] from black women in western Africa [reference group] -18·1%, 95% CI -28·2 to -8·0), and higher for populations from mixed (urban and rural) settings rather than urban settings (13·2%, 5·7 to 20·7, in analyses restricted to black women). The percentage of patients with late-stage disease at diagnosis in black Africans decreased over time (-10·5%, -19·3 to -1·6; for 2000 or later vs 1980 or before), but it was still higher around 2010 than it was in white and black women in the USA 40 years previously.
INTERPRETATION
Strategies for early diagnosis of breast cancer should be regarded as a major priority by cancer control programmes in sub-Saharan Africa.
FUNDING
None.
背景
撒哈拉以南非洲的乳腺癌发病率相对较低，但由于该地区的乳腺癌存活率较低，死亡率与高收入国家一样高。诊断时的分期是导致乳腺癌存活率低的一个主要因素。我们旨在对撒哈拉以南非洲的乳腺癌诊断分期进行系统评价和荟萃分析，以考察随时间推移的趋势，并研究该地区分期差异的来源。
方法
我们检索了 MEDLINE、Embase、Web of Knowledge 和 Africa-Wide Information，以确定发表于 2014 年 1 月 1 日之前、用任何语言发表的关于撒哈拉以南非洲女性乳腺癌分期的研究。我们采用随机效应荟萃分析来研究不同研究中晚期乳腺癌（III/IV 期）的百分比，并用荟萃回归分析来确定潜在的变异来源。将撒哈拉以南非洲女性在诊断时患有晚期乳腺癌的百分比与美国监测、流行病学和最终结果数据库中黑人和白人女性的相似估计值进行比较。
结果
共纳入 83 项研究，包括来自 17 个撒哈拉以南非洲国家的 26788 名女性。诊断时晚期疾病的百分比存在广泛的研究间异质性（中位数 74.7%，范围 30.3-100%，I=93.3%，p<0.0001）。在黑人女性中，不同地区的患者在诊断时患有晚期疾病的百分比没有差异，但与任何地区的黑人女性相比，南非的非黑人女性（与西非黑人女性相比的绝对差异[AD]-18.1%，95%CI-28.2 至-8.0）患有晚期疾病的比例更低，而来自城乡混合（城乡）环境的人群（仅限于黑人女性）则更高（13.2%，5.7 至 20.7）。黑人非洲人中诊断时患有晚期疾病的患者比例随着时间的推移而下降（-10.5%，-19.3 至-1.6；2000 年或以后 vs 1980 年或以前），但到 2010 年左右，仍高于美国黑人女性 40 年前和白人女性。
解释
癌症控制计划应将早期诊断乳腺癌的策略视为撒哈拉以南非洲的一个主要优先事项。
资金
无。
Zotero 插件