Espina Carolina, McKenzie Fiona, Dos-Santos-Silva Isabel
International Agency for Research on Cancer (IARC), Lyon, France.
International Agency for Research on Cancer (IARC), Lyon, France.
Ann Epidemiol. 2017 Oct;27(10):659-671.e7. doi: 10.1016/j.annepidem.2017.09.007. Epub 2017 Sep 22.
Africa has low breast cancer incidence rates but high mortality rates from this disease due to poor survival. Delays in presentation and diagnosis are major determinants of breast cancer survival, but these have not been comprehensively investigated in Africa.
MEDLINE, Embase, and Global Health were searched to identify studies reporting on delays in presentation and/or diagnosis of breast cancer published between January 1, 2000 and May 31, 2016. Data were synthesized in narrative, tabular, and graphical forms. Meta-analyses were not possible due to between-study differences in the way delays were reported.
Twenty-one studies were included in the review. Study-specific average times between symptom recognition and presentation to a health care provider ranged from less than 1 to 4 months in North Africa and from less than 3 to greater than 6 months in sub-Saharan Africa. Study-specific average times from presentation to diagnosis were less than 1 month in North Africa but ranged from less than 3 to greater than 6 months in sub-Saharan Africa. Reported reasons for these delays included patient-mediated (e.g., socioeconomic factors) and health system-mediated factors (e.g., referral pathways).
This systematic review revealed marked delays in presentation and diagnosis of breast cancer in Africa. Identification of their drivers is crucial to the development of appropriate control strategies in the continent.
非洲乳腺癌发病率较低，但由于生存率低，该疾病的死亡率较高。就诊和诊断延迟是乳腺癌生存的主要决定因素，但在非洲尚未对此进行全面调查。
检索MEDLINE、Embase和全球卫生数据库，以识别2000年1月1日至2016年5月31日期间发表的关于乳腺癌就诊和/或诊断延迟的研究报告。数据以叙述、表格和图表形式进行综合。由于各研究报告延迟的方式存在差异，无法进行荟萃分析。
该综述纳入了21项研究。在北非，从症状识别到就诊于医疗服务提供者的研究特定平均时间为不到1个月至4个月，在撒哈拉以南非洲为不到3个月至超过6个月。从就诊到诊断的研究特定平均时间在北非不到1个月，但在撒哈拉以南非洲为不到3个月至超过6个月。报告的这些延迟的原因包括患者介导的因素（如社会经济因素）和卫生系统介导的因素（如转诊途径）。
该系统评价揭示了非洲乳腺癌就诊和诊断存在明显延迟。确定其驱动因素对于在该大陆制定适当的控制策略至关重要。
