SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Non-Communicable Diseases Research Division, Wits Health Consortium (Pty) Ltd, Johannesburg, South Africa.
S Afr Med J. 2019 Mar 29;109(4):264-271. doi: 10.7196/SAMJ.2019.v109i4.13465.
Comorbidities occurring concurrently in breast cancer patients can be burdensome, as they may negatively influence time and stage of presentation.
To describe the comorbid health conditions among South African (SA) black women with and without breast cancer and to determine factors associated with advanced-stage presentation of breast cancer.
A population-based case-control study on breast cancer was conducted in black women in Soweto, SA, the SABC (South Africa Breast Cancer) study. Lifestyle information and blood samples were collected from 399 women with histologically confirmed new cases of invasive primary breast cancer, recruited prior to any therapy, and 399 age- and neighbourhood-matched controls without breast cancer. We compared self-reported metabolic diseases, depression, anthropometric measurements, blood pressure, HIV status and point-of-care lipid and glucose levels between patients with breast cancer and the control group.
In the whole population, the mean (standard deviation) age was 54.6 (12.9) years, the majority (81.2%) of the participants were overweight or obese, 85.3% had abdominal adiposity, 61.3% were hypertensive, 47.1% had impaired fasting plasma glucose, 8.4% had elevated total cholesterol, 74.8% had low high-density lipoprotein and 10.9% were assessed to be depressed. Ninety-one percent of the whole cohort had at least one metabolic disease. In the breast cancer group, 72.2% had one or more metabolic diseases only (HIV-negative and no evidence of depression), compared with 64.7% of the control group. From a multivariate logistic regression adjusted model, higher household socioeconomic status conferred a 19% reduction in the odds of having advanced-stage breast cancer at diagnosis, while hypertension, dyslipidaemia and HIV were not significantly associated with stage at breast cancer diagnosis in the adjusted model.
A large proportion of women experience several comorbidities, highlighting the need to address the chronic non-communicable disease epidemic in SA and to co-ordinate multidisciplinary primary-, secondary- and tertiary-level care in the country's complex healthcare system for better outcome.
乳腺癌患者同时存在的合并症可能会带来负担，因为它们可能会对就诊时间和分期产生负面影响。
描述南非黑人女性乳腺癌患者和非乳腺癌患者的合并健康状况，并确定与乳腺癌晚期就诊相关的因素。
在南非索韦托开展了一项基于人群的乳腺癌病例对照研究，即 SABC（南非乳腺癌）研究。从 399 名接受组织学确诊的新浸润性原发性乳腺癌治疗前的女性（病例组）和 399 名年龄和社区相匹配的无乳腺癌女性（对照组）中收集生活方式信息和血样。我们比较了病例组和对照组之间报告的代谢性疾病、抑郁、人体测量指标、血压、艾滋病毒状态以及即时检测的血脂和血糖水平。
在整个人群中，平均（标准差）年龄为 54.6（12.9）岁，大多数参与者（81.2%）超重或肥胖，85.3%有腹部肥胖，61.3%为高血压，47.1%有空腹血糖受损，8.4%总胆固醇升高，74.8%高密度脂蛋白低，10.9%有抑郁评估。整个队列中有 91%至少有一种代谢性疾病。在乳腺癌组中，72.2%仅有一种或多种代谢性疾病（艾滋病毒阴性且无抑郁证据），而对照组中这一比例为 64.7%。多变量逻辑回归调整模型显示，较高的家庭社会经济地位使诊断时患有晚期乳腺癌的可能性降低 19%，而高血压、血脂异常和艾滋病毒在调整后的模型中与乳腺癌的诊断分期无显著相关性。
很大一部分女性患有多种合并症，这突显了南非需要应对慢性非传染性疾病流行的问题，并需要在该国复杂的医疗保健系统中协调初级、二级和三级的多学科护理，以获得更好的治疗结果。
