Department of Public Health, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia.
Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
Breast Cancer Res Treat. 2021 Jan;185(1):117-124. doi: 10.1007/s10549-020-05919-5. Epub 2020 Sep 18.
Stage at diagnosis is a key determinant of breast cancer prognosis. In this study, we characterize stage at diagnosis and determine factors associated with advanced stage at diagnosis among women diagnosed with invasive breast cancer in Addis Ababa, capital city of Ethiopia.
Stage information was collected from medical records of 441 women with invasive breast cancer seen in seven major health facilities in Addis Ababa, from January 2017 to June 2018; these seven facilities capture 90% of all incident breast cancer cases in the city. We used multivariable Poisson regression model with robust variance to determine factors associated with advanced stage at diagnosis.
The predominant tumor histology was ductal carcinoma (83.7%). More than half of the tumors' grade was moderately or poorly differentiated. The median tumor size at presentation was 4 cm. Sixty-four percent of the patients were diagnosed at advanced stage of the disease (44% stage III and 20% stage IV), with 36% of the patients diagnosed at early-stage (5% stage I and 31% stage II). The prevalence of advanced stage disease was significantly higher among women who used traditional medicine before diagnostic confirmation (adjusted prevalence ratio [aPR] = 1.31; p = 0.001), had patient delay of > 3 months (aPR = 1.16; p = 0.042) and diagnosis delay of > 2 months (aPR = 1.24; p = 0.004). But it was lower among women who had history of breast self-examination (aPR = 0.77; p = 0.021).
Advanced stage at diagnosis of breast cancer among women in Addis Ababa is strongly associated with use of traditional medicine and with prolonged time interval between symptom recognition and disease confirmation. Community- and health systems-level interventions are needed to enhance knowledge about breast cancer and facilitate timely diagnoses.
诊断时的分期是乳腺癌预后的关键决定因素。本研究旨在描述诊断时的分期，并确定在埃塞俄比亚首都亚的斯亚贝巴诊断为浸润性乳腺癌的女性中与晚期诊断相关的因素。
从 2017 年 1 月至 2018 年 6 月在亚的斯亚贝巴的 7 家主要医疗机构就诊的 441 名浸润性乳腺癌女性的病历中收集分期信息；这 7 家医疗机构捕获了该市所有乳腺癌病例的 90%。我们使用多变量泊松回归模型和稳健方差来确定与晚期诊断相关的因素。
主要肿瘤组织学类型为导管癌（83.7%）。超过一半的肿瘤分级为中或低分化。就诊时肿瘤的中位大小为 4cm。64%的患者被诊断为疾病晚期（44%为 III 期，20%为 IV 期），36%的患者被诊断为早期（5%为 I 期，31%为 II 期）。在确诊前使用传统医学的女性中，晚期疾病的患病率明显更高（调整后的患病率比[aPR] = 1.31；p = 0.001），患者延迟就诊超过 3 个月（aPR = 1.16；p = 0.042）和诊断延迟超过 2 个月（aPR = 1.24；p = 0.004）。但有乳腺癌自我检查史的女性患病率较低（aPR = 0.77；p = 0.021）。
亚的斯亚贝巴的乳腺癌患者中，晚期诊断与使用传统医学和症状识别与疾病确诊之间的时间间隔延长密切相关。需要在社区和卫生系统层面采取干预措施，以提高对乳腺癌的认识并促进及时诊断。
