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Survival of breast cancer patients in rural Ethiopia

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

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.

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Abbreviations

BC:

Breast cancer

HR:

Hazard ratio

TN:

Triple negative

ER:

Estrogen receptor

PgR:

Progesterone receptor

IHC:

Immunohistchemistry

ENCR:

European network of cancer registries

MFS:

Metastasis-free survival

NST:

No special type

FISH:

Fluorescence in situ hybridization

CI:

Confidence interval

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Funding

Federal ministry of Research and Education (Germany).

Author information

Authors and Affiliations

  1. Department of Gynecology, Martin-Luther-University, Halle, Germany

    Pia Eber-Schulz, Christian Reibold, Christoph Thomssen & Eva Johanna Kantelhardt

  2. Ethiopian Evangelical Church of Mekane Yesus EECMY Aira Hospital, Aira, Ethiopia

    Wakuma Tariku

  3. School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia

    Adamu Addissie

  4. Department of Pathology, Martin-Luther-University, Halle, Germany

    Claudia Wickenhauser & Christine Fathke

  5. Maastricht University Medical Centre, Maastricht, The Netherlands

    Steffen Hauptmann

  6. American Cancer Society, Atlanta, USA

    Ahmedin Jemal

  7. Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University, Saale, Halle, Germany

    Eva Johanna Kantelhardt

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  1. Pia Eber-Schulz
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Correspondence to Eva Johanna Kantelhardt.

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Eber-Schulz, P., Tariku, W., Reibold, C. et al. Survival of breast cancer patients in rural Ethiopia. Breast Cancer Res Treat 170, 111–118 (2018). https://doi.org/10.1007/s10549-018-4724-z

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