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Outcomes and prognostic factors for women with breast cancer in Malawi

Abstract

Background

Breast cancer incidence in sub-Saharan Africa (SSA) is increasing, and SSA has the highest age-standardized breast cancer mortality rate worldwide. However, high-quality breast cancer data are limited in SSA.

Materials and Methods

We examined breast cancer patient and tumor characteristics among women in Lilongwe, Malawi and evaluated risk factor associations with patient outcomes. We consecutively enrolled 100 women ≥ 18 years with newly diagnosed, pathologically confirmed breast cancer into a prospective longitudinal cohort with systematically assessed demographic data, HIV status, and clinical characteristics. Tumor subtypes were further determined by immunohistochemistry, overall survival (OS) was estimated using Kaplan–Meier methods, and hazards ratios (HR) were calculated by Cox proportional hazard analyses.

Results

Of the 100 participants, median age was 49 years, 19 were HIV-positive, and 75 presented with late stage (III/IV) disease. HER2-enriched and triple-negative/basal-like subtypes represented 17% and 25% tumors, respectively. One-year OS for the cohort was 74% (95% CI 62–83%). Multivariable analyses revealed mortality was associated with HIV (HR, 5.15; 95% CI 1.58–16.76; p = 0.006), stage IV disease (HR, 8.86; 95% CI 1.07–73.25; p = 0.043), and HER2-enriched (HR, 7.46; 95% CI 1.21–46.07; p = 0.031), and triple-negative subtypes (HR, 7.80; 95% CI 1.39–43.69; p = 0.020).

Conclusion

Late stage presentation, HER2-enriched and triple-negative subtypes, and HIV coinfection were overrepresented in our cohort relative to resource-rich settings and were associated with mortality. These findings highlight robust opportunities for population- and patient-level interventions across the entire cascade of care to improve breast cancer outcomes in low-income countries in SSA.

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Acknowledgments

We are grateful to patients, families, staff, and leadership at Kamuzu Central Hospital and UNC Project-Malawi for their support of this project.

Funding

This study was supported by (1) UJMT Fogarty Global Health Fellowship Program: D43TW009340; (2) Lineberger Comprehensive Cancer Center: P30CA016086; (3) UNC Breast Cancer Specialized Program of Research Excellence: P50CA058223; (4) Malawi Cancer Consortium and Regional Center of Excellence for NCDs: U54CA190152, P20CA210285; (5) Medical Education Partnership Initiative: R24TW008927; (6) UNC Center for AIDS Research: P30AI050410.

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Correspondence to Satish Gopal or Tamiwe Tomoka.

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Youngblood, V.M., Nyirenda, R., Nyasosela, R. et al. Outcomes and prognostic factors for women with breast cancer in Malawi. Cancer Causes Control 31, 393–402 (2020). https://doi.org/10.1007/s10552-020-01282-4

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  • DOI: https://doi.org/10.1007/s10552-020-01282-4

Keywords

  • Breast cancer
  • Global health
  • Sub-Saharan Africa