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Determinants of stage at diagnosis of breast cancer in Nigerian women: sociodemographic, breast cancer awareness, health care access and clinical factors

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Abstract

Purpose

Advanced stage at diagnosis is a common feature of breast cancer in Sub-Saharan Africa (SSA), contributing to poor survival rates. Understanding its determinants is key to preventing deaths from this cancer in SSA.

Methods

Within the Nigerian Integrative Epidemiology of Breast Cancer Study, a multicentred case–control study on breast cancer, we studied factors affecting stage at diagnosis of cases, i.e. women diagnosed with histologically confirmed invasive breast cancer between January 2014 and July 2016 at six secondary and tertiary hospitals in Nigeria. Stage was assessed using clinical and imaging methods. Ordinal logistic regression was used to examine associations of sociodemographic, breast cancer awareness, health care access and clinical factors with odds of later stage (I, II, III or IV) at diagnosis.

Results

A total of 316 women were included, with a mean age (SD) of 45.4 (11.4) years. Of these, 94.9% had stage information: 5 (1.7%), 92 (30.7%), 157 (52.4%) and 46 (15.3%) were diagnosed at stages I, II, III and IV, respectively. In multivariate analyses, lower educational level (odds ratio (OR) 2.35, 95% confidence interval: 1.04, 5.29), not believing in a cure for breast cancer (1.81: 1.09, 3.01), and living in a rural area (2.18: 1.05, 4.51) were strongly associated with later stage, whilst age at diagnosis, tumour grade and oestrogen receptor status were not. Being Muslim (vs. Christian) was associated with lower odds of later stage disease (0.46: 0.22, 0.94).

Conclusion

Our findings suggest that factors that are amenable to intervention concerning breast cancer awareness and health care access, rather than intrinsic tumour characteristics, are the strongest determinants of stage at diagnosis in Nigerian women.

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Acknowledgments

The project described was supported by the Training Program in Nigeria for Non-communicable Diseases Research (TRAPING NCD) grant number FIC/NIH D43TW009106 from the Fogarty International Centre. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Fogarty International Centre or the National Institutes of Health.

Author’s contribution

EJA had the idea for the study, contributed to the study design, implementation and data analysis, drafted the manuscript and made subsequent revisions to the manuscript; VM had the idea for the study, supervised data analyses and provided critical revisions to the manuscript; OO, WB, MY, TY, EE, MA, IS, EM, IA, and BA contributed to data collection, data quality and approved the final draft; SNA contributed to the study design, data quality and manuscript revision; IDS supervised data analyses and provided critical revisions to the manuscript; CA had the idea for the study design, obtained funding, supervised data analyses and provided critical revisions to the manuscript. All authors read and approved the final draft.

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Authors and Affiliations

  1. Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK

    Elima Jedy-Agba & Isabel dos-Santos-Silva

  2. Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France

    Valerie McCormack

  3. National Hospital Abuja, Nigeria, Abuja, Nigeria

    Oluwole Olaomi & Wunmi Badejo

  4. University of Abuja Teaching Hospital, Gwagwalada, Nigeria

    Monday Yilkudi & Terna Yawe

  5. University of Nigeria Teaching Hospital, Enugu, Nigeria

    Emmanuel Ezeome

  6. Asokoro District Hospital, Abuja, Nigeria

    Iliya Salu

  7. Garki Hospital, Abuja, Nigeria

    Elijah Miner

  8. Wuse General Hospital, Abuja, Nigeria

    Ikechukwu Anosike

  9. Center for Research on Genomics and Global Health, National Human Genome Research Institute, Bethesda, MD, USA

    Sally N. Adebamowo

  10. Federal Staff Hospital, Abuja, Nigeria

    Benjamin Achusi

  11. Institute of Human Virology, University of Maryland and Marlene and Stewart Greenebaum Comprehensive Cancer Centre, Baltimore, MD, USA

    Clement Adebamowo

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  1. Elima Jedy-Agba
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  2. Valerie McCormack
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  11. Sally N. Adebamowo
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Correspondence to Elima Jedy-Agba.

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Jedy-Agba, E., McCormack, V., Olaomi, O. et al. Determinants of stage at diagnosis of breast cancer in Nigerian women: sociodemographic, breast cancer awareness, health care access and clinical factors. Cancer Causes Control 28, 685–697 (2017). https://doi.org/10.1007/s10552-017-0894-y

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