Stage at diagnosis of breast cancer in sub-Saharan Africa: a systematic review and meta-analysis

Lancet Glob Health. 2016 Dec;4(12):e923-e935. doi: 10.1016/S2214-109X(16)30259-5.


Background: The incidence of breast cancer in sub-Saharan Africa is relatively low, but as survival from the disease in the region is poor, mortality rates are as high as in high-income countries. Stage at diagnosis is a major contributing factor to poor survival from breast cancer. We aimed to do a systematic review and meta-analysis on stage at diagnosis of breast cancer in sub-Saharan Africa to examine trends over time, and investigate sources of variations across the region.

Methods: We searched MEDLINE, Embase, Web of Knowledge, and Africa-Wide Information to identify studies on breast cancer stage at diagnosis in sub-Saharan African women published before Jan 1, 2014, and in any language. Random-effects meta-analyses were done to investigate between-study heterogeneity in percentage of late-stage breast cancer (stage III/IV), and meta-regression analyses to identify potential sources of variation. Percentages of women with late-stage breast cancer at diagnosis in sub-Saharan Africa were compared with similar estimates for black and white women in the USA from the Surveillance, Epidemiology, and End Results database.

Findings: 83 studies were included, which consisted of 26 788 women from 17 sub-Saharan African countries. There was wide between-study heterogeneity in the percentage of late-stage disease at diagnosis (median 74·7%, range 30·3-100%, I2=93·3%, p<0·0001). The percentage of patients with late-stage disease at diagnosis did not vary by region in black women, but was lower in non-black women from southern Africa than in black women in any region (absolute difference [AD] from black women in western Africa [reference group] -18·1%, 95% CI -28·2 to -8·0), and higher for populations from mixed (urban and rural) settings rather than urban settings (13·2%, 5·7 to 20·7, in analyses restricted to black women). The percentage of patients with late-stage disease at diagnosis in black Africans decreased over time (-10·5%, -19·3 to -1·6; for 2000 or later vs 1980 or before), but it was still higher around 2010 than it was in white and black women in the USA 40 years previously.

Interpretation: Strategies for early diagnosis of breast cancer should be regarded as a major priority by cancer control programmes in sub-Saharan Africa.

Funding: None.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Africa South of the Sahara / epidemiology
  • African Continental Ancestry Group
  • Breast Neoplasms / diagnosis*
  • Breast Neoplasms / epidemiology
  • Breast Neoplasms / mortality
  • Humans
  • Incidence
  • Neoplasm Staging*
  • Women's Health