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Outcomes and Prognostic Factors for Women with Breast Cancer in Malawi
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March 02 2020
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Source: Cancer Causes Control. 31(4):393-402
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Alternative Title:Cancer Causes Control
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Description: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.
Material 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).
Conclusions:
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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Pubmed ID:32124187
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Pubmed Central ID:PMC7115156
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Funding:P30CA016086/Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill/ ; R24TW008927/University of North Carolina at Chapel Hill/ ; R24 TW008927/TW/FIC NIH HHS/United States ; U54 CA190152/CA/NCI NIH HHS/United States ; P20 CA210285/CA/NCI NIH HHS/United States ; ... More +
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