Factors associated with late-stage diagnosis of breast cancer among women in Addis Ababa, Ethiopia
Factors associated with late-stage diagnosis of breast cancer among women in Addis Ababa, Ethiopia
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DOI：
10.1007/s10549-020-05919-5
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发表时间：
2020-09-18
影响因子：
3.8
通讯作者：
Jemal, Ahmedin
中科院分区：
文献类型：
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作者：
Gebremariam, Alem;Dereje, Nebiyu;Jemal, Ahmedin
目的诊断时的分期是决定乳腺癌预后的关键因素.在这项研究中，我们在诊断阶段的特点，并确定在诊断中的妇女诊断为浸润性乳腺癌在阿迪斯，埃塞俄比亚首都的先进阶段的相关因素。方法从2017年1月至2018年6月在阿迪斯7家主要卫生机构就诊的441名浸润性乳腺癌妇女的病历中收集阶段信息;这7家机构占该市所有乳腺癌病例的90%。我们使用具有稳健方差的多变量泊松回归模型来确定与诊断时的晚期相关的因素。结果肿瘤组织学类型以导管癌为主（83.7%）。一半以上的肿瘤分级为中分化或低分化。就诊时的中位肿瘤大小为4 cm。64%的患者在疾病晚期被诊断（44%的III期和20%的IV期），36%的患者在早期被诊断（5%的I期和31%的II期）。在确诊前使用传统药物的妇女中，晚期疾病的患病率显著较高（校正患病率[aPR] = 1.31;p = 0.001），患者延迟> 3个月（aPR = 1.16;p = 0.042）和诊断延迟> 2个月（aPR = 1.24;p = 0.004）。但在有乳房自我检查史的妇女中，这一比例较低（aPR = 0.77;p = 0.021）。结论：阿迪斯妇女乳腺癌诊断的晚期与传统药物的使用以及症状识别和疾病确诊之间的时间间隔延长密切相关。需要社区和卫生系统一级的干预措施，以提高对乳腺癌的认识，并促进及时诊断。
Purpose Stage at diagnosis is a key determinant of breast cancer prognosis. In this study, we characterize stage at diagnosis and determine factors associated with advanced stage at diagnosis among women diagnosed with invasive breast cancer in Addis Ababa, capital city of Ethiopia. Methods Stage information was collected from medical records of 441 women with invasive breast cancer seen in seven major health facilities in Addis Ababa, from January 2017 to June 2018; these seven facilities capture 90% of all incident breast cancer cases in the city. We used multivariable Poisson regression model with robust variance to determine factors associated with advanced stage at diagnosis. Results The predominant tumor histology was ductal carcinoma (83.7%). More than half of the tumors' grade was moderately or poorly differentiated. The median tumor size at presentation was 4 cm. Sixty-four percent of the patients were diagnosed at advanced stage of the disease (44% stage III and 20% stage IV), with 36% of the patients diagnosed at early-stage (5% stage I and 31% stage II). The prevalence of advanced stage disease was significantly higher among women who used traditional medicine before diagnostic confirmation (adjusted prevalence ratio [aPR] = 1.31;p = 0.001), had patient delay of > 3 months (aPR = 1.16;p = 0.042) and diagnosis delay of > 2 months (aPR = 1.24;p = 0.004). But it was lower among women who had history of breast self-examination (aPR = 0.77;p = 0.021). Conclusions Advanced stage at diagnosis of breast cancer among women in Addis Ababa is strongly associated with use of traditional medicine and with prolonged time interval between symptom recognition and disease confirmation. Community- and health systems-level interventions are needed to enhance knowledge about breast cancer and facilitate timely diagnoses.