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Variations in Breast Cancer Survival Rates: A Systematic Review and Meta-Analysis of Data from the Entire Continent of Africa

33 Pages Posted: 4 Feb 2019

See all articles by Paddy Ssentongo

Paddy Ssentongo

Pennsylvania State University - Center for Neural Engineering

Joseph A. Lewcun

Pennsylvania State University - Milton S. Hershey Medical Center

Xavier Candela

Pennsylvania State University - Milton S. Hershey Medical Center

Anna E. Ssentongo

Pennsylvania State University - Milton S. Hershey Medical Center

Eustina G. Kwon

Pennsylvania State University - Milton S. Hershey Medical Center

Djibril M. Ba

Pennsylvania State University - Milton S. Hershey Medical Center

John S. Oh

Pennsylvania State University - Milton S. Hershey Medical Center

Forster Amponsah-Manu

Pennsylvania State University - Milton S. Hershey Medical Center

Alicia C. McDonald

Pennsylvania State University - Milton S. Hershey Medical Center

Vernon M. Chinchilli

Pennsylvania State University - Milton S. Hershey Medical Center

David I. Soybel

Pennsylvania State University - Milton S. Hershey Medical Center

Daleela G. Dodge

Pennsylvania State University - Milton S. Hershey Medical Center

More...

Abstract

Background: The survival from breast cancer in Africa is poor and yet the incidence rate is on the rise. Causes of variations in survival from breast cancer are not well understood. We aimed to do a systematic review and meta-analysis on 5-year survival rates of breast cancer on the entire continent of Africa and to examine trends over time, and investigate sources of variations across the region.

Methods: We searched MEDLINE, Embase, Cochrane Library to identify studies on breast cancer survival in African men and women published before October 17, 2018, and in any language. Random-effects meta-analyses were done to investigate between-study heterogeneity in 5-year survival rates of breast cancer and meta-regression analyses to identify potential sources of variation. 5-year survival rates of breast cancer in Africa were compared with similar estimates for black and white population in the USA from the Surveillance, Epidemiology, and End Results database.

Findings: 54 studies were included, which consisted of 18,970 women and men from 13 African countries, 8 of which were from sub-Saharan region. There was wide between-study heterogeneity in the survival rates (mean 52.9%, range 7-91%, I2=99.1%; p<0.0001). Age and gender adjusted 5-year survival rates were lower in sub-Saharan Africa (absolute difference [AD] from North Africa [reference group] -25.4% (95% CI: -34.97 to -15.82%), lower in predominantly black population compared to predominantly white population -25.9% lower (95% CI: -35.40 to -16.43%). Within sub-Saharan region, survival rates are lower in western and eastern region compared to southern region. Although triple negative cancer negatively correlated with survival, the correlation did not reach a statistical significance (r=-0.27, p=0.35). Survival rates are increasing over time more in white Africans compared to black Africans but the survival rates for Africans are still significantly lower when compared to the black and white populations in the USA, a high-income country.

Interpretation: Region and race-specific public health interventions coupled with genetic prospective studies are urgently needed to improve breast cancer survival Africa.

Funding Statement: Support was provided from the unrestricted funds from the Academic Enrichment Fund of the Department of Surgery and the David L. Nahrwold Endowment in the Penn State College of Medicine (DIS).

Declaration of Interests: The authors declare no competing interests.

Ethics Approval Statement: For this systematic review and meta-analysis, the authors developed a study protocol based on the PRISMA guidelines.

Keywords: Breast cancer survival, Sub-Saharan Africa, Continent of Africa, Meta-analysis

Suggested Citation

Ssentongo, Paddy and Lewcun, Joseph A. and Candela, Xavier and Ssentongo, Anna E. and Kwon, Eustina G. and Ba, Djibril M. and Oh, John S. and Amponsah-Manu, Forster and McDonald, Alicia C. and Chinchilli, Vernon M. and Soybel, David I. and Dodge, Daleela G., Variations in Breast Cancer Survival Rates: A Systematic Review and Meta-Analysis of Data from the Entire Continent of Africa (January 30, 2019). Available at SSRN: https://ssrn.com/abstract=3326638

Paddy Ssentongo (Contact Author)

Pennsylvania State University - Center for Neural Engineering ( email )

212 Earth and Engineering Sciences Building
University Park, PA 16802
United States

Joseph A. Lewcun

Pennsylvania State University - Milton S. Hershey Medical Center

PA
United States

Xavier Candela

Pennsylvania State University - Milton S. Hershey Medical Center

PA
United States

Anna E. Ssentongo

Pennsylvania State University - Milton S. Hershey Medical Center

PA
United States

Eustina G. Kwon

Pennsylvania State University - Milton S. Hershey Medical Center

PA
United States

Djibril M. Ba

Pennsylvania State University - Milton S. Hershey Medical Center

PA
United States

John S. Oh

Pennsylvania State University - Milton S. Hershey Medical Center

PA
United States

Forster Amponsah-Manu

Pennsylvania State University - Milton S. Hershey Medical Center

PA
United States

Alicia C. McDonald

Pennsylvania State University - Milton S. Hershey Medical Center

PA
United States

Vernon M. Chinchilli

Pennsylvania State University - Milton S. Hershey Medical Center

PA
United States

David I. Soybel

Pennsylvania State University - Milton S. Hershey Medical Center

PA
United States

Daleela G. Dodge

Pennsylvania State University - Milton S. Hershey Medical Center

PA
United States

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