BACKGROUND Improving breast cancer survival in sub-Saharan Africa (SSA) is urgently needed, requiring early diagnosis and improved access to treatment. However, data on the types of and barriers to receiving breast cancer therapy in this region are limited and have not been compared between different SSA countries and treatment settings. METHODS In different health care settings across Uganda, Nigeria and Namibian sites of the prospective African Breast Cancer - Disparities in Outcomes cohort study, we assessed the percentage of newly diagnosed breast cancer patients who received treatment (systemic, surgery and/or radiotherapy) for cancer and their socio-demographic and clinical determinants. Treatment data were systematically extracted from medical records, as well as self-reported by women during 6-month follow-up interviews, and were used to generate a binary indicator of treatment received within 12 months of diagnosis (yes/no), which was analysed via logistic regression. RESULTS Of 1325 women, cancer treatment had not been initiated treatment within 1 year of diagnosis for 227 (17%) women and 185 (14%) of women with stage I-III disease. Untreated percentages were highest in two Nigerian regional hospitals where 38% of 314 women were not treated (32% among stage I-III). At a national referral hospital in Uganda, 18% of 430 women were not treated (15% among stage I-III). In contrast, at a cancer care centre in Windhoek, Namibia, where treatment is provided free to the patient, all non-black (100%) and almost all (98.7%) black women had initiated treatment. Percentages of untreated women were higher in women from lower socio-economic groups, women who believed in traditional medicine and, in Uganda, in HIV+ women. Self-reported treatment barriers confirmed treatment costs and treatment refusal as contributors to not receiving treatment. CONCLUSIONS Financial support to ensure treatment access and education of treatment benefits are needed to improve treatment access for breast cancer patients across sub-Saharan Africa, especially at regional treatment centres, for lower socio-economic groups, and for the HIV-positive woman with breast cancer.

中文翻译：

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撒哈拉以南非洲地区乳腺癌治疗的不平等：一项前瞻性多国观察性研究的结果。


背景技术 迫切需要提高撒哈拉以南非洲地区 (SSA) 的乳腺癌生存率，需要早期诊断并改善治疗的可及性。然而，有关该地区接受乳腺癌治疗的类型和障碍的数据有限，并且尚未在不同的 SSA 国家和治疗环境之间进行比较。方法 在乌干达、尼日利亚和纳米比亚前瞻性非洲乳腺癌 - 结果差异队列研究的不同医疗保健环境中，我们评估了新诊断乳腺癌患者接受癌症治疗（全身、手术和/或放疗）的百分比及其社会人口和临床决定因素。治疗数据是从医疗记录以及女性在 6 个月的随访访谈中自我报告中系统提取的，并用于生成诊断后 12 个月内接受的治疗的二元指标（是/否），即通过逻辑回归进行分析。结果 在 1325 名女性中，227 名 (17%) 名女性和 185 名 (14%) 患有 I-III 期疾病的女性在诊断后 1 年内尚未开始治疗。尼日利亚两家地区医院未接受治疗的比例最高，314 名妇女中有 38% 未接受治疗（I-III 期为 32%）。在乌干达的一家国家转诊医院，430 名女性中有 18% 没有接受治疗（I-III 期为 15%）。相比之下，在纳米比亚温得和克的一个癌症护理中心，为患者提供免费治疗，所有非黑人（100%）和几乎所有（98.7%）黑人女性都开始接受治疗。未经治疗的妇女比例较高，其中社会经济地位较低群体的妇女、相信传统医学的妇女以及乌干达艾滋病毒阳性妇女中的比例较高。 自我报告的治疗障碍证实治疗费用和拒绝治疗是不接受治疗的原因。结论 需要提供财政支持，以确保治疗的可及性和治疗福利的教育，以改善撒哈拉以南非洲地区乳腺癌患者的治疗可及性，特别是在区域治疗中心、社会经济地位较低的群体以及患有乳腺癌的艾滋病毒阳性妇女的治疗可及性癌症。