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Barriers to early presentation of breast cancer among women in Soweto, South Africa

PURPOSE: Reported breast cancer incidence is rising in South Africa, where some women are diagnosed late and have poor outcomes. We studied patient and provider factors associated with clinical stage at diagnosis among women diagnosed at the Chris Hani Baragwanath Academic Hospital in Soweto, Johann...

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Autores principales: Joffe, Maureen, Ayeni, Oluwatosin, Norris, Shane Anthony, McCormack, Valerie Ann, Ruff, Paul, Das, Ishani, Neugut, Alfred I., Jacobson, Judith S., Cubasch, Herbert
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5796726/
https://www.ncbi.nlm.nih.gov/pubmed/29394271
http://dx.doi.org/10.1371/journal.pone.0192071
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author Joffe, Maureen
Ayeni, Oluwatosin
Norris, Shane Anthony
McCormack, Valerie Ann
Ruff, Paul
Das, Ishani
Neugut, Alfred I.
Jacobson, Judith S.
Cubasch, Herbert
author_facet Joffe, Maureen
Ayeni, Oluwatosin
Norris, Shane Anthony
McCormack, Valerie Ann
Ruff, Paul
Das, Ishani
Neugut, Alfred I.
Jacobson, Judith S.
Cubasch, Herbert
author_sort Joffe, Maureen
collection PubMed
description PURPOSE: Reported breast cancer incidence is rising in South Africa, where some women are diagnosed late and have poor outcomes. We studied patient and provider factors associated with clinical stage at diagnosis among women diagnosed at the Chris Hani Baragwanath Academic Hospital in Soweto, Johannesburg in 2015–2016. METHODS: From face-to-face interviewer-administered questionnaires we compared self-reported socioeconomics, demographics, comorbidities, risk factors, personal and health system barriers, and from patient clinical records, clinical staging, receptor subtype, and tumor grade among 499 consecutive women newly diagnosed with advanced stage (III/IV) breast cancer versus those diagnosed early (stage 0/I/II). Logistic regression models were used to identify factors associated with advanced stage at diagnosis. RESULTS: Among the women, 243 (49%) were diagnosed at early and 256 (51%) at advanced stages. In the multiple logistic regression adjusted model, completion of high school or beyond (odds ratio (OR) 0.59, and greater breast cancer knowledge and awareness (OR 0.86) were associated with lower stage of breast cancer at presentation. Advanced stage was associated with Luminal B (OR 2.25) and triple-negative subtypes (OR 3.17) compared to luminal A, with delays >3 months from first breast symptoms to accessing the health system (OR 2.79) and with having more than 1 visit within the referral health system (OR 3.19) for 2 visits; OR 2.73 for ≥3 visits). CONCLUSIONS: Limited patient education, breast cancer knowledge and awareness, and health system inefficiencies were associated with advanced stage at diagnosis. Sustained community and healthcare worker education may down-stage disease and improve cancer outcomes.
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spelling pubmed-57967262018-02-16 Barriers to early presentation of breast cancer among women in Soweto, South Africa Joffe, Maureen Ayeni, Oluwatosin Norris, Shane Anthony McCormack, Valerie Ann Ruff, Paul Das, Ishani Neugut, Alfred I. Jacobson, Judith S. Cubasch, Herbert PLoS One Research Article PURPOSE: Reported breast cancer incidence is rising in South Africa, where some women are diagnosed late and have poor outcomes. We studied patient and provider factors associated with clinical stage at diagnosis among women diagnosed at the Chris Hani Baragwanath Academic Hospital in Soweto, Johannesburg in 2015–2016. METHODS: From face-to-face interviewer-administered questionnaires we compared self-reported socioeconomics, demographics, comorbidities, risk factors, personal and health system barriers, and from patient clinical records, clinical staging, receptor subtype, and tumor grade among 499 consecutive women newly diagnosed with advanced stage (III/IV) breast cancer versus those diagnosed early (stage 0/I/II). Logistic regression models were used to identify factors associated with advanced stage at diagnosis. RESULTS: Among the women, 243 (49%) were diagnosed at early and 256 (51%) at advanced stages. In the multiple logistic regression adjusted model, completion of high school or beyond (odds ratio (OR) 0.59, and greater breast cancer knowledge and awareness (OR 0.86) were associated with lower stage of breast cancer at presentation. Advanced stage was associated with Luminal B (OR 2.25) and triple-negative subtypes (OR 3.17) compared to luminal A, with delays >3 months from first breast symptoms to accessing the health system (OR 2.79) and with having more than 1 visit within the referral health system (OR 3.19) for 2 visits; OR 2.73 for ≥3 visits). CONCLUSIONS: Limited patient education, breast cancer knowledge and awareness, and health system inefficiencies were associated with advanced stage at diagnosis. Sustained community and healthcare worker education may down-stage disease and improve cancer outcomes. Public Library of Science 2018-02-02 /pmc/articles/PMC5796726/ /pubmed/29394271 http://dx.doi.org/10.1371/journal.pone.0192071 Text en © 2018 Joffe et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Joffe, Maureen
Ayeni, Oluwatosin
Norris, Shane Anthony
McCormack, Valerie Ann
Ruff, Paul
Das, Ishani
Neugut, Alfred I.
Jacobson, Judith S.
Cubasch, Herbert
Barriers to early presentation of breast cancer among women in Soweto, South Africa
title Barriers to early presentation of breast cancer among women in Soweto, South Africa
title_full Barriers to early presentation of breast cancer among women in Soweto, South Africa
title_fullStr Barriers to early presentation of breast cancer among women in Soweto, South Africa
title_full_unstemmed Barriers to early presentation of breast cancer among women in Soweto, South Africa
title_short Barriers to early presentation of breast cancer among women in Soweto, South Africa
title_sort barriers to early presentation of breast cancer among women in soweto, south africa
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5796726/
https://www.ncbi.nlm.nih.gov/pubmed/29394271
http://dx.doi.org/10.1371/journal.pone.0192071
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