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- Title
Analysis of the Breast Cancer Journey in Namibia.
- Authors
Boucheron, Pauline; Zietsman, Annelle; Pontac, Johanna; Hansen, Rolf; Anderson, Benjamin O.; Togawa, Kayo; Macharia, Peter M.; Foerster, Milena; Schüz, Joachim; dos-Santos-Silva, Isabel; McCormack, Valerie
- Abstract
Key Points: Question: What are the priorities for strengthening the breast cancer (BC) journey in Namibia? Findings: In this cohort study of 405 Namibian women with incident BC recruited at the main national public oncology center, Black women were disadvantaged all along their BC journey compared with their mixed ancestry and White counterparts. There was a statistically significantly lower overall survival 3 years after BC diagnosis in Black women (60%) vs mixed ancestry and White women (85%). Meaning: These findings suggest that improvements that address the prevailing racial disparities in survival are needed across the whole BC journey to reduce BC mortality in Namibia. This cohort study describes the breast cancer journey of Namibian women by race using the World Health Organization Global Breast Cancer Initiative framework. Importance: Breast cancer (BC) is the leading cancer among women in Namibia. Examining the BC journey in this multiracial country where inequalities remain large is needed to inform effective interventions to reduce BC mortality. Objective: To describe the entire BC journey of Namibian women by race, utilizing the World Health Organization Global Breast Cancer Initiative (GBCI) framework. Design, Setting, and Participants: This cohort study used the Namibian subset of the African Breast Cancer–Disparities in Outcomes prospective cohort. Participants were all Namibian residents with confirmed incident BC who presented at the main national public oncology center of the Windhoek Central Hospital (WCH). Follow-up started from recruitment (September 8, 2014, to October 5, 2016) and ended up to 3 years after diagnosis (December 13, 2014, to September 27, 2019). Data analysis was conducted from June 2022 to August 2023. Exposures: Participants' self-reported ethnicities were aggregated into 3 population groups: Black, mixed ancestry, and White. Main Outcomes and Measures: Three-year overall survival (OS) was examined using Cox models, and summary statistics were used to describe women's BC journey, including GBCI pillar key performance indicators: (1) early stage (TNM I or II) diagnosis (population benchmark ≥60%), (2) prompt diagnosis, ie, 60 days or less to first health care practitioner visit (population benchmark 100%), and (3) completion of recommended multimodal treatment (MT, ie, surgery plus chemotherapy) (population benchmark ≥80%). Results: Of 405 women, there were 300 (74%) Black (mean [SD] age, 53 [15] years), 49 (12%) mixed ancestry (mean [SD] age, 53 [7] years), and 56 (14%) White (mean [SD] age, 59 [12] years) patients. Three-year OS was lowest in Black women (60% [95% CI, 54%-66%]; mixed ancestry: 80% [95% CI, 65%-89%]; White: 89% [95% CI, 77%-95%]), who had lower prevalence of early stage diagnosis (Black: 37% [95% CI, 31%-42%]; mixed ancestry and White: 75% [95% CI, 66%-83%]) and timely diagnosis (Black: 60% [95% CI, 54%-66%]; mixed ancestry and White: 77% [95% CI, 69%-85%]), while MT completion (Black: 53% [95% CI, 46%-59%]; mixed ancestry and White: 63% [95% CI, 50%-73%]) was low in all women. Conclusions and Relevance: In this cohort study of 405 Namibian residents with BC, marked racial disparities in survival were paralleled by inequities all along the BC journey. To improve BC survival, interventions are needed to promote earlier diagnosis in Black Namibian women and to increase MT initiation and completion in all women.
- Subjects
NAMIBIA; CONFIDENCE intervals; INTERVIEWING; CONCEPTUAL structures; RESEARCH funding; SURVIVAL analysis (Biometry); HEALTH equity; DATA analysis software; BREAST tumors; LONGITUDINAL method; OVERALL survival; PROPORTIONAL hazards models
- Publication
JAMA Network Open, 2023, Vol 6, Issue 11, pe2341402
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.41402