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. 2017 Dec;3(6):765-772.
doi: 10.1200/JGO.2016.006098. Epub 2017 Mar 27.

Breast Cancer in Ghana: Demonstrating the Need for Population-Based Cancer Registries in Low- and Middle-Income Countries

Abigail S Thomas  1 , Kelley M Kidwell  1 , Joseph K Oppong  1 , Ernest K Adjei  1 , Ernest Osei-Bonsu  1 , Angela Boahene  1 , Evelyn Jiggae  1 , Kofi Gyan  1 , Sofia D Merajver  1
Affiliations

Breast Cancer in Ghana: Demonstrating the Need for Population-Based Cancer Registries in Low- and Middle-Income Countries

Abigail S Thomas et al. J Glob Oncol. 2017 Dec.

Abstract

Purpose Breast cancer, the most common cancer worldwide, is the leading cause of cancer mortality in Ghanaian women. Previous studies find Ghanaian women are diagnosed at a younger age and at more advanced stages (III and IV), and have tumors with characteristics similar to African American women. We sought to remedy gaps in knowledge about breast cancer survival in Ghana and its relation to demographic and biologic factors of the tumors at diagnosis to assist in cancer control and registration planning. Methods Individuals with a breast cancer diagnosis who sought care at Komfo Anokye Teaching Hospital from 2009 to 2014 were identified via medical records. Follow-up telephone interviews were held to assess survival. Kaplan-Meier plots and Cox proportional hazards models assessed survival associated with clinical and demographic characteristics. Results A total of 223 patients completed follow-up and were analyzed. The median survival was 3.8 years. Approximately 50% of patients were diagnosed with grade 3 tumors, which significantly increased the risk of recurrence or death (hazard ratio [HR] for grade 2 versus 1, 2.98; 95% CI, 1.26 to 7.02; HR grade 3 v 1, 2.56; 95% CI, 1.08 to 6.07; P = .04). No other variables were significantly associated with survival. Conclusion Higher tumor grade was significantly associated with shorter survival, indicating impact of aggressive biology at diagnosis on higher risk of cancer spread and recurrence. Contrary to prevailing notions, telephone numbers were not reliable for follow-up. Collecting additional contact information will likely contribute to improvements in patient care and tracking. A region-wide population-based active registry is important to implement cancer control programs and improve survival in sub-Saharan Africa.

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Conflict of interest statement

Abigail S. Thomas

No relationship to disclose

Kelley M. Kidwell

No relationship to disclose

Joseph K. Oppong

No relationship to disclose

Ernest K. Adjei

No relationship to disclose

Ernest Osei-Bonsu

No relationship to disclose

Angela Boahene

No relationship to disclose

Evelyn Jiagge

No relationship to disclose

Kofi Gyan

No relationship to disclose

Sofia D. Merajver

No relationship to disclose

Figures

Fig 1
Fig 1
The distribution of age at diagnosis for the 223 patients included in this analysis from 2009 to 2014 and 1,246 patients not used in analysis. The average age at diagnosis was 51 years (standard deviation [SD], 14 years) and the median age was 50 years for those analyzed for survival. The average age at diagnosis for those not used in analysis was 50 years (SD, 14) and the median age was 48 years. A t test to determine significant difference in the distribution of age was performed (P = .22).
Fig 2
Fig 2
The Kaplan-Meier survival curve for all patients analyzed at Komfo Anokye Teaching Hospital from 2009 to 2014. The median time to death or recurrence was 3.8 years. The average time to follow-up was 2.4 years from the date of diagnosis.
Fig 3
Fig 3
The survival curve by grade at diagnosis with tumor grades 1, 2, and 3 (P = .02) for the population at Komfo Anokye Teaching Hospital analyzed from 2009 to 2014.
Fig 4
Fig 4
The survival curve for triple-negative breast cancer (TNBC) patients compared with all other hormone statuses (P = .82) for the population analyzed at Komfo Anokye Teaching Hospital from 2009 to 2014. Those with TNBC hormone status of 1 were positive for TNBC and those with TNBC hormone status of 0 were all other hormone-status patients.
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