Three‐year survival of breast cancer patients attending a one‐stop breast care clinic nested within a primary care health facility in sub‐Saharan Africa‐Zambia

• Published in: International journal of cancer 2024-07, Vol.155 (2), p.261-269
• Main Authors: Songiso, Mutumba, Nuñez, Olivier, Cabanes, Anna, Mutale, Mpimpa, Munalula, Jabulani, Pupwe, George, Henry‐Tillman, Ronda, Parham, Groesbeck P.
• Format: Article
• Language: English
• Subjects: Biopsy; Breast cancer; breast cancer early diagnosis; breast cancer in sub‐Saharan Africa; breast cancer survival; Diagnosis; down‐staging breast cancer; Health care; Health facilities; Life expectancy; Life span; Medical diagnosis; Medical prognosis; Patients; Primary care; Survival; Survival analysis; Ultrasonic imaging; Ultrasound; Womens health
• ISSN: 0020-7136; 1097-0215
• DOI: 10.1002/ijc.34920

In Zambia, women with breast symptoms travel through multiple levels of the healthcare system before obtaining a definitive diagnosis. To eradicate this critical barrier to care, we nested a novel breast specialty service platform inside a large public‐sector primary healthcare facility in Lusaka, Zambia to offer clinical breast examination, breast ultrasound, and ultrasound‐guided core needle biopsy in a one‐stop format, tightly linked to referral for treatment. The objective of the study was to determine the life expectancy and survival outcomes of a prospective cohort of women diagnosed with breast cancer who were attended to and followed up at the clinic. The effect of breast cancer stage on prognosis was determined by estimating stage‐specific crude survival using the Kaplan–Meier method. Survival analysis was used to estimate mean lifespan according to age and stage at diagnosis. We enrolled 302 women with histologically confirmed breast cancer. The overall 3‐year survival was 73%. An increase in patients presenting with early breast cancer and improvements in their survival were observed. Women with early‐stage breast cancer had a lifespan similar to the general population, while loss of life expectancy was significant at more advanced stages of disease. Our findings suggest that implementing efficient breast care services at the primary care level can avert a substantial proportion of breast cancer‐related deaths. The mitigating factor appears to be stage of disease at the time of diagnosis, the cause of which is multifactorial, with the most influential being delays in the referral process. What's new? In Zambia, women with breast symptoms travel through multiple levels of the healthcare system before obtaining a definitive diagnosis. This study analyzed the survival outcomes of a prospective cohort of women diagnosed with breast cancer at a one‐stop breast care clinic nested within a public primary care level facility. Using African Breast Cancer – Disparities in Outcomes (ABC‐DO) survival data for comparison, the authors provide evidence that offering opportunistic screening and diagnostic services to symptomatic women at the primary healthcare level, and tightly linking diagnosis to treatment, can downshift cancer stage at the time of diagnosis, thereby improving survival outcomes.