Addressing Breast Cancer Challenges in Resource-Limited Settings: A Comprehensive Analysis of the African Context
Addressing Breast Cancer Challenges in Resource-Limited Settings: A Comprehensive Analysis of the African Context
Nachammai Annamalai and Joshua Karickal (Equal Contribution),
and Dr Lopamudra Das Roy
Published: October/2023
@BreastCancerHub, All Rights Reserved
Abstract
Breast cancer is a significant public health concern worldwide, including in Africa. As a complex disease influenced by a combination of genetic, lifestyle, and environmental factors, its burden has become amplified due to limited healthcare access and infrastructure. The study aims to investigate the role of lifestyle and environmental factors in the development and progression of breast cancer along with the current screening processes, treatments, and other aspects associated with breast cancer in the continent. Extensive literature review and data analysis, using resources from databases such as PubMed and the National Institutes of Health (NIH) covered the majority of the research methodology. The study also incorporated data from other reliable cancer-focused sources, from continent-based organizations. Statistical analysis was conducted to identify significant results and correlations chartered from graphs found within reliable sources. The findings reveal that Africa's underdevelopment significantly impacts the accessibility of healthcare services, particularly for underserved populations, thereby exacerbating the breast cancer crisis. Furthermore, regional differences in environmental and key risk factors were identified as having a substantial influence on breast cancer rates across Africa. In conclusion, this study underscores the urgent need for improved healthcare accessibility and cancer screening processes in Africa. The findings have broad implications for public health policy, calling for a comprehensive approach to combat the rising incidence of breast cancer. It is recommended that further research should be done to develop tailored prevention, earlier screening, and cohesive treatment strategies for different African regions, considering their unique demographic factors, lifestyles, and healthcare capabilities.
Statistics for Breast Cancer in Africa
Breast cancer poses a health issue in Africa with its occurrence differing across regions due to factors such as healthcare accessibility, awareness levels, and lifestyle choices.
● Incident rate per 100,000 women: Southern (46.2), West (37.3), East (29.9), and Central (27.9) [1].
● Mortality rate per 100,000 women: Southern (15.6), West (17.8), East (15.4), and Central (15.8) [1].
● Less than 1% of all Breast Cancer cases in developed countries are male Breast Cancer, making it a rare condition [2]. Little is known about the origin of male breast cancer due to the disease’s rarity, and studies on female breast cancer provided the best therapy options for treating male breast cancer [3].
● In Africa, the age-standardized incidence rate is 37.9/100,000 [2, 4].
Age Variation for Breast Cancer in Africa
Breast cancer is an ongoing healthcare issue in Africa that affects both men and women. It has patterns of occurrence across age groups. This detailed analysis aims to shed light on the situation of breast cancer in Africa by examining how it appears at stages of life and investigating the factors that contribute to its prevalence, in each age group.
Less than 1% of breast cancer cases in affluent nations are in men, making it a rare disease. Little is known about the genesis of male breast cancer due to the disease's rarity, and the best course of treatment for male breast cancer was determined by research on female breast cancer. There was also a geographic region of Africa that was found to have the greatest male-to-female breast cancer ratio (>6%) two decades ago. Due to the rarity of male breast cancer, the majority of studies on this condition in Africa are small, even after years of data collection [3].
Breast Cancer in women ages 15-39:
Breast cancer has started to rise in many cases in countries throughout Africa. Countries like Nigeria have many females that are at risk of Breast Cancer with a high mortality rate, this comes from the poor habit of seeking health in the late stages, as well as very low standards of female education, and economic factors preventing many to get the right treatment. Another reason why so many young females are at risk of Breast Cancer is because of lower estrogen receptor (ER) positivity, as well as more lymph node positivity. Nigeria has reported the highest Breast Cancer mortality rate in Africa. [4, 5].
For example, in the countries mentioned in the figure, there are multiple cancer registries. These registries submit their cancer reports to the central government regularly and some registry members sit on the NCCP board for making policies for their countries.
Breast Cancer in women ages 40-59:
When women reach their 40s and 50s the chances of developing breast cancer increase [4]. This particular age group witnesses an occurrence of breast cancer cases compared to women. Multiple factors contribute to this rise, such, as changes in hormones, reproductive history, and lifestyle decisions. Moreover, disparities in healthcare accessibility can impact detection and prompt treatment. It is crucial to establish screening initiatives and enhance access to healthcare facilities as measures towards better breast cancer outcomes for middle-aged women, in Africa [6].
Breast Cancer in women ages 60 and above:
As women get older the risk of breast cancer increases, for those aged 60 and above [4]. In Africa, this specific age range is more susceptible to higher rates of breast cancer. It is widely known that advancing age is a factor in developing breast cancer. Although changes in breast tissue due to aging contribute to this increased risk other factors like genetics and environmental influences also have a role to play. Encouraging screenings for breast cancer and promoting self-examination is essential for detection, which can potentially lead to more successful treatment outcomes [6, 7].
Heterogeneity of Breast Cancer Receptor Status Across Certain Regions in Africa
Emerging research has unveiled a complex and disparate landscape of breast cancer receptor statuses across different geographic regions in Africa, highlighting the diversity of breast cancer subtypes within the continent. These disparities show the need for a multifaceted approach to breast cancer management tailored to the distinct molecular characteristics present in each region [8].
Age-at-diagnosis distributions by subtype are shown above among African-American patients. ERP, PRP, and HER2P tumors all had peak incidences in the middle to late forties and a slight dip in the mid-fifties, indicating a deceleration of the rate of increase of the underlying incidence rates [9].
In North Africa, for instance, countries such as Egypt and Algeria have reported a relatively high prevalence of hormone receptor-positive cancers (ER and/or PR positive) [9,10]. A study conducted in Egypt showed that about 60% of breast cancer cases were ER-positive and 55% were PR-positive, indicative of a hormone-driven cancer subtype that is typically responsive to hormone therapy [11]. Additionally, another study in ER+ levels shows a majority reporting proportions between 0.40 and 0.80 in North Africa and between 0.20 and 0.70 in sub-Saharan Africa– which are both very high [12].
In contrast, Sub-Saharan Africa exhibits a higher prevalence of triple-negative breast cancer (TNBC), which is characterized by the absence of ER, PR, and HER2 protein. These cancers are often more aggressive and have a poorer prognosis due to limited treatment options. In Nigeria, for example, a significant proportion of breast cancer cases were reported to be of the triple-negative subtype, with prevalence rates as high as 34%. Similar trends have been observed in countries like South Africa and Ghana [13, 14].
In East Africa, populations have reported a mixed picture. For instance, in Kenya, there is a relatively high prevalence of HER2-positive breast cancer, while in Ethiopia, the prevalence of TNBC appears to be higher [15]. ER, PR and HER-2 statuses also varied across Uganda and Tanzania. HER2-positive cases were reported, but the prevalence might not have been as high as in Western countries.
According to a study, 1808 potentially eligible studies were identified of which 67 were included in the systematic review and 60 were included in the meta-analysis. Claudin-low breast cancers are aggressive tumors defined by the low expression of key components of cellular junctions, associated with mesenchymal and stemness features. Pooled TNBC frequency in Central Africa is expected to be 95% CI.
In West African countries, similar to other regions, hormone receptor-positive (ER+ and/or PR+) tumors tend to be more common than HER2-positive or triple-negative tumors. PR+ tumors tend to be more common in Ghana as well as Senegal.
In Côte d'Ivoire, PR+ tumors have been observed to be more prevalent while HER2-positive and triple-negative tumors are generally less common but still occur [16]. The minute differences shown in receptor statuses across different countries come to show the diversity of breast cancer. It’s important to remember that breast cancer receptor status can vary not only among different countries but also within different population groups within a country [14, 17].
These regional variations in receptor statuses may be influenced by inconsistencies in data collection and interpretation across different regions. In contrast, genetic predisposition is a topic for discussion. For example, being born with inherited faulty genes doesn't mean that a person will get cancer. However, they have a higher risk of developing particular types of cancer than other people, with breast cancer falling into that category. They are also more likely to develop cancer at a younger age [18].
These differences show the urgent need for tailored public health interventions, improved diagnostic capabilities, and enhanced access to appropriate treatments, including targeted therapies for HER2-positive cancers and hormone therapies for ER and PR-positive cancers [19, 20]. However, further research is necessary to fully understand driving factors and to develop comprehensive, region-specific approaches to breast cancer management in Africa. Moreover, the importance of building robust, continent-wide cancer registries and research networks cannot be overstated, as these would facilitate a better understanding of epidemiology and molecular subtypes within the African continent [21, 23].
Ethnicity and Demographics of Breast Cancer in Africa
Breast cancer is a very broad, complex disease, affected by ethical and demographic factors. It's important to understand how ethnicity and demographics impact breast cancer rates to create prevention, diagnosis, and treatment strategies. By studying the relationship between ethnicity, demographics, and breast cancer incidence, we not only gain an understanding of this widespread disease but also empower healthcare professionals and policymakers to implement targeted interventions that reduce health disparities among different groups.
Africa is the second biggest continent in the world, as well as it is the most diverse continent. There are over 3,000 ethnic groups that span throughout the continent. This is important to know because if a certain ethnic group had a gene that was more prone to being likely to receive Breast Cancer then scientists could help make a cure and it would help lower the mortality rate [24].
● Sub-Saharan Africa (SSA) is very diverse with plenty of ethnic groups, but they are also in the lower socioeconomic class, which makes it harder for them to receive the correct treatment, and leads to a higher mortality rate [25].
● In Northern Africa, there are much bigger ethnic groups, but they seem to be in the higher socioeconomic class, which lets them receive the correct treatment, with an accurate diagnosis [25].
Often genetic factors also depend on ethnic groups. Certain genetic mutations that increase the risk of breast cancer, such as BRCA1 and BRCA2 mutations, are found in all populations, but their prevalence can differ among ethnic groups. Some ethnic groups in Africa may have a higher prevalence of specific genetic mutations that increase the risk of breast cancer [26].
This is a picture of Africa with all the different ethnic groups that reside in it. Each color represents a different ethnic group, with titles. As shown, North Africa has less diversity when compared to the Western, Eastern, Southern, and Central parts of Africa [9].
With varying ethnicities, customs also vary. Cultural beliefs and practices can influence breast cancer awareness, screening, and treatment-seeking behaviors. Some communities may prioritize traditional remedies over modern medical interventions [25, 26].
Additional demographics include age, inhabiting areas, and other facts. Breast cancer tends to occur at an earlier age in African women compared to their Western counterparts. This means that a higher proportion of African women are diagnosed with breast cancer before the age of 40. As for other factors, breast cancer rates are generally higher in urban areas due to lifestyle changes, better access to healthcare, and changing reproductive patterns. In conclusion, limited access to early detection and treatment services, as well as poor healthcare infrastructure, can contribute to delayed diagnosis and higher mortality rates among women in lower socioeconomic groups [26].
Cultural Variation Leading to Late Detection Throughout Africa
Northern Africa
1.INorthern Africa culture does not have that much of a big impact. Most of North Africa is where the higher socioeconomic class lives. The families that live here can afford better treatment and attend higher-class hospitals. This is a reason why a lot more accurate Breast Cancer incidence data and reports are available about this region. In other regions because of low funding and poor management, the reports are inadequate and inaccurate [28, 29].
● The fear of a cancer diagnosis and the associated treatment processes, such as surgery and chemotherapy, can be a significant deterrent to seeking medical help, which is one of the factors that affect this region [30].
2. Western Africa
This region of Africa is mostly rural with multiple small tribes inhabiting its land. Many of these tribes have certain rules and standards for their people. If a woman who can only be a mom and take care of the family was diagnosed with Breast Cancer she would be deemed worthless by her family and tribe, because she would be considered more of a liability than an asset for them. This is a major reason why some diagnosis is delayed till its advanced stages [31, 32].
● Many African communities here hold traditional beliefs about illness and healing. Some individuals may initially turn to traditional healers, herbal remedies, or spiritual interventions before seeking modern medical care [28, 33]. Mistrust in Western medicine can cause individuals to not believe in medical practices due to historical and cultural factors [34].
● Certain cultural practices also take place here. For example, some people cover their bodies or avoid discussions about sensitive topics, making it more difficult for individuals to notice changes in their bodies or to communicate about health concerns [33, 34].
3. Central Africa
Many of the people that live in this region like other regions fall to false propaganda and myths about getting diagnosed with cancer. This is slowly decreasing because many health organizations are proving these myths wrong and the number of incidents are decreasing. [35]
● Societal norms and gender roles can influence women's autonomy in decision-making about their health. Women in certain cultures might prioritize their family's needs over their health or may not have the authority to seek medical help without male permission [34, 36]
4. Eastern Africa
Eastern Africa is a very poor urban region, because of low funding and terrible structure many hospitals are of low quality. Even if a woman went to a doctor because she noticed unusual symptoms and signs from her breast, because the doctor is not trained correctly, he might dismiss it as something else [37, 38].
● Due to the challenges related to healthcare infrastructure, including limited access to medical facilities, diagnostic tools, and treatment options, people get delayed diagnosis and treatment [38, 39].
5. Southern Africa
In Southern Africa, many of the incidences of Breast Cancer happen at the advanced stages, because of failure to recognize signs and symptoms at an earlier stage. Another reason why there are growing incidences of Breast Cancer in this region is because of socioeconomic status, many cannot afford the correct treatment or receive the correct help [40, 41].
● This lack of awareness and education can also place disadvantages on treatment. Limited health literacy and awareness about breast cancer and its symptoms can hinder early detection efforts. Some individuals might not recognize the signs of breast cancer or may mistake them for less serious conditions [39 - 41].
Breast Cancer Screening Protocols and Execution in Africa
Breast cancer is the most common cancer among women globally, and its incidence is rising in Africa. Early detection through systematic screening can significantly improve survival rates. However, due to various challenges, breast cancer screening protocols require tailored approaches in African countries. There are no national maintenance agencies in Africa, but the CANSA (Cancer Association of South Africa) periodically suggests that inhabitants get tested and also recommends discussion of any breast health problems with primary physicians [42].
As for other guidelines to follow, The World Health Organization (WHO) recommends systematic mammography screening for women between the ages of 40 to 75 years in sub-Saharan Africa [43]. Most screening recommendations in SSA follow guidelines from North America and Europe, therefore, there is a critical need for a contextual adaptation, which will ensure the true benefits of screening in improving the health outcomes of women [44].
Also, it is important to note that screening has been shown through studies to reduce the breast cancer mortality rate by 30% – 40%. Current screening guidelines universally endorse screening in the 40–50-year-old age group and it has been proven in the literature that mammography starting from age 40 reduces mortality from breast cancer [42, 44, 45].
1. Existing Breast Cancer Screening Protocols:
1.1 Clinical Breast Examination (CBE):
The lack of Modern technology in Africa makes it harder for women to be checked for signs and symptoms of Breast Cancer. In Sub-Saharan Africa, the incidence rates are increasing because of lack of exposure to Breast Cancer signs and symptoms. The Clinical Breast Examination has helped many women discover at an early stage of Breast Cancer, but sadly due to an insufficient number of trained doctors and nurses, there aren’t enough treatments going on currently [47].
1.2 Mammography:
● Normal mammograms are only available to wealthy individuals who have private access [42 ]. Underdeveloped countries generally practice using normal mammograms. However, these are not always as accurate as they seem to miss (give false-negative results) about ½ of cancers in women with dense breasts, which is 1 in 8 people [48].
● Supplemental tests with 3D mammograms or tomosynthesis are modernizing, but have yet to reach all the sectors of Africa. Tomosynthesis was FDA-approved in 2011 in Africa for both breast cancer screening and diagnosis but has been used in Europe and other parts of the world since 2008. The first tomosynthesis digital mammography machine in South Africa was installed at a Linksfield branch in 2012 and has since been upgraded in a suburb called Johannesburg, in SSA. The latest machinery and software are implemented at both Linksfield and Sunninghill branches, according to a breast cancer company. Due to the southern location, many people are not able to access these testing resources [49].
1.3 Breast Self-Examination (BSE):
While BSE can increase breast cancer awareness, its effectiveness as a standalone screening tool is debated. It is often recommended as an adjunct to clinical examination, but many people don’t have access to this.
● This is the main reason why the BSE is so vital, it is of no/low cost, and sufficient in replacement of modern technology. Surprisingly, a study done in North, South, East, and West Africa showed that it was very low for usage among women in South Africa and the highest usage in West Africa. A disadvantage of this examination though is that it needs to be performed in combination with the other screening methods [48, 50].
2. Efficacy of Existing Screening Protocols:
Studies have reported varying sensitivities and specificities of CBE and mammography in African populations. Possible harms of screening in the absence of linkage to care are prone to occur. The main issue resides in the gap between conducting good screening programs and appropriate follow-ups with diagnosis and treatment remains one of the major challenges of screening throughout Africa [51].
3. Emerging Technologies in Breast Cancer Screening:
3.1 Breast Ultrasound:
Breast ultrasound is often used as a supplementary imaging modality, particularly in situations where mammography is unavailable or inconclusive.
● It has yet to appear in underdeveloped regions of Africa but has started in the Southern portion. Nonradiologist clinicians (doctors and nurses) in a rural sub-Saharan African hospital built strong skills in diagnostic breast ultrasound over 23 months of combined in-person training and remote mentorship [52].
Efforts that should be made:
● According to an ABC-DO prospective cohort study that studied women older than 18, a large proportion of patients with non-metastatic breast cancer did not initiate, fully complete, or abandon treatment with surgery, systemic therapy, radiotherapy, or an appropriate combination of these. Studies of this type highlight the need for improved treatment access and completion throughout Africa to potentially prevent premature breast cancer deaths [41].
● Secondly, digital mammography tests should be more widespread and accessible. These tests offer conventional film-screen mammography and can enhance breast cancer detection in African settings wherever digital infrastructure is available. Wealthy countries should begin implementing in areas with digital access, which will hopefully trickle down over time [53].
● Next, Mobile Health (or mHealth) technologies should be put in place. Smartphone applications and text message reminders have shown promise in breast cancer awareness campaigns and in facilitating self-examination practices. Africa currently does not have them; however, the consideration of new technologies can show an exponential change in treatments [54].
● Lastly, Breast Self-Examination should be greatly encouraged in all the impoverished countries in Africa, because there is a high chance that vital funding will spread throughout the continent slowly. So, if women are taught how to self-examine and doctors and nurses are trained correctly, there is surely a chance that both the incident and mortality rates will decrease [43, 54].
Role of Lifestyle and Environmental Factors in Breast Cancer in Africa
1. Lifestyle Factors:
1.1 Dietary Patterns:
Certain dietary patterns have been associated with an increased risk of breast cancer. High consumption of processed and red meats, saturated fats, and sugary beverages, coupled with low intake of fruits, vegetables, and whole grains, may contribute to an elevated risk. In Africa, dietary patterns vary across countries and regions, influenced by cultural practices and the availability of food resources [55, 56].
Tribal groups in Africa have adjusted to eating whatever they have access to or hunting for food and additional resources. Common foods of these groups may be organic plant-based food (berries and nuts) with little meat, and fish often added for flavor. These are unrefined natural foods, which are healthy eating habits [57].
1.2 Physical Activity:
Insufficient engagement in regular physical activity has been associated with an increased risk of breast cancer. In Africa, varying levels of physical activity are observed due to differences in occupation, urbanization, and access to recreational facilities. Sedentary individuals are presented with the highest risk of developing breast cancer as obesity has close connections with the heart and body [28].
1.3 Reproductive Factors:
Reproductive factors, such as early age at first menstruation, nulliparity, and late menopause, have been linked to an increased risk of breast cancer, which has been observed mostly amongst the white population. Sociocultural factors and variations in reproductive behaviors across African countries and regions contribute to differences in breast cancer risk profiles. [58]
Childbirth can vary from region to region. Late child-bearing tends to contribute to the rise in breast cancer incidence, specifically in South Africa– predominantly among the white population [58]. However, in West Africa, early childbearing among the African-American population has projected a higher risk of developing breast cancer. According to work and tests facilitated by BCH in Sierra Leone has shown that the younger population (with early child-birth) was prone to risk.
The Breast Cancer Hub helps the women & men of Sierra Leone through collaboration with “The Thinking Pink Breast Cancer Foundation”. facilitating screening programs and patient treatment [46].© Breast Cancer Hub
2. Environmental Factors:
2.1 Hormonal Exposures:
Exposure to exogenous hormones, such as hormone replacement therapy and oral contraceptives, has been implicated in breast cancer development. However, the prevalence and impact of these exposures in Africa may vary based on factors such as availability, affordability, and cultural practices [60].
2.2 Environmental Pollution:
Exposure to environmental pollutants, including air pollution, pesticides, and industrial chemicals, may contribute to breast cancer risk. Africa faces various environmental challenges, including pollution from industries, improper waste disposal, and indoor air pollution from biomass fuel use, which may have implications for breast cancer incidence [58, 60].
2.3 Infectious Agents:
Breast cancer is a non-transmissible and noninfectious disease. Unlike some cancers that have infection-related causes, such as human papillomavirus (HPV) infection and cervical cancer, there are no known viral or bacterial infections linked to the development of breast cancer [61].
Lifestyle and environmental factors play a crucial role in breast cancer development and outcomes in Africa. Collaborative efforts involving policymakers, healthcare providers, and communities should be necessary [62].
Key Risk Factors in Areas Contributing to the Ongoing Breast Cancer Scenario
Breast cancer stems from mutations that are caused by a wide range of factors. Major causations come from UV radiation, smoking, radon exposure, and x-ray/gamma-ray radiation exposure. These factors are widespread and present in most parts of the world, as well as throughout Africa.
● The non-modifiable factors that can cause breast cancer include female sex, older age, family history, ethnicity/race, genetic mutation, pregnancy and breastfeeding, menstrual period and menopause, the density of breast tissue, previous history of breast cancer, non cancerous breast diseases and previous radiation therapy [65]. As for your menstrual cycles, women who give birth under the age of 30 are generally less prone to getting breast cancer. Bearing a child later on and breastfeeding them then, increases your risk [66]. This is true in some cases but may vary in specific regions, so conducting more research is key.
Breast cancer in North Africa is characterized by an early age of onset, with over 50% of patients diagnosed under the age of 50, compared to 20% in high-income countries (HICs) [67]. This could be attributed to genetic factors, such as BRCA1 and BRCA2 mutations, which have been reported in high frequency in this region [68)].
In East Africa, particularly Uganda and Kenya, breast cancer is the third most common cancer. The increased prevalence of breast cancer in East Africa is associated with lifestyle changes, including diet and physical inactivity [46, 68)]. Moreover, a higher prevalence of triple-negative breast cancer, a subtype associated with poorer prognosis, has been reported in East Africa [69].
In West Africa, the prevalence of breast cancer is relatively lower compared to North and East Africa. However, the mortality rates are high due to late presentation and lack of adequate diagnostic and treatment facilities [70]. Risk factors include high body mass index (BMI) and alcohol consumption, which are increasingly common in urban areas. One key factor that had been implicated in the increasing incidence of breast cancer in Africa and Nigeria, in particular, was the increasing adoption of Westernized lifestyles and behaviors resulting in changes in diet, later age of reproduction, and reduction in physical activity among the African population [71].
In Southern Africa, particularly South Africa, the breast cancer scenario is similar to that in HICs due to its more advanced healthcare system and urbanization. Risk factors in this region include reproductive factors (like late childbearing), hormone replacement therapy, and alcohol consumption [72]. Additionally, due to the high levels of sun exposure that people receive in this region, UV radiation presents a risk.
Data on breast cancer in Central Africa are relatively scant, but available evidence suggests that late-stage presentation is common. Additionally, late-stage presentation and inadequate healthcare facilities contribute significantly to the high mortality rates [68, 71, 72].
Socioeconomic Status’s Role in Breast Cancer Treatment throughout Africa
Although age and living conditions play a large factor in treatments, one’s degree of wealth and comfort contribute highly to their chances of obtaining this cancer and going through treatment. Due to the costs and access to treatments, lower socioeconomic status is associated with a higher breast cancer incidence and poorer outcomes in multiple underdeveloped countries. Factors such as limited access to healthcare, inadequate screening, and delayed diagnosis contribute to the disparities observed among different socioeconomic groups in Africa.
Multiple studies found that lower SES is often linked to delayed diagnosis, inadequate access to healthcare services, and poorer treatment outcomes for breast cancer patients in Africa.
● A study conducted by Adisa et al. (2012) in Nigeria found that women with a lower SES had a higher likelihood of delayed diagnosis of breast cancer compared to those with a higher SES. The study revealed that socioeconomic factors such as income, education level, and occupation influenced the delay in seeking medical care, which resulted in advanced stages of cancer at the time of diagnosis [73, 74].
● Another study by Pace et al. (2015) in South Africa revealed that women from lower socioeconomic backgrounds faced barriers such as financial constraints, lack of health insurance, transportation issues, and limited awareness of available treatment options. As a result, these women were less likely to receive timely and appropriate treatment [75].
● A systematic review conducted by Sighoko et al. (2017) found that women from lower SES backgrounds had lower overall survival rates compared to those from higher SES backgrounds. The authors suggested that this disparity could be attributed to differences in access to quality healthcare, including early detection programs, diagnostic facilities, and treatment centers [76].
On the other hand, a higher degree of wealth may provoke people to take part in alcohol consumption, smoking, eating a lot of food, etc. These activities can also cause people to be prone to the disease, so it goes both ways. During the past three decades, this situation has been changing: while the incidence of breast cancer remained lower among the higher SES group, mortality is now significantly higher among women of low SES relative to their high SES counterparts [76, 77].
In several studies, higher socioeconomic status (as measured by such factors as education, income, and housing) has been linked with higher breast cancer risks [78, 79]. Adult literacy rates, as reported by the Word Bank [80], show some correlation to breast cancer incidence (using data from GLOBOCAN, restricted to countries with adequate reporting [78]) but there are outliers, possibly reflecting imprecise measures (Figure 3).
Figure 3 shows that women in higher socioeconomic classes may have a high prevalence of breast cancer risk factors (e.g., late age at first birth, early menarche, late menopause, obesity, and heavy alcohol consumption [81]), although studies have not specifically evaluated this. It is also possible that disease ascertainment is more accurate among women of higher socioeconomic status.
Current Breast Cancer Treatment Accessibility in Africa
Treating breast cancer in Africa has caused obstacles due to discrepancies in healthcare infrastructure and resources. Multiple organizations and initiatives are working towards bridging these gaps and enhancing breast cancer management in Africa.
There are options in Africa in which someone can receive Breast Cancer Treatment depending on what stage they are in. Some of the treatment options are surgery, chemotherapy, hormonal, biological, and radiation therapy [82].
Around two-thirds of all SSA countries don’t have a radiotherapy facility, so many women have no choice but to get a mastectomy. Many women use alternative ways of treatment such as herbs, visiting native doctors, and attending prayer camps, this leads to a very poor prognosis. Another important piece of healthcare SSA is missing is trained health professionals who can help in cancer care and diagnosis [82].
Many citizens that live in SSA, are part of the lower socio-economic class, so they cannot afford treatment like chemo or radiotherapy. It is a whole lot cheaper for them to just get a mastectomy [82].
Countries such as Chad, Niger, and South Sudan often face challenges in providing cancer treatment options. Unfortunately, the majority of their populations do not have access to cancer care [83]. However, countries like South Africa, Nigeria, Kenya, and Ghana have equipped cancer treatment facilities and offer a wider array of treatments including surgery, chemotherapy, and radiation therapy as well as opportunities to participate in clinical trials. However, it's important to note that in these countries access to cancer care may be limited in some areas [83, 84].
North and South Africa have about 60% of all of Africa’s radiotherapy facilities, this shows how far drained the SSA is when it comes to the correct treatment facilities that could help prevent a lot of deaths [85].
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Interesting facts about African Countries affecting the Breast Cancer scenario
● Breast Cancer tends to occur at younger ages for women here when compared to their Western counterparts [86].
● Southern Africa had the highest incidence trend of Breast Cancer cases, but because of large amounts of unregistered data and numerous obstacles, they did not report the highest mortality [86].
● In certain cultures throughout the African Continent, getting a mastectomy to remove the cancer is seen as a sign of worthlessness, this discourages many from getting help in the early stages [86].
● In SSA the five-year breast cancer survival rate is less than 40% compared to the 86% in the USA [86].
● Some African countries have put a unique spin on breast cancer awareness by incorporating traditional African patterns and fabrics into awareness campaigns, making the message culturally relevant [87].
● Storytelling is an integral part of many African cultures. Some awareness campaigns use storytelling techniques, such as radio programs or community gatherings, to share personal stories of breast cancer survivors and emphasize the importance of early detection [87].
● Most Women living with the SSA are diagnosed in the late stages making the treatment more difficult, and expensive leading to a higher death rate [88].
● Because of cancer myths and big stigma, most cancer patients are abandoned by their families after their diagnosis [88].
● A big reason why many women in SSA get diagnosed in the advanced stages of Breast Cancer is because the health workers are not trained to identify signs or symptoms of the cancer either [88].
● Around 94,378 new cases of Breast Cancer are annually diagnosed in SSA [89].
● Studies have shown that a factor in why Breast Cancer cases might be growing in SSA is because the women there have adjusted their lifestyles that favor high incident rates [90].
● A study showed that a low intake of saturated fatty acid intake might be a factor in developing breast cancer in Tanzania [90].