Breast cancer in sub-Saharan African women

Abstract

The literature on breast cancer in sub-Saharan women is reviewed. In general, breast cancer is the second most common malignancy of women in the region, after cancer of the uterine cervix. Available reports indicate that data on the disease are incomplete and mostly, of epidemiological or clinical nature. Breast cancer is less common in sub-Saharan Africa compared to the Western countries (USA or Europe), occurs in younger individuals with peak incidences about a decade younger and the majority present late, with advanced, sometimes terminal disease. Absence of health educational programmes on cancer as well as lack of screening facilities in nearly all countries in the region are contributory factors to the late presentation of the cases. The need for more in-depth studies of the disease in the black African population has been highlighted.

Although epidemiologic studies of breast cancer in sub-Saharan Africa are not available, the disease is considered the second most prevalent cancer among Black women in the region (exceeded only by cervical cancer). In Africa, as in the rest of the world, infiltrating duct carcinoma is the most common histologic type. Observed has been a trend toward relatively young age at diagnosis and presentation at late stages of disease progression. Early age at first birth and breast feeding--associated with a reduced risk of breast cancer in white women--do not appear to exert a protective effect among African women. Contributing to the late presentation of breast cancer cases is the lack of educational programs on breast self-examination and screening technologies such as mammography. Also unavailable are standard methods of treatment such as radiation, chemotherapy, and hormone receptor assay. The prognosis for women with breast cancer in sub-Saharan Africa is quite poor due to the advanced stage of most cases, poor patient compliance, the lack of treatment options, poor drug supplies, inadequate transportation, and a shortage of trained personnel.