title: Stage at diagnosis of breast cancer in sub-Saharan Africa: a systematic review and meta-analysis.
abstract: The incidence of breast cancer in sub-Saharan Africa is relatively low, but as survival from the disease in the region is poor, mortality rates are as high as in high-income countries. Stage at diagnosis is a major contributing factor to poor survival from breast cancer. We aimed to do a systematic review and meta-analysis on stage at diagnosis of breast cancer in sub-Saharan Africa to examine trends over time, and investigate sources of variations across the region.
  
  
  
  We searched MEDLINE, Embase, Web of Knowledge, and Africa-Wide Information to identify studies on breast cancer stage at diagnosis in sub-Saharan African women published before Jan 1, 2014, and in any language. Random-effects meta-analyses were done to investigate between-study heterogeneity in percentage of late-stage breast cancer (stage III/IV), and meta-regression analyses to identify potential sources of variation. Percentages of women with late-stage breast cancer at diagnosis in sub-Saharan Africa were compared with similar estimates for black and white women in the USA from the Surveillance, Epidemiology, and End Results database.
  
  
  
  83 studies were included, which consisted of 26 788 women from 17 sub-Saharan African countries. There was wide between-study heterogeneity in the percentage of late-stage disease at diagnosis (median 74·7%, range 30·3-100%, I2=93·3%, p<0·0001). The percentage of patients with late-stage disease at diagnosis did not vary by region in black women, but was lower in non-black women from southern Africa than in black women in any region (absolute difference [AD] from black women in western Africa [reference group] -18·1%, 95% CI -28·2 to -8·0), and higher for populations from mixed (urban and rural) settings rather than urban settings (13·2%, 5·7 to 20·7, in analyses restricted to black women). The percentage of patients with late-stage disease at diagnosis in black Africans decreased over time (-10·5%, -19·3 to -1·6; for 2000 or later vs 1980 or before), but it was still higher around 2010 than it was in white and black women in the USA 40 years previously.
  
  
  
  Strategies for early diagnosis of breast cancer should be regarded as a major priority by cancer control programmes in sub-Saharan Africa.
  
  
  
  None.
authors.affiliation: Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Institute of Human Virology, Abuja, Nigeria.
authors.forename: Elima
authors.initials: E
authors.lastname: Jedy-Agba
authors.affiliation: Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France.
authors.forename: Valerie
authors.initials: V
authors.lastname: McCormack
authors.affiliation: Department of Epidemiology and Public Health, University of Maryland Marlene and Stewart Greenebaum Comprehensivew Cancer Center, Baltimore, MD, USA; Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Clement
authors.initials: C
authors.lastname: Adebamowo
authors.affiliation: Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK. Electronic address: isabel.silva@lshtm.ac.uk.
authors.forename: Isabel
authors.initials: I
authors.lastname: Dos-Santos-Silva
mesh_terms: D017954:Africa South of the Sahara / Q000453:epidemiology; D044383:Black People; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D015994:Incidence; D009367:Neoplasm Staging; D016387:Women's Health