Dissecting the journey to breast cancer diagnosis in sub-Saharan Africa: Findings from the multi-country ABC-DO cohort study.

Most breast cancer patients in sub-Saharan Africa (SSA) are diagnosed at advanced stages after prolonged symptomatic periods. In the multi-country African Breast Cancer-Disparities in Outcomes cohort, we dissected the diagnostic journey to inform down-staging interventions. At hospital presentation for breast, women recalled their diagnostic journey, including dates of first noticing symptoms and healthcare provider (HCP) visits. Negative binomial regression models were used to identify correlates of the duration of the diagnostic journey. Among 1429 women, the median (IQR) length (months) of the diagnostic journey ranged from 11.3 (5.7-21.2) in Ugandan, 8.2 (3.4-16.4) in Zambian, 6.5 (2.4-15.7) in Namibian-black to 5.6 (2.3-13.1) in Nigerian and 2.4 (0.6-5.5) in Namibian non-black women. Time from first HCP contact to diagnosis represented, on average, 58%-79% of the diagnostic journey in each setting except Nigeria where most women presented directly to the diagnostic hospital with advanced disease. The median number of HCPs visited was 1 to 4 per woman, but time intervals between visits were long. Women who attributed their initial symptoms to cancer had a 4.1 months (absolute) reduced diagnostic journey than those who did not, whilst less-educated (none/primary) women had a 3.6 months longer journey than more educated women. In general, most settings the long journey to breast cancer diagnosis is not primarily due to late first-presentation but to prolonged delays after first-presentation to diagnosis. Promotion of breast cancer awareness and implementation of accelerated referral pathways for women with suspicious symptoms are vital to downstaging the disease in the region. This article is protected by copyright. All rights reserved.