Table 1.
Main characteristics of the 21 studies included in the review
| Author, year [ref no] | Country (sample size) | Hospital/clinic, location | Hospital/clinic-based catchment population∗ | Recruitment |
Eligibility criteria | Age (y) | Tumor characteristics |
Total quality score (max. score = 30) | |||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Type of hospital/clinic† | Type of sample‡ | Timing of§ | Time period | ||||||||||||
| First symptom(s) | Late stage‖ | Size (cm) | Grade | ER status/histology | |||||||||||
| Quantitative studies (n = 16) | |||||||||||||||
| North Africa (n = 8) | |||||||||||||||
| Ahmed, 2014 [11] | Sudan (n = 141) | National Cancer Institute, Wad Medani city | M (U: 55.6%; R: 44.4%) | T | C | Re | April 2009 to May 2010 | LABC who attended the breast clinic | Md: 46 Ra: 25–71 Me: 47 |
n/a | LABC (IIIA: 13.2%; IIIB: 78.5%; IIIC: 8.3%) | n/a | I: 2.1% II: 20.1% III: 77.8% |
ER+: 70.1% IDC: 77.1% |
14 |
| Aloulou, 2015 [12] | Morocco (n = 130) | Department of Radiotherapy, CHU Mohammed VI, Marrakech (public teaching hospital) | n/a | T | C | Re | Jan 2012 to Jan 2013 | Histologically confirmed BC | Me: 46 Ra: 20–78 |
Lump: 58.5%; ulceration: 16.2%; metastasis: 13.8%; inflammation: 11.5% | T2–T4: 75% | Me: 3.5 | II: 56% III: 28% |
IDC: 90% | 14 |
| Benbakhta, 2015 [13] | Morocco (n = 200) | Department of Radiotherapy, National Institute of Oncology, Rabat | U: 74% | T | C | P | Dec 2012 to May 2013 | Inclusion: all female patients with BC diagnosis treated at this institution, Moroccan nationality, provided written consent. Exclusion: those who had started neoadjuvant chemotherapy. |
Me ± SD: 49.1 ± 10.7 Ra: 25–82 |
Breast lump: 46% | III: 43%; IV: 3% | Me: 4.1 | n/a | n/a | 23 |
| El-Shinawi, 2013 [14] | Egypt (n = 45) | Ain Shams University Hospital Breast Clinic | M (Greater Cairo: 63%) | T | C | P | Feb 2010 to Dec 2010 | Inclusion: recently diagnosed BC patients (<6 mo). Exclusion: patients unaware of their disease, recurrence disease, poor general health (289 excluded) |
Md ± SD: 47 ± 10.2 Me ± SD: 48.2 ± 10.2 |
Painless breast mass: 57.8%; painful breast mass: 15.6% | n/a | n/a | n/a | n/a | 15 |
| Ermiah, 2012 [15] | Libya (n = 200) | African Oncology Institute (NOI), Sabratha | n/a | T | C | P | Jan 1, 2008 to Dec 31, 2009 | Female patients with BC diagnosed at NOI | Me: 45.4 Ra: 22–75 |
Lump: 68%; skin changes: 15.5%; nipple discharge: 13.5%; systemic: 3.0% | III: 54%; IV: 11.5% | T1 and T2 (≤5 cm): 40%; T3 and T4: 60% |
n/a | n/a | 19 |
| Landolsi, 2010 [16] | Tunisia (n = 160) | Dept. of Medical Oncology, Centre Hospitalier Universitaire Farhat Hached, Sousse | M (U: 37%; R: 63%) | T | C | P | Sept 1, 2005–March 31, 2006 | Patients presenting with a locally advanced (T3 or T4) or a metastatic BC | Me: 48 Ra: 27–85 |
n/a | T3: 25%; T4: 71%; M1: 24% | Me: 6.3 cm (range: 3–15 cm) | n/a | n/a | 18 |
| Mousa, 2011 [17] | Egypt (n = 163) | Tanta Cancer Center, Gharbiah province (the largest cancer center in the Nile delta region) | M (U: 36.8%; R: 63%) | T | C | P | Dec 2009 to Nov 2010 | Newly diagnosed BC cases | Md: 53 Me ± SD: 51.6 ± 11.5 |
Mass: 77.4%; pain: 7.6%; nipple discharge: 3.1%; increased breast size: 2.5%; axillary mass: 2.5%; other: 6.9% | III and IV: 60.9% | n/a | n/a | n/a | 25 |
| Stapleton, 2011 [9] | Egypt (n = 343) | National Cancer Institute, Cairo (n = 200) & Tanta Cancer Center, Gharbiah (n = 143) | M | T | C | P | July 2007 to Aug 2008 | Inclusion criteria: females with a newly diagnosed or treated BC between July 2007 and August 2008 recruited from chemotherapy outpatient clinics. Exclusion criteria: patients aged <18 y, pregnant or lactating, previous cancer diagnosis |
Me ± SD: 49.2 ± 10.9 (early stage) Me ± SD: 49.9 ± 11.0 (late stage) |
n/a | Late stage: 46.1% | n/a | n/a | n/a | 23 |
| Sub-Saharan Africa (n = 8) | |||||||||||||||
| Clegg-Lamptey, 2009 [18] | Ghana (n = 66) | Korle Bu Teaching Hospital | n/a | T | O | P | Sept 2007 to July 2008 | Newly diagnosed BC | Md: 43 Ra: 20–84 Me: 44.8 |
n/a | n/a | n/a | n/a | n/a | 16 |
| Ezeome, 2010 [19] | Nigeria (n = 162) | University of Nigeria Teaching Hospital Enugu | n/a | T | C | P | June 1999 to June 2001 and April 2003 to May 2005 | BC patients managed at the Surgical Oncology unit at the University of Nigeria Teaching Hospital Enugu who provided consent | Md: 45 Ra: 21–77 Me: 45.7 |
n/a | III: 40.8%; IV: 37.5% | n/a | n/a | n/a | 23 |
| Ibrahim, 2012 [20] | Nigeria (n = 201) | Lagos State University Teaching Hospital | U | T | C | P | Jan 2009 to Dec 2010 | All female BC patients referred to one of the general surgery outpatient clinics of Lagos State University Teaching Hospital | Me: 49.82 (SD: 13.59) Ra: 23–104 |
n/a | III: 62.7%; IV: 16.4% | n/a | n/a | n/a | 23 |
| Marcus, 2013 [21] | South Africa (n = 103) | Sebokeng Hospital, Gauteng | U | Level 2 public regional hospital | C | Re | Jan 2007 to Dec 2010 | All patients presenting at the breast clinic with advanced BC (IIB or higher) | Me: 59 Ra: 34–83 |
Breast lump: 84.5%; axillary node abnormal: 19.4%; abscess/ulcers: 7.8%; nipple discharge: 6.8%; pain: 4.9% (not mutually exclusive) | III–IV: 95.1% | n/a | n/a | n/a | 13 |
| Otieno, 2010 [22] | Kenya (n = 166; 98.8% females) | Kenyatta National Hospital | M | T | C | P | Oct 1, 2003 to 31 March, 2006 | Inclusion: all (male and female) patients who attended the breast clinic or were admitted to the three surgical wards with advanced BC (stages III/IV). Exclusions: patients with treated or recurrent BC |
Me: 47 Ra: 17–88 |
Breast lump: 87.3% | III/IV: 100% | n/a | n/a | n/a | 15 |
| Pace, 2015 [23] | Rwanda (n = 144) | Butaro and Rwinkwavu rural hospitals | R | S or T (n/a) | C | P | Nov 2012 to Feb 2014 | Inclusion: women aged ≥21 y with pathologically confirmed BC. Exclusions: women diagnosed elsewhere >6 mo without initial staging |
Md: 49 | Breast pain: 59% | III: 52%; IV: 24% | n/a | n/a | n/a | 25 |
| Price, 2012 [24] | Cameroon (n = 50 BC cases; includes other cancers) | Yaounde General Hospital—the only one in the country to offer chemotherapy | M | T | C | P | July 13, 2010 to Aug 12, 2010 | Patients aged ≥18 y with primary invasive BC (98% with histological confirmation) and who received chemotherapy; 96% female | Me: 46 Ra: 29–75 |
n/a | n/a | n/a | n/a | n/a | 20 |
| Toure, 2013 [25] | Cote d'Ivoire (n = 350) | University Hospital of Treichville, Abidjan | M | T | C | Re | Jan 2008 to Dec 2011 | Patients with a histologically confirmed adenocarcinoma of the breast | Me: 42 Ra: 18–81 |
Breast lump: 6%; inflammation: 54%; ulcer: 18%; nipple blood discharge: 8%; metastases: 14% | III: 76.3%; IV: 14.3% | n/a | n/a | Adenocarcinoma: 100% | 19 |
| Quantitative and qualitative studies (n = 2) | |||||||||||||||
| Dye, 2010 [26] | Ethiopia (n = 69; 98.1% females) | Tikur Anbessa Hospital | M | T | C | P | 2008 (1 mo only) | Randomly selected female and male BC patients seen at Tikur Anbessa Hospital over the span of 1 mo (similar characteristics to the total population). Patients or their families were interviewed. | Me: 44.5 | n/a | n/a | n/a | n/a | n/a | 10 |
| Ly, 2002 [27] | Mali (n = 44; 43 females) | Hôpital du Point-G, Bamako | M | T | C | P | Sep 15, 1998 to Aug 15, 2000 | Newly diagnosed and histologically confirmed BC patients (male and female) seen at the hematology/oncology service | Me (SD): 46 ± 19.5 Ra: 25–80 |
Breast lump: 39%; breast pain: 39%; pruritus (itching): 12%; nipple blood discharge: 6.8%; ulcer: 4.5% | III: 40.9%; IV: 45.5% | n/a | n/a | n/a | 7 |
| Qualitative studies (n = 3) | |||||||||||||||
| Ekortarl, 2007 [28] | Cameroon (n = 9 BC cases; 11 subjects with other types of cancer) | Yaounde General Hospital | M | T | O | P | n/a | Cancer patients who presented with advanced disease or who reappeared at an advanced stage after having abandoned treatment at the oncology division | Ra: 34–63 | n/a | Advanced BC: 100% | n/a | n/a | n/a | n/a |
| Mbuka-Ongona, 2012 [29] | Botswana (n = 11) | Princess Marina Hospital, Gaborone (the only hospital in the country with oncology services) | M | T | O | P | 2007 | Inclusion: all female adult BC patients seen and managed at Princess Marina Hospital. Exclusions: aged <18 y; too ill; or mentally incapacitated |
Me: 54 Ra: 37–76 |
Most common: painless lump; second most common: bloody nipple discharge | Majority stage III | n/a | n/a | n/a | n/a |
| Pruitt, 2015 [30] | Nigeria (n = 31) | University College Hospital Ibadan | M | T | C | P | July 2011 | All female BC patients seen in the radiotherapy and surgery clinics, aged ≥18 y, regardless of ethnicity, language, or stage. | Md: 51 Ra: 28–80 |
n/a | n/a | n/a | n/a | n/a | n/a |
BC = breast cancer; BSE = breast self-examination; CBE = clinical breast examination; CHU = Centre Hospitalier Universitaire; ER = estrogen receptor; IDC = invasive ductal carcinoma; IQR = interquartile range; LABC = locally advanced breast cancer; Md = median; Me = mean; n/a = not reported in the original publication; Ra = range.
∗
Population-based: urban (U), rural (R), mixed (M) area, or not reported (n/a).
†
Primary (P), secondary (S), or tertiary (T) hospital/clinic.
‡
Opportunistic (O) or consecutive (C) sample of patients.
§
Patients recruited prospectively (P) or retrospectively (Re).
‖
Stages III–IV (note: T2 can be staged as III A).