Abstract
Introduction
Breast cancer is the most commonly diagnosed cancer among women worldwide and a leading cause of cancer-related mortality. Survival varies across regions, with most deaths occurring in low- and middle-income countries due to limited early detection and treatment access. This study aimed to estimate the 5-year survival rate and identify determinants of decreased survival among patients with breast cancer in Africa.
Methods
A systematic review of only retrospective cohort studies was conducted using PubMed, Hinari, EMBASE, Google Scholar, African Journals Online, African Index Medicus and Web of Science. The literature search was conducted for a 1-month duration (1–30 November 2024). We included all available articles without restriction on publication date to ensure a comprehensive review. Methodological quality was assessed using the Newcastle-Ottawa 2016 Critical Appraisal Checklist. Publication bias was evaluated using funnel plots and Egger’s test, and heterogeneity was assessed with the I
2
test. Data were analysed with Stata V.17.
Results
55 articles with 19 577 participants from 19 countries were included; 37 studies (4622 participants) were used to estimate pooled 5-year survival. The pooled 5-year survival rate of patients with breast cancer in Africa was 40.38% (95% CI 33.92 to 46.83%). Reduced survival was strongly associated with tumour characteristics, including tumour stage >2 (HR 3.06, 95% CI 2.02 to 4.09), negative oestrogen receptor status (HR 2.52, 95% CI 1.89 to 3.15), tumour size >5 cm (HR 1.62, 95% CI 1.48 to 1.76), positive nodal status (HR 1.64, 95% CI 1.58 to 1.70) and higher histological grade (HR 1.26, 95% CI 1.22 to 1.29). Treatment-related factors such as single-agent chemotherapy (HR 1.78, 95% CI 1.04 to 2.53) and patient-related factors, including comorbidities (HR 1.45, 95% CI 1.40 to 1.50) and illiteracy (HR 6.54, 95% CI 4.39 to 8.69), were also associated with reduced survival.
Conclusion
This study reveals a critically low 5-year survival rate of 40.4% for breast cancer in Africa. Poor survival is linked to advanced tumour features, suboptimal treatment and patient-related factors, with comorbidities and illiteracy being the strongest patient-related factors. These results highlight the urgent need for integrated strategies focused on early diagnosis, public education, equitable access to multimodal therapies and systematic management of comorbidities across the continent.
PROSPERO registration number
CRD420261387399.