Epidemology of Breast Cancer:Risk Factors,Treatment Adherenceand Outcome of Breast Cancer Patients Attending Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
| dc.contributor.advisor | Ali,Ahmed (PhD) | |
| dc.contributor.advisor | Tsegaye,Aster(PhD) | |
| dc.contributor.advisor | Addissie,Adamu(PhD) | |
| dc.contributor.advisor | Taye,Girma (PhD) | |
| dc.contributor.advisor | Assefa,Mathewos (MD) | |
| dc.contributor.author | Hassen,Fatuma(Phd) | |
| dc.date.accessioned | 2025-08-13T07:49:50Z | |
| dc.date.available | 2025-08-13T07:49:50Z | |
| dc.date.issued | 2023-09 | |
| dc.description.abstract | Background: Breast cancer is the most common cancer and the leading cause of cancer deaths among women worldwide. In resource-limited nations, the combination of late presentation, low survival rates, a poor health care system, and a lack of health care financing resource contribute to the population's perception that treatments for breast cancer are ineffective or unavailable, thereby causing more delay in diagnosis and treatment. Adherence has been identified as a primary determinant of patient outcome and clinical benefit. In Ethiopia, breast cancer is one of the most commonly diagnosed cancers among women. However, due to constrained health resources and poor awareness among the population, most patients did not visit health facilities for early diagnosis and treatment. As a result, most patients did not benefit from treatment since most Ethiopian women are frequently diagnosed at an advanced stage. Moreover, non-adherence to chemotherapy is not well investigated in patients attending their treatment in Addis Ababa, Ethiopia. Objective: The objective of the study was to assess the epidemiology of breast cancer among patients treated at the Oncology Department, Tikur Anbessa Specialized Hospital, and Addis Ababa, Ethiopia. Methods: The study applied multiple epidemiologic designs. A case-control study was conducted from May 2018 to June 2019. A total of 230 cases and 230 controls (care givers) participated in order to assess the sociodemographic and hematologic profiles and risk factors for breast cancer. The cross-sectional study was conducted among 164 breast cancer patients taking chemotherapy. In addition, secondary data were also collected to assess the outcome of breast cancer patients treated from September 2010 to August 2014 at TASH. Data were collected using face-to-face interviews, chart reviews, and telephone interviews. An independent student t- test was performed to compare the mean hematological parameters. A chi-square test was done to see if there was a significant difference in hematologic parameters between cases and controls. A binary logistic regression analysis was conducted to examine the association between potential risk factors and breast cancer. A multivariable logistic regression model-based analysis was conducted to control the effect of potential confounding factors. Median ages at diagnosis and the interquartile range (IQR) were calculated. Based on life table analysis, one-, three-, five-, and 10-year overall survival rates were calculated. Median survival estimates were obtained using the xv Kaplan-Meier survival analysis method. Survival curves were compared using the log-rank statistic. Cox's proportional hazards model was used for bivariate and multivariable analyses. Results: The mean (+ SD) ages of study patients for the case-control study were 42.8 (+12.1) and 39.3 (+11.1) years for cases and controls (caregivers of cancer patients), respectively. Nearly half, or 100 (43.5%) of patients and 34 (14.8%) of controls, did not have any formal education. Moreover, the majority, 175 (76.1%) of cases and 155 (67.4%) of controls, were married. The mean values of most hematological parameters were significantly lower among cases. Moreover, the mean platelet count was higher among cases. However, there was no significant difference in the total white cell count among cases and controls. On the other hand, nearly half, 89 (46.6%) cases and 96 (41.7%) controls, were blood group O. Blood group AB was the least common, accounting for 19 (9.9%) and 20 (8.7%) of the cases and controls, respectively. However, a statistically significant association was not found between breast cancer and the ABO or Rh blood type. Based on risk factor analysis, the odds of breast cancer were higher among illiterate women (AOR: 2.57; 95% CI: 1.38–4.99) and among those who were unemployed (AOR: 3.78; 95% CI: 1.46–9.78; P = 0.006) as compared to educated and employed women. However, the odds of breast cancer were 0.19 times lower among pre-obese women (AOR. 0.19(95%CI: 0.19; 95% CI: 0.043–0.826) compared to underweight women. Based on factors related to life style, consumption of oil solid at room temperature was associated with breast cancer (AOR: 3.50, 95% CI: 2.18–5.62, P<0.001). In addition, women who used animal dung or wood as a source of fuel had higher odds of breast cancer (AOR: 4.91, 95% CI: 2.72–8.86, P<0.001) compared to women who used electricity as a source of fuel. Moreover, women who had previous benign surgery, post-menopausal women, and women with early menarche (<12 years) had significantly higher odds of breast cancer as compared to women who had no previous benign surgery, premenopausal women, and menarche >15 years, respectively. While women who had moderate physical activities had significantly lower odds of breast cancer as compared to women who had no moderate physical activities, In the study that investigates adherence to chemotherapy, among 164 breast cancer patients, 137 (83.5%) were adherent to their chemotherapy. Severe illness was one of the main reasons for non-adherence. Distance from the referral center and types of xvi recommended treatment regimens were significantly associated with non-adherence. For survival analysis, our retrospective cohort study included a total of 402 patients, with a median [IQR] age at diagnosis of patients 43[35–50] years. The median follow-up time was 58.3 months. By the end of follow-up, 233 (58%) of the patients were dead. The five- and ten-year survival rates were 50% and 34%, respectively. Based on multivariable cox regression analysis, advanced stage at diagnosis (HR = 3.84; 95% CI 2.00–7.35, P< 0.001) and cancer metastasized tumor 1.79 (95% CI 1.13-2.83, P = 0.012) were significantly associated with a higher risk of death. Conclusion and recommendations: Based on the findings of the case-control study, illiterate women had higher odds of breast cancer. As compared to controls, the majority of the hematological profiles of patients were significantly lower. The study demonstrated there was no significant association between the ABO/Rh blood group and breast cancer. The result of the risk factors for breast cancer revealed that occupational status, using wood or animal dung as a source of fuel, consumption of solid oil, menopausal status, early menarche, and previous benign breast surgery were linked with breast cancer. While women with a history of moderate physical exercise had lower odds of breast cancer. Regarding level of adherence, good adherence to chemotherapy was observed among 137 (83.5%). The most identified factor for non-adherence was the severity of the illness. The study also indicated a relatively poor survival rate, which was associated with a late-stage diagnosis and metastasizing cancer. Based on the findings, we recommend that attention be given to high-risk breast cancer groups and those with designated hematologic abnormalities. Efforts should be exerted for further study with a large sample size in order to establish the purpose of the ABO blood group in the prognosis of breast cancer. There is also a need to design applicable interventions to inform women about lifestyle changes to decrease breast cancer risk in high-risk groups. Since distance, transportation cost, and access to health care are the most important factors that determine adherence to chemotherapy, the extension of cancer screening and treatment centers should be encouraged. Moreover, there is a need for strengthening public awareness and mass screening to enhance early initiation of treatment, reduce advanced stages, and improve the survival of patients. | |
| dc.identifier.uri | https://etd.aau.edu.et/handle/123456789/6667 | |
| dc.language.iso | en_US | |
| dc.publisher | Addis Ababa University | |
| dc.subject | Breast cancer | |
| dc.subject | hematological profiles | |
| dc.subject | risk factors | |
| dc.subject | adherence | |
| dc.subject | survival | |
| dc.title | Epidemology of Breast Cancer:Risk Factors,Treatment Adherenceand Outcome of Breast Cancer Patients Attending Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia | |
| dc.type | Thesis |