Background and Aims

Breast cancer survival rates in sub-Saharan Africa are low, but in other settings breast cancer has a good prognosis. An understanding of the determinants of poor breast cancer outcomes for patients with breast cancer in Africa will inform strategies to improve survival. Such strategies are especially needed now, in light of the expected demographic and lifestyle-related increases in the incidence burden over the next few decades.

The conceptual framework of ABC-DO is that a within-Africa comparison of breast cancer survival provides more informative and useful insights into differences in survival rates than can be achieved by comparisons with countries in other world regions. Comparisons between settings with more similar resources, none of which have general population-based breast cancer screening programmes, will identify settings with better survival prospects and the reasons for them, for later implementation elsewhere.

ABC-DO will examine the proximal and distal factors that explain poor breast cancer survival in sub-Saharan Africa. The aims of ABC-DO are:

• To measure survival rates for patients with breast cancer across public hospitals in different African settings.
  
  
• To identify determinants of breast cancer survival that account for within-setting, between-woman survival differences, and for between-setting differences. Proximal determinants will include stage, tumour biology, treatment received, age, anthropometry, and comorbidities.
  Distal factors will include socioeconomic status, culture, and health-care access and beliefs.
  
  
• To identify context-specific factors that can be targeted to most effectively improve breast cancer survival in Africa.
  
  
• To dissect the entire time-specified journey of a patient with breast cancer, from pre-diagnosis onwards to identify therapy components and their delays that influence breast cancer survival.
  
  
• To implement active follow-up after breast cancer diagnosis with low losses to follow-up using mobile phones and real-time mHealth technologies for data collection.
  
  

ABC-DO is funded by Susan G. Komen and the United States National Cancer Institute (R01 CA244559).