From: Breast cancer screening in sub-Saharan Africa: a systematic review and ethical appraisal
Author (year), country | Screening protocol, interval, longest follow-up | Participants, n study group ; control group | Age at enrollment (years) | Relevant screening outcomes metrics measured and findings |
---|---|---|---|---|
Apffelstaedt [18] (2008), RSA | Mammography, retrospective review of a prospective cohort of opportunistic mammography screening Interval: NR Longest follow-up: NR | 7638 | Age ≥ 40 | Cancer cases diagnosed: 7.2/1000 examinations |
Abuidris [19] (2013), Sudan | CBE, conducted by trained local volunteers chosen from the community, using a cluster randomized design Interval: NR Longest follow-up: 34 months | 14,788; 24,550 | Age ≥ 18 | Cancer cases diagnosed: 9 malignant + 8 DCIS (per 10,309 in the study group) vs 3 + 0 respectively control group; ~ < 1/1000 examinations |
Brakohiapa [20] (2013), Ghana | Mammography, retrospective review of opportunistic mammography screening Interval: NR Longest follow-up: 1 year | 106 | NR | Cancer cases diagnosed: 6 IDC and 0 DCIS in the mammography screening group; ~ 56/1000 examinations |
Luyeye Mvila [21] (2014), DRC | CBE, conducted by trained healthcare professionals, as part of a breast awareness campaign Interval: NR Longest follow-up: 34 months | 4315 (CBE); 1113 (mammography)a | Age ≥ 18 | Cancer cases diagnosed: 87 malignant + 13 DICS; Stage shifting: 24% Stage I & II; 75% stage III |
Apffelstaedt [22] (2014), RSA | Mammography, utilizing opportunistic screening in a mobile breast screening unit Interval: NR Longest follow-up: 18 months | 2712 | Age ≥ 40 | Cancer cases diagnosed: 3.71/1000 examinations |
Apffelstaedt [23] (2014), RSA | Mammography, retrospective review of a prospective cohort of opportunistic mammography screening Interval: NR Longest follow-up: NR | 3774 | Age ≥ 40 | Cancer cases diagnosed: 11.4/1000 examinations |
Ngoma [24] (2015), Tanzania | CBE, conducted by trained lay personnel in a cluster randomized design Interval: annually Longest follow-up: 3 years | Y1 6686; 3915b Y2 6534; 3915 Y3 6241; 3915 | NR | Stage Shifting: Stage I&II in year 1,2 & 3 in the study group vs control group = 0,%, 33%, 50% (p = NS) vs 9%, 60%, 67% (p = 0.021) Total expenditure: $45,000 / year |
Gutnik [25] (2016), Malawi | CBE, conducted by trained laywomen as breast health workers (BHW), in the clinic setting Screening interval: NR Longest follow-up: NR | 1000 | Age > 30 | Cancer cases diagnosed*: 2 per 1000 examinations PPV of CBE exam: 48% for BHW compared to physician exam |
Sayed [26] (2016), Kenya | CBE, conducted by healthcare professionals in “breast awareness camps in the hospital setting Screening interval: NR Longest follow-up: NR | 833 | Age ≥ 15 | Cancer cases diagnosed: 2 per 1000 exams in asymptomatic women |
Omidiji [27] (2017), Nigeria | Mammogram vs ultrasound, conducted by radiologists. self-controlled cross-sectional design Screening interval: NR Longest follow-up: NR | 300 | Age 30—60 | Cancer cases diagnosed: 1 IDC and 6 DCIS per 300 asymptomatic women; 3.3 per 1000 examinations Positive predictive value: 33.3% for ultrasound compared with mammogram |
Pinder [28] (2018), Zambia | CBE, conducted by trained healthcare professionals Interval: NR Longest follow-up: NR | 1955 | NR | Cancer cases diagnosed: < 1% diagnosed with invasive cancer (17/1955); ~ 8.7 / 1000 examinations |
Ginsberg [29] (2012), SSA | Mammography, cost effectiveness of mammography screening in a mathematically modelling study using WHO-CHOICE methods Interval: biennial Longest follow-up: NA | c | 50—70 | CEA: Biennial screening mammography + treatment of all stages cost between $Int2248 and $Int4596 per DALY averted |
Zelle [30] (2012), Ghana | CBE, conducted by trained community nurses and screening mammography in a mathematical modelling study using WHO-CHOICE methods Interval: Biennial Longest follow-up: NA | d | 40–69 (CBE) 50–69; 40–69 (Mammography) | CEA: Biennial CBE in women aged 40–69 + treatment for all stages seems the most cost effective—$1299 per DALY averted |
Ralaidovy (2018), Eastern SSA [31] | Mammography, using “Generalized Cost-Effectiveness Analysis” Interval: Biennial Longest follow-up: NA | e | 50–69 | ICER: Biennial mammography in women 50–69 linked with timely diagnosis and treatment at 95% coverage – I$485 per HLY gained |
Birnbaum [32] (2018), E. Africa (Uganda) | CBE, combined with multiple treatment strategies to assess breast cancer outcomes Interval: Annual Longest follow-up: 10-year cumulative outcomes | f | 30 – 49 50—69 | ARR: 113 (per 100,000 women) YLS: 418 (per 1000,000 women) |