Int J Cancer. 2020 Nov 12. doi: 10.1002/ijc.33387. Online ahead of print.
The presence of pre-existing morbidities poses a challenge to cancer patient care. There is little information on the profile and prevalence of multi-morbidities in breast cancer patients across middle to lower income countries (MIC and LIC) in Sub-Saharan Africa (SSA). The African Breast Cancer-Disparities in Outcomes breast cancer cohort spans upper MICs South Africa and Namibia, lower MICs Zambia and Nigeria and LIC Uganda. At cancer diagnosis 7 morbidities were assessed: obesity, hypertension, diabetes, asthma/chronic obstructive pulmonary disease, heart disease, tuberculosis and HIV. Logistic regression models were used to assess determinants of morbidities and the influence of morbidities on advanced stage (stage III/IV) breast cancer diagnosis. Among 2189 women, morbidity prevalence was highest for obesity (35%, country-specific range 15-57%), hypertension (32%, 15-51%) and HIV (16%, 2-26%) then for diabetes (7%, 4-10%), asthma (4%, 2-10%), tuberculosis (4%, 0-8%) and heart disease (3%, 1-7%). Obesity and hypertension were more common in upper MICs and in higher socio-economic groups. Overall, 27% of women had at least 2 pre-existing morbidities. Older women were more likely to have obesity (odds ratio: 1.09 per 10 years, 95% CI 1.01-1.18), hypertension (1.98, 1.81-2.17), diabetes (1.51, 1.32-1.74) and heart disease (1.69, 1.37-2.09) and were less likely to be HIV positive (0.64, 0.58-0.71). Multi-morbidity was not associated with stage-at-diagnosis, with the exception of earlier stage in obese and hypertensive women. Breast cancer patients in higher income countries and higher social groups in SSA face the additional burden of pre-existing non-communicable diseases, particularly obesity and hypertension, exacerbated by HIV in Southern/Eastern Africa.