Prevalence and Determinants of Breast Cancer Screening in Four Sub-Saharan African Countries: a Population-based Study

Overview

Journal BMJ Open

Specialty General Medicine

Date 2020 Oct 13

PMID 33046473

Citations 30

Authors

Djibril M Ba

Paddy Ssentongo

Edeanya Agbese

Yanxu Yang

Ramata Cisse

Brehima Diakite

Cheick Bougadari Traore

Bakarou Kamate

Yaya Kassogue

Guimogo Dolo

Etienne Dembele

Hama Diallo

Mamoudou Maiga

Affiliations

Soon will be listed here.

Abstract

Objectives: Breast cancer is the most prevalent cancer and the second leading cause of cancer-related deaths among women after cervical cancer in much of sub-Saharan Africa. This study aims to examine the prevalence and sociodemographic-socioeconomic factors associated with breast cancer screening among women of reproductive age in sub-Saharan Africa.

Design: A weighted population-based cross-sectional study using Demographic and Health Surveys (DHS) data. We used all available data on breast cancer screening from the DHS for four sub-Saharan African countries (Burkina Faso, Ivory Coast, Kenya and Namibia). Breast cancer screening was the outcome of interest for this study. Multivariable Poisson regression was used to identify independent factors associated with breast cancer screening.

Setting: Four countries participating in the DHS from 2010 to 2014 with data on breast cancer screening.

Participants: Women of reproductive age 15-49 years (N=39 646).

Results: The overall prevalence of breast cancer screening was only 12.9% during the study period, ranging from 5.2% in Ivory Coast to 23.1% in Namibia. Factors associated with breast cancer screening were secondary/higher education with adjusted prevalence ratio (adjusted PR)=2.33 (95% CI: 2.05 to 2.66) compared with no education; older participants, 35-49 years (adjusted PR=1.73, 95% CI : 1.56 to 1.91) compared with younger participants 15-24 years; health insurance coverage (adjusted PR=1.57, 95% CI: 1.47 to 1.68) compared with those with no health insurance and highest socioeconomic status (adjusted PR=1.33, 95% CI : 1.19 to 1.49) compared with lowest socioeconomic status.

Conclusion: Despite high breast cancer mortality rates in sub-Saharan Africa, the prevalence of breast cancer screening is substantially low and varies gradually across countries and in relation to factors such as education, age, health insurance coverage and household wealth index level. These results highlight the need for increased efforts to improve the uptake of breast cancer screening in sub-Saharan Africa.

Citing Articles

Multifaceted barriers associated with clinical breast examination in sub-Saharan Africa: A multilevel analytical approach.

Ayebeng C, Okyere J, Okantey C, Addo I PLoS One. 2025; 20(1):e0316800.

PMID: 39804868 PMC: 11730425. DOI: 10.1371/journal.pone.0316800.

Clinical breast examination and its associated factors among reproductive age women in Ghana: multilevel logistic regression analysis.

Gebreegziabher Z, Semagn B, Walle A, Belay M, Wondie W, Degefaw G Front Oncol. 2025; 14():1413076.

PMID: 39777338 PMC: 11703916. DOI: 10.3389/fonc.2024.1413076.

Prevalence and determinants of pregnancy termination for childbearing women using the modified Poisson regression model: a cross-sectional study of the Tanzania Demographic and Health Survey (TDHS) 2022.

Mbona S, Chifurira R, Ndlovu B, Ananth A BMC Public Health. 2025; 25(1):56.

PMID: 39773354 PMC: 11706135. DOI: 10.1186/s12889-024-21203-3.

Determinants of breast cancer screening among women of reproductive age in sub-Saharan Africa: A multilevel analysis.

Seifu B, Mekuria Negussie Y, Asnake A, Daba Chinkey F, Fente B, Asmare Z PLoS One. 2024; 19(12):e0312831.

PMID: 39729464 PMC: 11676565. DOI: 10.1371/journal.pone.0312831.

Awareness and its determinant factors towards breast examination to detect breast cancer among reproductive age women in Kenya: Multi level analysis of the recent demographic and health survey data.

Wassie M, Zegeye A, Aemro A, Terefe B, Zeleke G, Workneh B PLoS One. 2024; 19(12):e0314700.

PMID: 39637069 PMC: 11620592. DOI: 10.1371/journal.pone.0314700.

References

Spiegelman D, Hertzmark E . Easy SAS calculations for risk or prevalence ratios and differences. Am J Epidemiol. 2005; 162(3):199-200. DOI: 10.1093/aje/kwi188. View

. Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2009; 151(10):716-26, W-236. DOI: 10.7326/0003-4819-151-10-200911170-00008. View

Black E, Richmond R . Improving early detection of breast cancer in sub-Saharan Africa: why mammography may not be the way forward. Global Health. 2019; 15(1):3. PMC: 6325810. DOI: 10.1186/s12992-018-0446-6. View

Ssentongo P, Lewcun J, Candela X, Ssentongo A, Kwon E, Ba D . Regional, racial, gender, and tumor biology disparities in breast cancer survival rates in Africa: A systematic review and meta-analysis. PLoS One. 2019; 14(11):e0225039. PMC: 6872165. DOI: 10.1371/journal.pone.0225039. View

Titilayo A, Palamuleni M, Olaoye-Oyesola J, Owoeye O . Religious Perceptions and Attitudes of Men towards Discontinuation of Female Genital Cutting in Nigeria: Evidence from the 2013 Nigeria Demographic and Health Survey. Afr J Reprod Health. 2018; 22(1):20-28. DOI: 10.29063/ajrh2018/v22i1.2. View

Ba D, Ssentongo P, Agbese E, Kjerulff K . Prevalence and predictors of contraceptive use among women of reproductive age in 17 sub-Saharan African countries: A large population-based study. Sex Reprod Healthc. 2019; 21:26-32. DOI: 10.1016/j.srhc.2019.06.002. View

Kisuya J, Wachira J, Busakhala N, Naanyu V, Chite A, Omenge O . Impact of an educational intervention on breast cancer knowledge in western Kenya. Health Educ Res. 2015; 30(5):786-96. DOI: 10.1093/her/cyv043. View

Viens L, Perin D, Senkomago V, Neri A, Saraiya M . Questions About Cervical and Breast Cancer Screening Knowledge, Practice, and Outcomes: A Review of Demographic and Health Surveys. J Womens Health (Larchmt). 2017; 26(5):403-412. PMC: 5530254. DOI: 10.1089/jwh.2017.6441. View

Korir A, Okerosi N, Ronoh V, Mutuma G, Parkin M . Incidence of cancer in Nairobi, Kenya (2004-2008). Int J Cancer. 2015; 137(9):2053-9. DOI: 10.1002/ijc.29674. View

10.

Lipschitz S . Screening mammography with special reference to guidelines in South Africa. SA J Radiol. 2019; 22(2):1370. PMC: 6837783. DOI: 10.4102/sajr.v22i2.1370. View

11.

Mishra V, Vaessen M, Boerma J, Arnold F, Way A, Barrere B . HIV testing in national population-based surveys: experience from the Demographic and Health Surveys. Bull World Health Organ. 2006; 84(7):537-45. PMC: 2627390. DOI: 10.2471/blt.05.029520. View

12.

Gebremariam A, Addissie A, Worku A, Assefa M, Pace L, Kantelhardt E . Time intervals experienced between first symptom recognition and pathologic diagnosis of breast cancer in Addis Ababa, Ethiopia: a cross-sectional study. BMJ Open. 2019; 9(11):e032228. PMC: 6858206. DOI: 10.1136/bmjopen-2019-032228. View

13.

Lunani L, Abaasa A, Omosa-Manyonyi G . Prevalence and Factors Associated with Contraceptive Use Among Kenyan Women Aged 15-49 Years. AIDS Behav. 2018; 22(Suppl 1):125-130. PMC: 6132050. DOI: 10.1007/s10461-018-2203-5. View

14.

Bray F, Ferlay J, Soerjomataram I, Siegel R, Torre L, Jemal A . Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; 68(6):394-424. DOI: 10.3322/caac.21492. View

15.

Berry D, Cronin K, Plevritis S, Fryback D, Clarke L, Zelen M . Effect of screening and adjuvant therapy on mortality from breast cancer. N Engl J Med. 2005; 353(17):1784-92. DOI: 10.1056/NEJMoa050518. View

16.

Ba D, Ssentongo P, Kjerulff K, Na M, Liu G, Gao X . Adherence to Iron Supplementation in 22 Sub-Saharan African Countries and Associated Factors among Pregnant Women: A Large Population-Based Study. Curr Dev Nutr. 2019; 3(12):nzz120. PMC: 6867960. DOI: 10.1093/cdn/nzz120. View

17.

Magadi M, Madise N, Rodrigues R . Frequency and timing of antenatal care in Kenya: explaining the variations between women of different communities. Soc Sci Med. 2000; 51(4):551-61. DOI: 10.1016/s0277-9536(99)00495-5. View

18.

Gabe R, Duffy S . Evaluation of service screening mammography in practice: the impact on breast cancer mortality. Ann Oncol. 2005; 16 Suppl 2:ii153-62. DOI: 10.1093/annonc/mdi718. View

19.

Abuidris D, Elsheikh A, Ali M, Musa H, Elgaili E, Ahmed A . Breast-cancer screening with trained volunteers in a rural area of Sudan: a pilot study. Lancet Oncol. 2013; 14(4):363-70. DOI: 10.1016/S1470-2045(12)70583-1. View

20.

Akinyemiju T . Socio-economic and health access determinants of breast and cervical cancer screening in low-income countries: analysis of the World Health Survey. PLoS One. 2012; 7(11):e48834. PMC: 3498259. DOI: 10.1371/journal.pone.0048834. View