ArticlePloS one2023
Drivers of disparities in stage at diagnosis among women with breast cancer: South African breast cancers and HIV outcomes cohort.
Article in PloS one, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 2 of them syntheses that pooled it.
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Who cites it
15 citing papers in PubMed, 2 syntheses or guidelines pooled it, 9 citations in OpenAlex.
- Where do delays occur? A systematic review of the barriers to early breast cancer diagnosis across South Africa's health system.BMJ open · 2026Pooled it
- Stage at Diagnosis and Molecular Subtype Distribution of Breast Cancer in Sub-Saharan Africa: A Systematic Review.Cancer reports (Hoboken, N.J.) · 2026Pooled it
- Impact of and recovery after Covid-19 on breast cancer diagnosis and care in Johannesburg, South Africa.BMC cancer · 2026Article
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- Article
- Impact of socioeconomic status on tumor stage, molecular subtype distribution, treatment adherence, and survival outcomes in breast cancer.Frontiers in oncology · 2026Article
- Factors Associated with Delays in Breast Cancer Diagnosis in Low- and Middle-income Countries: A Scoping Review.International journal of community based nursing and midwifery · 2026Review
- Overall survival, poverty differentials, and mediating pathways among women with breast cancer: South African Breast Cancer and HIV Outcomes cohort.The oncologist · 2025Article
- Bone Mineral Density in Black South African Women Newly Diagnosed With Breast Cancer Living With and Without HIV.JCO global oncology · 2025Article
- Article
- Review
- Article
- Breast cancer in women by HIV status: A report from the South African National Cancer Registry.PloS one · 2024Article
- The Sociocultural Influences on Breast Cancer Screening among Rural African Women in South Africa.International journal of environmental research and public health · 2023Article
- The South African breast cancer and HIV outcomes study: Profiling the cancer centres and cohort characteristics, diagnostic pathways, and treatment approaches.PLOS global public health · 2023Article
Corrections and comments
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Authors and funding
19 authors at 7 institutions in 4 countries.
Funding
Abstract
objectiveIn low- and middle-income countries (LMICs), advanced-stage diagnosis of breast cancer (BC) is common, and this contributes to poor survival. Understanding the determinants of the stage at diagnosis will aid in designing interventions to downstage disease and improve survival from BC in LMICs.
methodsWithin the South African Breast Cancers and HIV Outcomes (SABCHO) cohort, we examined factors affecting the stage at diagnosis of histologically confirmed invasive breast cancer at five tertiary hospitals in South Africa (SA). The stage was assessed clinically. To examine the associations of the modifiable health system, socio-economic/household and non-modifiable individual factors, hierarchical multivariable logistic regression with odds of late-stage at diagnosis (stage III-IV), was used.
resultsThe majority (59%) of the included 3497 women were diagnosed with late-stage BC disease. The effect of health system-level factors on late-stage BC diagnosis was consistent and significant even when adjusted for both socio-economic- and individual-level factors. Women diagnosed in a tertiary hospital that predominantly serves a rural population were 3 times (OR = 2.89 (95% CI: 1.40-5.97) as likely to be associated with late-stage BC diagnosis when compared to those diagnosed at a hospital that predominantly serves an urban population. Taking more than 3 months from identifying the BC problem to the first health system entry (OR = 1.66 (95% CI: 1.38-2.00)), and having luminal B (OR = 1.49 (95% CI: 1.19-1.87)) or HER2-enriched (OR = 1.64 (95% CI: 1.16-2.32)) molecular subtype as compared to luminal A, were associated with a late-stage diagnosis. Whilst having a higher socio-economic level (a wealth index of 5) reduced the probability of late-stage BC at diagnosis, (OR = 0.64 (95% CI: 0.47-0.85)).
conclusionAdvanced-stage diagnosis of BC among women in SA who access health services through the public health system was associated with both modifiable health system-level factors and non-modifiable individual-level factors. These may be considered as elements in interventions to reduce the time to diagnosis of breast cancer in women.
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