Evolution of stage at diagnosis of breast cancer over three consecutive 5-year periods in Guinea: Experience from a tertiary center.

INTRODUCTION

Breast cancer is the leading cause of cancer-related mortality among women worldwide. In sub-Saharan Africa, it is often diagnosed at an advanced stage. This study aimed to analyze changes in the stage at diagnosis of breast cancer across three five-year periods in a tertiary center in Guinea.

METHODS

A retrospective observational descriptive and analytical study was conducted at Donka University Hospital between January 2009 and December 2023. Bivariate and multivariable analyses (Firth penalized logistic regression) were performed to identify factors associated with advanced-stage diagnosis.

RESULTS

A total of 1051 patients were included: 16.4% during 2009-2013, 22.8% during 2014-2018, and 60.8% during 2019-2023. The median age at diagnosis was 45 years [IQR: 36-57], and Women accounted for 97.8% of cases. Stage III and IV disease represented 56.6% and 28.2% of cases, respectively. Early-stage disease increased from 7.4% in 2009-2013-10.0% in 2019-2023 (p < 0.001). Among cases with available immunohistochemical data, triple-negative breast cancer was the predominant molecular subtype (75/196 cases). In multivariable analysis, residence in Conakry (OR = 0.44, 95% CI: 0.24-0.76; p = 0.003) and diagnosis in the most recent period (OR = 0.52, 95% CI: 0.28-0.91; p = 0.022) were independently associated with lower odds of advanced-stage presentation.

CONCLUSION

Breast cancer remains predominantly diagnosed at an advanced stage in our setting. Geographic proximity to specialized care is the strongest independent determinant of early detection, underscoring the urgent need to decentralize diagnostic services and strengthen national cancer control infrastructure.