Down-staging of breast cancer in the pre-screening era: Experiences from Chris Hani Baragwaneth Academic Hospital, Soweto, South Africa

We aimed to investigate the stage of breast cancer at first diagnosis and assess possible determinants of late-stage presentation. A consecutive series of women with newly diagnosed breast cancer at Chris Hani Baragwanath Academic Hospital (CHBAH), Soweto, South Africa were analysed. We retrospectively reviewed electronic patient records. Data were extracted for: (i) stage and year at diagnosis; (ii) travel distance (estimated straight-line distance from GPS-coded residential address to CHBAH); (iii) receptor subtypes; and (iv) age of patient. Generalised linear models were applied to estimate risk ratios for late- v. early-stage disease.Of the patients (N=1 071) studied, the mean age was 55 years and 90% were black Africans. Patients who lived >20 km from the hospital (n=347; 61.8%) presented with late-stage disease (stage 3/4) compared with 50.2% who lived ≤20 km from the hospital (n=724; p=0.02). The majority of patients (74%) >70 years of age who lived >20 km away presented with advanced breast cancer. However, in younger patients, age showed no clear association with stage at presentation. Travel distance was an important predictor of later-stage disease at diagnosis, which was more noticeable in elderly patients. Patients with more aggressive triple-negative and HER2+ tumours presented with later-stage disease