Predictors of advanced-stage presentation among breast and cervical cancer patients in Ethiopia

Breast and cervical cancers are the most common causes of cancer incidence and mortality in women in Africa. Women with breast and cervical cancers in Sub-Saharan Africa (SSA) are frequently diagnosed at advanced stages. Delays in health seeking, diagnosis and treatment are contributing factors to high mortality in Ethiopia. This study aimed to assess predictors of advanced stage presentation among breast and cervical cancer patients attending public hospitals in Addis Ababa, Ethiopia. A cross-sectional study was conducted with a total of 418 patients at Tikur Anbessa specialized hospital and Saint Pauls’ Hospital Millennium Medical College from October to November 2021. Stages III and IV were considered advanced stages. Data were collected by reviewing medical records and in face-to-face interviews with a structured questionnaire. Bivariate and multivariate analyses were performed to examine the association between independent and outcome variables. A total of 269 patients with breast cancer and 149 patients with cervical cancer were included in the study, and the mean age was 44 years (SD = 10.9 years) and 50 years (SD = 11.2) years, respectively. About 66.9% of breast cancers and 71.1% of cervical cancers were diagnosed at an advanced disease stage. Rural residence (AOR = 2.041, 95% CI: 1.108–3.758), indirect referral (AOR = 3.8, 95% CI: 1.485–9.946), financial difficulty (AOR = 10, 95% CI: 1.859–56.495) and no prior advise/awareness about screening (AOR = 4.029 95%CI: 1.658–10.102) were independent predictors of advanced-stage presentation. This study revealed a high prevalence of advanced-stage breast and cervical cancer diagnosis in Ethiopia, similar to data collected 10 years ago, despite the introduction of a cancer control plan in 2015. For better implementation, interventions should aim to improve referral pathways, adapt screening and early detection services and increase cancer awareness at the community level in a culturally accepted way. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Yes ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethical clearance was secured from the Institutional Review Board of the School of Public Health, College of Health Science, and Addis Ababa University (SPH/1119/2021) I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data are available from the College of Health Sciences, Addis Ababa University Institutional Ethics Committee (contact via chs.irb@aau.edu.et) for researchers who meet the criteria for access to confidential data. * AAU : Addis Ababa University TASH : Tikur Anbessa Specialized Hospital SPHMMC : St. Paul’s Hospital Millennium Medical College SPSS : Statistical Package for The Social Sciences AOR : adjusted odds ratio CI : confidence interval SD : standard deviation HCP : healthcare providers VIF : variance inflation factor ETB : Ethiopian birr