Survival rates among patients with cervical or breast cancer followed from 2019 to 2024 at three University Hospitals (CHU) in Bamako
Study design
Retrospective observational study
Background
Cervical (UCC) and breast cancers are the main cancers in terms of incidence and mortality in Mali. Since 2018, Doctors Without Borders has been supporting the Malian Ministry of Health in its fight against these cancers. Five years after the launch of the “Oncology Project”, a study was conducted to assess the overall survival and factors associated with mortality of women followed up under this partnership.
Our role
Study coordination
Partners
- Ministry of Health and Social Development of Mali
- CHU Hôpital Point G
- CHU Gabriel Touré
- CHU Hôpital du Mali
Methods
This is a retrospective observational study using medical records of patients diagnosed with UCC or breast cancer in Bamako between 2019 and 2022. Overall survival at 1, 2 and 3 years was estimated using the Kaplan-Meier method, and factors associated with mortality were determined using the cox model and restricted mean survival time.
Results
A total of 964 patients were included, of whom 341 had cervical cancer and 623 had breast cancer. The median age at diagnosis for cervical and breast cancers was 54 [IQR: 45–63] years and 47 [IQR: 37–58] years, respectively. More than three-quarters of the women had advanced-stage cervical cancer (75.2%) and breast cancer (77.1%) at diagnosis. For cervical cancer, overall survival at 1 year, 2 years, and 3 years was 88%, 70%, and 55%, respectively. The risk of death was influenced by early-stage disease at diagnosis (aHR: 0.47; 95% CI: [0.28–0.78]), the years of diagnosis 2021 (HRa: 3.79; 95% CI: [1.61–8.96]), and 2022 (aHR: 8.33; 95% CI: [3.57–19.40]). Furthermore, survival among patients diagnosed at an advanced stage was significantly better (p<0.05) when multimodal treatment (chemotherapy + surgery / chemoradiotherapy) was administered. For breast cancer, overall survival at 1 year, 2 years, and 3 years was 91%, 80%, and 72%, respectively. The risk of death was influenced by early-stage diagnosis (aHR: 0.57; 95% CI: [0.36–0.90]), comorbidities (HRa: 1.77; 95% CI: [1.08–2.92]), and the years of diagnosis 2021 (HRa: 3.20; 95% CI: [1.74–5.89]) and 2022 (HRa: 5.97; 95% CI: [3.26–10.90]). Furthermore, patients diagnosed at an advanced stage had significantly better survival (p<0.05) when they received combination therapy (chemotherapy ± radiation therapy + surgery).
Conclusion
This study reports some of the highest survival rates in sub-Saharan Africa and highlights the importance of early screening and multidisciplinary care in reducing the burden of cervical and breast cancer in Mali.
