Educational Opportunities for Down-Staging Breast Cancer in Low-Income Countries: an Example from Tanzania

  • Kristen Yang
  • Khadija Msami
  • Rose Calixte
  • Julius Mwaiselage
  • Joan Dorn
  • Amr S. SolimanEmail author


While more than 90% of breast cancer patients in western countries survive for at least 5 years, the survival rate in Tanzania is less than 45% because of late stage at presentation. The aim of this study was to identify patient and health system factors related to early or late stages of a breast cancer diagnosis. The study was conducted at the Ocean Road Cancer Institute (ORCI) in Dar es Salaam, Tanzania, and included interviews with 196 breast cancer patients diagnosed with early (stage I/II, n = 44) or late (stage III/IV, n = 152) stage who were referred to ORCI from January 2016 to August 2018. The questionnaire elicited information regarding disease history, sociodemographics, barriers to navigating the health system, and patient attitudes towards breast cancer. More early-stage patients (54.5%) stated history of previous breast examinations before their initial diagnosis compared to late-stage patients (19.7%) (p = < 0.001). Financial restraints were cited more often as barriers to diagnosis among late-stage presentation patients (55.7%) compared to early-stage patients (35.5%) (p = 0.047). Patients who were diagnosed at late-stage (47.5%) were also more likely to state time restraints as significant barriers to their diagnosis than early-stage patients (25.8%) (p = 0.041). Although the late diagnosis of breast cancer will take immense efforts of policy workers to resolve, this study offers significant opportunities for making immediate health system changes through patient and physician education that can aid in reducing diagnosis delay in Tanzania other low-income developing countries, and low-income communities within the USA.


Breast cancer Education Down-staging Delayed diagnosis Tanzania Developing countries 



We would like to thank the healthcare team at the Ocean Road Cancer Institute for assistance during data collection. Kristen Yang was funded by the Department of Community Health and Social Medicine and the Cancer Epidemiology Education in Special Populations Program of the City University of New York School of Medicine.

Compliance with Ethical Standard

Informed consent was received by all participants of the study in compliance with the Ocean Road Cancer Institute’s Bioethics Committee and the City College of New York’s Institutional Review Board.

There are no potential conflicts of interest.


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Copyright information

© American Association for Cancer Education 2019

Authors and Affiliations

  1. 1.Department of Community Health and Social MedicineCity University of New York School of MedicineNew YorkUSA
  2. 2.Ocean Road Cancer InstituteDar es SalaamTanzania

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