Estimating overall survival for breast cancer in Ghana: A time-to-event meta-analysis

To estimate overall survival among patients with breast cancer in Ghana by synthesizing time-to-event data from published studies using reconstructed individual patient data.

We conducted a search of PubMed, SCOPUS and Embase for studies published from inception to November 28, 2025. Eligible studies directly provided Kaplan-Meier survival curves for overall survival (OS) for patients with breast cancer. Pseudo-individual patient data were digitized from published survival curves using WebPlotDigitizer, and survival curves were reconstructed with the IPDfromKM method and a one-stage Cox proportional hazards model with random effects was used to pool survival estimates. Exploratory meta-regression analyses were performed to assess sources of heterogeneity. This study was registered with PROSPERO, CRD420251243132.

Six observational studies (2114 patients) conducted across major referral centers in four regions of Ghana (Greater Accra, Eastern, Ashanti, and Volta) met inclusion. The mean age was 47.3 years, with most patients presenting with stage III disease (47.2%). The pooled median OS was 4.4 years (95% CI: 4.0-5.0), and the estimated 5-year survival rate was 46.5%. Substantial heterogeneity in survival outcomes was observed across studies, with 5-year OS ranging from 1.6% to 78.8%. Meta-regression identified median follow-up as a significant moderator of mortality rates accounting for 89.46% of between-study heterogeneity.

This study provides an estimate of breast cancer survival in Ghana and shows poor long-term breast cancer survival in Ghana, although interpretation should be cautious given the substantial heterogeneity across studies and potential immortal time bias in one included study. These findings highlight the need for improved survival reporting, and stronger population-based cancer registries to better benchmark outcomes and guide breast cancer control efforts in Ghana.