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Breast cancer in Mali: Advanced-stage diagnosis associated with socioeconomic vulnerability
Adégné Togo1, Clémence Schantzs2, Hamidou Niangaly3
1Laboratoire de recherche appliquée pour le développement de la chirurgie et de l'anatomie (LARADECA), Faculté de médecine et odontostomatologie (FMOS), Université des sciences des techniques et des technologies de Bamako (USTTB), CHU Gabriel Touré, Bamako, Mali. Ceped, Université Paris Cité, Université Sorbonne Paris Nord, IRD, Inserm, F-75006 Paris, France. Service de chirurgie générale, Centre hospitalo-universitaire Gabriel Touré, Laboratoire de recherche appliquée pour le développement de la chirurgie et de l'anatomie (LARADECA), Faculté de médecine et d'odontostomatologie (FMOS), Université des sciences des techniques et des technologies de Bamako (USTTB), Bamako, Mali.
Introduction:
Breast cancer is common and often diagnosed at an advanced stage in Mali. The aim of this study was to describe the stage at diagnosis and to identify associated factors.
Methods:
As part of the SENOVIE project, a prospective multicenter cohort study was conducted from October 2023 to October 2024 in five healthcare facilities in Bamako. The clinical stage at diagnosis was assessed according to the UICC classification. A univariate analysis was performed, followed by a multivariable multinomial logistic regression.
Results:
A total of 265 patients were included in this study. Early-stage diagnosis (stages I–II) was observed in 13.6% of patients, late-stage diagnosis (stage III) in 63.4%, and metastatic disease (stage IV) in 23.0%. In univariate analysis, late-stage diagnosis was associated with living outside Bamako (p = 0.019), lack of formal education (p = 0.005), low socioeconomic status, absence of health insurance (p = 0.012), and not owning a television (p = 0.042). In multivariable analysis, only body mass index remained significantly associated with stage at diagnosis. Overweight patients were more likely to be diagnosed at an early stage (aOR = 2.99; 95% CI: 1.19–7.48), while obese patients were less likely to be diagnosed at a metastatic stage (aOR = 0.26; 95% CI: 0.12–0.60).
Discussion:
These findings confirm the high proportion of advanced-stage diagnoses in Mali and suggest that socioeconomic factors and care pathways influence diagnostic delay.
Conclusion:
In Mali, breast cancer is predominantly diagnosed at a late stage. Body mass index is associated with stage at diagnosis. Strengthening screening and improving access to care are essential to promote earlier diagnosis.