Clinical presentation, diagnostic pathway, treatment patterns, and survival among women with cytologically diagnosed breast cancer in two national referral hospitals in Niger: A five- year retrospective multicenter cohort study
Year: 2026
Type: preprint
Study design: Observational Study
Abstract: Background Breast cancer is the leading cancer among women worldwide, with disproportionately high mortality in low- and middle-income countries due to delayed diagnosis and limited access to comprehensive care. Contemporary data describing breast cancer management in Niger remain scarce. This study aimed to describe the clinical presentation, diagnostic pathway, treatment patterns, and survival of women with breast cancer managed in the country's two national referral hospitals. Methods We conducted a retrospective multicenter cohort study including women with breast cancer diagnosed by fine-needle aspiration cytology (FNAC), with or without subsequent histopathological confirmation, between January 2020 and December 2024 at the National Cancer Control Center (CNLC) of Niamey and the Issaka Gazoby Maternity Hospital(MIG). Duplicate records were identified and merged using the unique national identification number assigned by the National Cancer Control Center, ensuring that each patient was included only once. Demographic, clinicopathological, treatment, and follow-up data were extracted from medical records. Overall survival was estimated using the Kaplan-Meier product-limit method from the date of cytological diagnosis to death or censoring. Patients alive at five years, alive at the last documented contact, or lost to follow-up were censored at their last known date alive. Results A total of 674 women were included. The median age was 45 years (interquartile range: 35–53), and 70.0% presented with AJCC Stage III-IV disease after a median consultation delay of 7 months. Although FNAC established the diagnosis in all patients, only 25.5% underwent histopathological confirmation, and no patients received immunohistochemical characterization. Modified radical mastectomy was the predominant surgical procedure, and chemotherapy was administered to most patients, whereas radiotherapy and endocrine therapy remained available to only about one-third of women. During follow-up, 10.4% died and 28.5% were lost to follow-up. Kaplan-Meier analysis demonstrated significantly poorer overall survival among women presenting with advanced-stage disease (log-rank P < 0.001). Conclusions Breast cancer in Niger is characterized by delayed presentation, advanced-stage disease, and major deficiencies in pathological diagnosis despite universal access to cytological confirmation. Limited availability of histopathology, immunohistochemistry, radiotherapy, and long-term follow-up constrain delivery of guideline-concordant care. Strengthening early diagnosis, expanding pathology and molecular diagnostic services, reducing financial barriers, and improving continuity of care should be priorities for breast cancer control in Niger and similar resource-constrained settings.
Source: Research Square
Institutions: Université Abdou Moumouni, Université André Salifou
Language: English
Subfield: Pathology and Forensic Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7211865751