Sociodemographic disparities associated with advanced stages and distant metastatic breast cancers at diagnosis in Indonesia: a cross-sectional study
IG Budhi Setyawan, Dian Kurnia, Kunta Setiaji, Sumadi Lukman Anwar, Deni J. Purwanto, Yohana Azhar, Selamat Budijitno, Desak Gede Agung Suprabawati, Sasongko Hadi Priyono, Bintang Abadi Siregar, Ramses Indriawan, Effif Syofra Tripriadi, Mulawan Umar, John Pieter, Kristanto Yuli Yarso, Dedy Hermansyah, Ign Gunawan Wibisana, Wirsma Arif Harahap, Walta Gautama, Dimyati Achmad
Abstract
Background: The global health burden of breast cancer is increasing with 5-year survival rates being much shorter in low-income and middle-income countries. Sociodemographic and clinical disparities in early cancer detection affect long-term outcome. Methods: The authors compared social, demographic, and pathological characteristics associated with metastatic and late stages of breast cancer diagnosis using data collected from a special registry developed by Perhimpunan Bedah Onkologi Indonesia (PERABOI) in 2015. Results: Of 4959 patients recruited in this study, 995 women (20.1%) were diagnosed with metastatic breast cancer. Lower education status and living in rural areas were significantly associated with Stage IV at diagnosis [odds ratio (OR)=1.256, 95% CI=1.093–1.445, P =0.001; and OR=1.197, 95% CI=1.042–1.377, P =0.012; respectively). Main complaints other than lump (ulceration, breast pain, and discharge) and occupation as a housewife were also associated with the presentation of metastatic diseases (OR=2.598, 95% CI=2.538–3.448, P< 0.001 and OR=1.264, 95% CI=1.056–1.567, P =0.030, respectively). Having lower education and living outside Java and Bali islands were associated with the diagnosis of late-stage breast cancers (OR=1.908, 95% CI=1.629–2.232, P< 0.001 and OR=3.039, 95% CI=2.238–4.126, P <0.001; respectively). A higher proportion of breast cancer patients were relatively younger with bigger tumour size, positive axillary nodal involvement, and more frequent Human epidermal growth factor receptor 2 overexpression. Conclusion: The authors identified sociodemographic disparities in the metastatic and late-stage diagnosis of breast cancers among Indonesian women. The subsequent action is required to reduce disparities faced by women with lower social and educational levels for early diagnosis and better healthcare access.