Breast cancer in Mali: Advanced-stage diagnosis associated with socioeconomic vulnerability

Abstract

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.