Grant Number:	5R01CA244559-04 Interpret this number
Primary Investigator:	Mccormack, Valerie
Organization:	International Agency For Res On Cancer
Project Title:	African Breast Cancer - Disparities in Outcomes - Plus (Abc-Do Plus)
Fiscal Year:	2023

Project Summary Breast cancer is the most common type of cancer diagnosed and the second cause of cancer death in sub-Saharan African women. The few studies on breast cancer survival in this region reported low short-term survival rates, but none were able to comprehensively address reasons for low survival, how to improve survival, nor assess five-year and longer-term survival and survivorship. Further, the impact of more aggressive molecular subtypes, common in women of African-descent, on breast cancer survival in sub-Saharan Africa has not yet been investigated. The African Breast Cancer-Disparities in Outcomes (ABC-DO) study is a five-country sub-Saharan African breast cancer cohort initiated in 2014. During 3 years of recruitment, over 2100 women were recruited in Uganda, Nigeria, Zambia, Namibia, and South Africa. In the proposed project, ABC-DO-Plus, we will build on ABC-DO – namely the established collaborations, research staff, tumor collections, ethical and legal permissions; and novel and successful mobile-Health (mHealth)-implemented follow-up – to actively follow-up women for a further 2 years to 5 years post-diagnosis, examine for the first time 5-year survival overall and by key prognostic factors, molecular subtypes, treatment availability, affordability and compliance, socioeconomic determinants and comorbidities present in this setting, particularly high BMI and HIV. Breast cancer survivorship research, i.e. the health of women with breast cancer post- treatment, has largely been neglected in sub-Saharan Africa. ABC-DO-Plus will examine, for the first time, longitudinal changes in health-related quality of life up to 5 years after a woman’s breast cancer diagnosis. ABC-DO-Plus will inform interventions needed to mitigate the excessive number of deaths of women with the disease, and improve the quality-of-life of survivors. Utilizing a within-African framework of five countries with different cancer care politics, but also representing individual socioeconomic and cultural diversity, will enable comparisons across settings and hereby identification of modifiable factors influencing BC survival. Furthermore, its findings on the proportions of more aggressive tumor molecular subtypes, and how these may affect survival, as well as on the impact on survival of comorbidities such as HIV, will be of relevance to other black women in the US and elsewhere. The success of the proposed ABC-DO-Plus, and its manifold goals, will be ensured through continuity of the experience of the previous 4+ years’ ABC-DO fieldwork, its established research infrastructure, and the efficient mHealth follow-up approach of this unique cohort.




Longitudinal changes in health-related quality of life after a breast cancer diagnosis in sub-Saharan Africa: Evidence from the prospective ABC-DO cohort.
Authors: Mohammed S. , Galukande M. , Naamala A. , Parham G. , Pinder L. , Anele A. , Offiah S.A. , Zietsman A. , Schüz J. , McCormack V. , et al. .
Source: International Journal Of Cancer, 2026-01-29 00:00:00.0; , .
EPub date: 2026-01-29 00:00:00.0.
PMID: 41609400
Related Citations

Survival deficits in young women with breast cancer in sub-Saharan Africa: the African Breast Cancer-Disparities in Outcomes cohort.
Authors: Mo T. , Partridge A. , Joffe M. , Cubasch H. , Galukande M. , Parham G. , Pinder L. , Anele A. , Offiah S.A. , Zietsman A. , et al. .
Source: Journal Of The National Cancer Institute, 2025-11-01 00:00:00.0; 117(11), p. 2298-2307.
PMID: 40795175
Related Citations

Breast cancer overall survival, annual risks of death, and survival gap apportionment in sub-Saharan Africa (ABC-DO): 7-year follow-up of a prospective cohort study.
Authors: Mo T. , Joffe M. , Cubasch H. , Galukande M. , Parham G. , Pinder L. , Zietsman A. , Anderson B.O. , Naamala A. , Kaggwa A. , et al. .
Source: The Lancet. Global Health, 2025 Oct; 13(10), p. e1681-e1690.
PMID: 40975077
Related Citations

Barriers to Breast Cancer Care for Women Presenting at District and Regional-Level Hospitals in Ghana: Findings From the African Breast Cancer-Disparities in Outcomes Ghana Study.
Authors: Narh C.T. , Afetor M. , Baiden F.E. , Agbeko A. , Commeh M.E. , Aziato L. , Dos-Santos-Silva I. , McCormack V. , Vanderpuye V. , ABC-DO Ghana team , et al. .
Source: Jco Global Oncology, 2025 Oct; 11, p. e2500275.
EPub date: 2025-10-29 00:00:00.0.
PMID: 41160780
Related Citations

HIV status alters immune cell infiltration and activation profile in women with breast cancer.
Authors: Bauer M. , Santos P. , Wilfer A. , van den Berg E. , Zietsman A. , Vetter M. , Kaufhold S. , Wickenhauser C. , Dos-Santos-Silva I. , Chen W.C. , et al. .
Source: Nature Communications, 2025-05-20 00:00:00.0; 16(1), p. 4699.
EPub date: 2025-05-20 00:00:00.0.
PMID: 40393975
Related Citations

Measuring the WHO Global Breast Cancer Initiative Pillars' key performance indicators in Sub-Saharan Africa: experience in the African Breast Cancer-Disparities in Outcomes hospital-based cohort study.
Authors: Boucheron P. , Zietsman A. , Anele A. , Offiah A.U. , Galukande M. , Parham G. , Pinder L. , Mo T. , Foerster M. , Schüz J. , et al. .
Source: Eclinicalmedicine, 2025 Mar; 81, p. 103104.
EPub date: 2025-02-13 00:00:00.0.
PMID: 40034567
Related Citations

Quality of life in long-term breast cancer survivors in Sub-Saharan Africa: the African Breast Cancer-Disparities in Outcomes study.
Authors: Boucheron P. , McCormack V. , Naamala A. , Oyamienlen C.S. , Pontac J. , Kaggwa A. , Nakazibwe T. , Nteziryayo A. , Ezeigbo E. , Iwuoha K. , et al. .
Source: Journal Of Cancer Survivorship : Research And Practice, 2024-12-10 00:00:00.0; , .
EPub date: 2024-12-10 00:00:00.0.
PMID: 39656419
Related Citations

Impact of Cancer Across the Intergenerational Family: A Multidimensional Perspective From African Countries.
Authors: Simba H. , Kapambwe S. , Bates M.J. , Anorlu R. , Mutebi M. , Guida F. , Schüz J. , McCormack V. .
Source: Jco Global Oncology, 2024 Sep; 10, p. e2400116.
EPub date: 2024-10-03 00:00:00.0.
PMID: 39361909
Related Citations

Geospatial disparities in survival of patients with breast cancer in sub-Saharan Africa from the African Breast Cancer-Disparities in Outcomes cohort (ABC-DO): a prospective cohort study.
Authors: Kim J. , Macharia P.M. , McCormack V. , Foerster M. , Galukande M. , Joffe M. , Cubasch H. , Zietsman A. , Anele A. , Offiah S. , et al. .
Source: The Lancet. Global Health, 2024-05-21 00:00:00.0; , .
EPub date: 2024-05-21 00:00:00.0.
PMID: 38788756
Related Citations

Analysis of the Breast Cancer Journey in Namibia.
Authors: Boucheron P. , Zietsman A. , Pontac J. , Hansen R. , Anderson B.O. , Togawa K. , Macharia P.M. , Foerster M. , Schüz J. , Dos-Santos-Silva I. , et al. .
Source: Jama Network Open, 2023-11-01 00:00:00.0; 6(11), p. e2341402.
EPub date: 2023-11-01 00:00:00.0.
PMID: 37921764
Related Citations

Regional Variation in the Tumor Microenvironment, Immune Escape and Prognostic Factors in Breast Cancer in Sub-Saharan Africa.
Authors: Bauer M. , Vetter M. , Stückrath K. , Yohannes M. , Desalegn Z. , Yalew T. , Bekuretsion Y. , Kenea T.W. , Joffe M. , van den Berg E.J. , et al. .
Source: Cancer Immunology Research, 2023-06-02 00:00:00.0; 11(6), p. 720-731.
PMID: 37058582
Related Citations

Drivers of disparities in stage at diagnosis among women with breast cancer: South African breast cancers and HIV outcomes cohort.
Authors: Mapanga W. , Norris S.A. , Craig A. , Ayeni O.A. , Chen W.C. , Jacobson J.S. , Neugut A.I. , Ruff P. , Cubasch H. , O'Neil D.S. , et al. .
Source: Plos One, 2023; 18(2), p. e0281916.
EPub date: 2023-02-16 00:00:00.0.
PMID: 36795733
Related Citations

Reproductive history and breast cancer survival: Findings from the African breast cancer-Disparities in outcomes cohort and implications of Africa's fertility transition on breast cancer prognosis.
Authors: Boucheron P. , Anele A. , Offiah A.U. , Zietsman A. , Galukande M. , Parham G. , Pinder L.F. , Anderson B.O. , Foerster M. , Schüz J. , et al. .
Source: International Journal Of Cancer, 2022-12-22 00:00:00.0; , .
EPub date: 2022-12-22 00:00:00.0.
PMID: 36545890
Related Citations

Global and regional estimates of orphans attributed to maternal cancer mortality in 2020.
Authors: Guida F. , Kidman R. , Ferlay J. , Schüz J. , Soerjomataram I. , Kithaka B. , Ginsburg O. , Mailhot Vega R.B. , Galukande M. , Parham G. , et al. .
Source: Nature Medicine, 2022-11-20 00:00:00.0; , .
EPub date: 2022-11-20 00:00:00.0.
PMID: 36404355
Related Citations

Treatment guideline concordance, initiation, and abandonment in patients with non-metastatic breast cancer from the African Breast Cancer-Disparities in Outcomes (ABC-DO) cohort in sub-Saharan Africa: a prospective cohort study.
Authors: Foerster M. , McCormack V. , Anderson B.O. , Boucheron P. , Zietsman A. , Cubasch H. , Joffe M. , Anele A. , Offiah S. , Galukande M. , et al. .
Source: The Lancet. Oncology, 2022-05-09 00:00:00.0; , .
EPub date: 2022-05-09 00:00:00.0.
PMID: 35550274
Related Citations

Disparities in breast cancer survival between women with and without HIV across sub-Saharan Africa (ABC-DO): a prospective, cohort study.
Authors: Chasimpha S. , McCormack V. , Cubasch H. , Joffe M. , Zietsman A. , Galukande M. , Parham G. , Pinder L.F. , Anele A. , Adisa C.A. , et al. .
Source: The Lancet. Hiv, 2022 03; 9(3), p. e160-e171.
PMID: 35245508
Related Citations

Self-reported arm and shoulder problems in breast cancer survivors in Sub-Saharan Africa: the African Breast Cancer-Disparities in Outcomes cohort study.
Authors: Boucheron P. , Anele A. , Zietsman A. , Galukande M. , Parham G. , Pinder L.F. , Andersson T.M. , Anderson B.O. , Foerster M. , Schüz J. , et al. .
Source: Breast Cancer Research : Bcr, 2021-11-24 00:00:00.0; 23(1), p. 109.
EPub date: 2021-11-24 00:00:00.0.
PMID: 34819118
Related Citations

Geospatial barriers to healthcare access for breast cancer diagnosis in sub-Saharan African settings: The African Breast Cancer-Disparities in Outcomes Cohort Study.
Authors: Togawa K. , Anderson B.O. , Foerster M. , Galukande M. , Zietsman A. , Pontac J. , Anele A. , Adisa C. , Parham G. , Pinder L.F. , et al. .
Source: International Journal Of Cancer, 2021-05-01 00:00:00.0; 148(9), p. 2212-2226.
EPub date: 2020-12-08 00:00:00.0.
PMID: 33197280
Related Citations

Dissecting the journey to breast cancer diagnosis in sub-Saharan Africa: Findings from the multicountry ABC-DO cohort study.
Authors: Foerster M. , McKenzie F. , Zietsman A. , Galukande M. , Anele A. , Adisa C. , Parham G. , Pinder L. , Schüz J. , McCormack V. , et al. .
Source: International Journal Of Cancer, 2021-01-15 00:00:00.0; 148(2), p. 340-351.
EPub date: 2020-08-04 00:00:00.0.
PMID: 32663320
Related Citations

Maternally Orphaned Children and Intergenerational Concerns Associated With Breast Cancer Deaths Among Women in Sub-Saharan Africa.
Authors: Galukande M. , Schüz J. , Anderson B.O. , Zietsman A. , Adisa C. , Anele A. , Parham G. , Pinder L.F. , Mutumba S. , Lombe D. , et al. .
Source: Jama Oncology, 2020-12-23 00:00:00.0; , .
EPub date: 2020-12-23 00:00:00.0.
PMID: 33355599
Related Citations

The multimorbidity profile of South African women newly diagnosed with breast cancer.
Authors: Ayeni O.A. , Norris S.A. , Joffe M. , Cubasch H. , Nietz S. , Buccimazza I. , Singh U. , Čačala S. , Stopforth L. , Chen W.C. , et al. .
Source: International Journal Of Cancer, 2020-07-15 00:00:00.0; 147(2), p. 361-374.
EPub date: 2019-10-25 00:00:00.0.
PMID: 31600408
Related Citations