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PMC Articles

Population-Level Access to Breast Cancer Early Detection and Diagnosis in Nigeria

PMCID: PMC10730078

PMID: 38096465

Abstract

PURPOSE Mammography, breast ultrasound (US), and US-guided breast biopsy are essential services for breast cancer early detection and diagnosis. This study undertook a comprehensive evaluation to determine population-level access to these services for breast cancer early detection and diagnosis in Nigeria using a previously validated geographic information system (GIS) model. METHODS A comprehensive list of public and private facilities offering mammography, breast US, and US-guided breast biopsy was compiled using publicly available facility data and a survey administered nationally to Nigerian radiologists. All facilities were geolocated. A cost-distance model using open-source population density (GeoData Institute) and road network data (OpenStreetMap) was used to estimate population-level travel time to the nearest facility for mammography, breast US, and US-guided biopsy using GIS software (ArcMAP). RESULTS In total, 1,336 facilities in Nigeria provide breast US, of which 47.8% (639 of 1,336) are public facilities, and 218 provide mammography, of which 45.4% (99 of 218) are public facilities. Of the facilities that provide breast US, only 2.5% (33 of 1,336) also provide US-guided breast biopsy. At the national level, 83.1% have access to either US or mammography and 61.7% have access to US-guided breast biopsy within 120 minutes of a continuous one-way travel. There are differences in access to mammography (64.8% v 80.6% with access at 120 minutes) and US-guided breast biopsy (49.0% v 77.1% with access at 120 minutes) between the northern and southern Nigeria and between geopolitical zones. CONCLUSION To our knowledge, this is the first comprehensive evaluation of breast cancer detection and diagnostic services in Nigeria, which demonstrates geospatial inequalities in access to mammography and US-guided biopsy. Targeted investment is needed to improve access to these essential cancer care services in the northern region and the North East geopolitical zone.

Full Text

In total, 97 Nigerian radiologists were provided with the survey. Among active BISON members, the response rate was 68.4% (39 of 57) versus 100% (40 of 40) from the non–BISON-affiliated radiologists. In total, data on DI facility location were obtained from a total of 79 radiologists, which included 51 complete surveys with responses to all data fields (Fig 1). Respondents provided data for an additional 275 US facilities and 139 mammography facilities not captured by the MOH data set. The survey data were combined with the comprehensive facility data provided by the MOH.
Overall, 92.2% (47 of 51) of surveyed radiologists interpret mammography, whereas 98.0% (50 of 51) perform and interpret breast US. Of those performing breast US, 68.6% (35 of 51) perform US-guided breast biopsy (Fig 2). Among radiologist performing US-guided breast biopsy, 51.4% (18 of 35) of respondents received training in the procedure during residency or fellowship versus 34.3% (12 of 35) trained/mentored while in practice. Radiologists performing US-guided breast biopsies have been doing so for a mean of 6.5 years (SD, 4.8).
Across the country, 1,336 DI facilities perform breast US, of which 47.8% (639 of 1,336) are publicly administered. US services are available in every state and geopolitical zone of the country. In total, 218 DI facilities offer mammography, of which 45.4% (99 of 218) are publicly administered. Taraba State (North East) and Zamfara State (North West) do not have any mammography capacity. Only one mammography facility was identified in Jigawa State (North West; Fig 3). Of note, all 218 facilities that offer mammography also offer US. Only 2.5% (33 of 1,336) of the US facilities in Nigeria offer US-guided breast biopsy. Seventy-three percent (72.7%, 24 of 33) of facilities with US-guided breast biopsy services are publicly administered.
Access to DI for early breast cancer detection at the national level is robust in Nigeria, with 83.1% of the population within 120 minutes of travel to a facility with either mammogram or breast US (Fig 4). Across the six geopolitical zones, population-level access to breast US is >80% at 120 minutes of continuous one-way travel, with access between the north (83.7%) and south (82.7%) near parity. For mammography, the national population-level access is 72.1% at 120 minutes (Table 1). However, population-level access to mammography varies by geopolitical zone and region (Fig 4). In the South East, 85.1% of the population has access to mammography within 120 minutes of continuous travel compared with 57.9% in the North East. In southern Nigeria, 80.6% of the population has access at 120 minutes versus just 64.8% in the north.
To establish a pathologic diagnosis, a biopsy is required. Nationally, population-level access to US-guided breast biopsy is 61.9% at 120 minutes. This improves to 80.8% when continuous travel is extended to 240 minutes (Table 2). Similar to mammography, access to US-guided breast biopsy varies considerably between the geopolitical zone and the region. Within 60 minutes of continuous travel from the place of residence, 62.6% of the population in the South West geopolitical zone has access to US-guided breast biopsy compared with a mean of just 23.1% in the rest of the country. Although inequalities in access to US-guided breast biopsy improve as travel time increases, parity is not reached for US-guided breast biopsy by 240 minutes of continuous one-way travel. In the North East geopolitical zone, 68.7% of the population has access to US-guided biopsy within 240 minutes of travel versus 85.4% in the South East. Outside of the North East, the remaining five geopolitical zones have >80% population-level access to this essential service within 240 minutes of travel (Table 2).

Sections

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