Characteristics of the participating studies: North Africa (54 studies).

a<p>HER2 testing was performed but not included in the review because it was not possible to estimate the standard error as the sample size was NK.</p>b<p>Only HR+ (ER+ and/or PR+) estimates are provided.</p>c<p>Only HR+ (defined as subtypes Luminal A + Luminal B) estimates are provided.</p>d<p>Only the results from IHC (versus ICH) were included in the review.</p><p>AJCC, American Joint Committee on Cancer; BC, breast cancer; IBC, inflammatory breast cancer; IDC, invasive ductal carcinoma; ICH, immunocytochemistry; IgG, Immunoglobulin G; MR, medical records; n/a, not applicable; NK, not given in the paper; NOS, not otherwise specified.</p><p>Characteristics of the participating studies: North Africa (54 studies).</p

Summary of the characteristics of the 80 participating studies.

a<p>Percentage of the number given in the total row (percentages for each variable do not always add to 100 because of rounding errors).</p>b<p>Includes four studies from Morocco (number of women with known ER, PR, and HER2 status: 1,451, 1,451, and 411, respectively), three from Libya (378, 378, 78, respectively), two from Sudan (162, 162, and 114, respectively), and two from Algeria (296, 296, and 296, respectively) (see <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001720#pmed-1001720-t001" target="_blank">Tables 1</a> and <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001720#pmed-1001720-t002" target="_blank">2</a>).</p>c<p>Includes a multi-centric study <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001720#pmed.1001720-Huo1" target="_blank">[8]</a> with several centres based in Nigeria and one in Senegal (number of women with known ER, PR, and HER2 status: 378, 378, and 378, respectively).</p>d<p>Includes two studies from Mali (number of women with known ER, PR, and HER2 status: 273, 272, and 113, respectively); four from Ghana (320, 293, and 258, respectively); two from Uganda (296, 183 and 183, respectively), two from Kenya (278, 158 and 192, respectively), two from Tanzania (125, 125 and 0, respectively), and one from Madagascar (75 and 77, respectively) (see <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001720#pmed-1001720-t001" target="_blank">Tables 1</a> and <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001720#pmed-1001720-t002" target="_blank">2</a>).</p>e<p>Defined according to the last year in which patient recruitment took place.</p>f<p>If information on menopausal status was not available women aged >50 years at diagnosis were classified as postmenopausal.</p><p>Summary of the characteristics of the 80 participating studies.</p

Breast cancer ranking among women for (a) incidence and (b) mortality, Africa, 2012 [1].

<p>Breast cancer ranking among women for (a) incidence and (b) mortality, Africa, 2012 <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001720#pmed.1001720-International1" target="_blank">[1]</a>.</p

International and ethnic comparisons in the proportion of ER+ disease.

<p>IBC, inflammatory breast cancer; N-IBC, non-inflammatory breast cancer; Nk, information not given in the original paper; SEER, Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute, US (data downloaded from <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001720#pmed.1001720-Surveillance1" target="_blank">[6]</a> using the same methods as in <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001720#pmed.1001720-McCormack1" target="_blank">[9]</a>); SSA, sub-Saharan Africa.</p

Characteristics of the participating studies: Sub-Saharan Africa (26 studies).

a<p>Only Series 1 (<i>n</i> = 378) was included in the review. Series 2 is a replicate sample (<i>n</i> = 129) which was excluded because of a) potential overlap with other studies included in the review; and b) the number of ER+, PR+ and HER2+ known was not reported.</p>b<p>Methods for PR and HER2 testing are provided in the paper but no estimates for these two receptors are given.</p><p>AJCC, American Joint Committee on Cancer; BC, Breast cancer; IBC, inflammatory breast cancer; IDC, invasive ductal carcinoma; ICH, immunocytochemistry; MR, medical records; n/a, not applicable; NK, not given in the paper; NOS, not otherwise specified.</p><p>Characteristics of the participating studies: Sub-Saharan Africa (26 studies).</p

Sources of between-study heterogeneity in the proportions of ER+, PR+, and HER2+ cases from meta-regression analyses.

a<p>Adjusted for all other variables in the table except tumor grade (this variable was not included in the model because of potential for over-adjustment). The variable study design was not included in the final models because it was not associated with the frequency of ER+, PR+, or HER2+ in the crude or adjusted analyses.</p>b<p>Missing values were included as separate categories.</p>c<p>Defined according to the last year in which patient recruitment took place.</p>d<p>Mean or median age of study cases at the time of breast cancer diagnosis; for studies that provided only age categories the mean was estimated from the mid-point and frequency of each category.</p>e<p>These numbers are higher than the total number of North African studies included in the review (<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001720#pmed-1001720-t003" target="_blank">Table 3</a>) because one study <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001720#pmed.1001720-Boufettal1" target="_blank">[26]</a> presented separate ER+ and PR+ estimates for ages <35 y and 36–50 y and another <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001720#pmed.1001720-Chaher1" target="_blank">[55]</a> presented separate ER+, PR+, and HER2+ estimates for inflammatory (IBC) and non-IBC locally advanced breast cancer (LABC).</p>f<p><i>p</i>-values for interaction between region and timing of receptor testing for ER+: <i>p</i><0.001 in the crude analysis, <i>p</i><0.001 in the adjusted analysis; PR+: <i>p</i> = 0.10 in the crude analysis, <i>p</i> = 0.17 in the adjusted analysis; HER2+: <i>p</i> = 0.37 in the crude analysis, <i>p</i> = 0.52 in the adjusted analysis.</p><p>Sources of between-study heterogeneity in the proportions of ER+, PR+, and HER2+ cases from meta-regression analyses.</p

Flow diagram detailing study identification, screening, and eligibility.

<p>Many abstracts could fit into more than one exclusion category; these were allocated to the first eligible category in the order listed here.</p

Proportion of ER+ disease by year of diagnosis, North and sub-Saharan Africa.

<p>IBC: inflammatory breast cancer; LABC: non-IBC locally advanced breast cancer; N-IBC: non-inflammatory breast cancer. *These studies provided only a combined HR estimate for tumors that were either ER+ or PR+ <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001720#pmed.1001720-ElHawary1" target="_blank">[33]</a> or ER+ and/or PR+ (<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001720#pmed.1001720-Abbas1" target="_blank">[29]</a>; <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001720#pmed.1001720-Zeeneldin1" target="_blank">[43]</a>; <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001720#pmed.1001720-Hussein2" target="_blank">[52]</a>; <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001720#pmed.1001720-Boder1" target="_blank">[63]</a>; <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001720#pmed.1001720-Bouzid1" target="_blank">[64]</a>; <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001720#pmed.1001720-Salama1" target="_blank">[71]</a>).</p

Proportion of ER+ disease by timing of receptor testing, North and sub-Saharan Africa.

<p>IBC, inflammatory breast cancer; LABC, non-IBC locally advanced breast cancer; N-IBC, non-inflammatory breast cancer. *These studies provided only a combined HR estimate for tumors that were either ER+ or PR+ <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001720#pmed.1001720-ElHawary1" target="_blank">[33]</a> or ER+ and/or PR+ (<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001720#pmed.1001720-Abbas1" target="_blank">[29]</a>; <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001720#pmed.1001720-Zeeneldin1" target="_blank">[43]</a>; <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001720#pmed.1001720-Hussein2" target="_blank">[52]</a>; <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001720#pmed.1001720-Boder1" target="_blank">[63]</a>; <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001720#pmed.1001720-Bouzid1" target="_blank">[64]</a>; <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001720#pmed.1001720-Salama1" target="_blank">[71]</a>).</p

Proportion of ER+ disease by tumor grade, North and sub-Saharan Africa.

<p>IBC, inflammatory breast cancer; LABC, non-IBC locally advanced breast cancer; N-IBC: non-inflammatory breast cancer. *These studies provided only a combined HR estimate for tumors that were either ER+ or PR+ <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001720#pmed.1001720-ElHawary1" target="_blank">[33]</a> or ER+ and/or PR+ (<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001720#pmed.1001720-Zeeneldin1" target="_blank">[43]</a>; <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001720#pmed.1001720-Hussein2" target="_blank">[52]</a>; <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001720#pmed.1001720-Boder1" target="_blank">[63]</a>; <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001720#pmed.1001720-Bouzid1" target="_blank">[64]</a>; <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001720#pmed.1001720-Salama1" target="_blank">[71]</a>).</p