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In four countries, follow\u2010up interviews were conducted 3\u2010monthly over 7\u2009years using the European Organisation for Research and Treatment of Cancer Quality of Life 30\u2010item core questionnaire version 3. Multilevel mixed\u2010effects models identified correlates of GHS. Overall, 1358 women from Namibia, Nigeria, Uganda and Zambia were included, with a mean age of 50.6 (SD\u2009=\u200913.7) years. Median follow\u2010up time was 3 (IQR\u2009=\u20092\u20135) years, with a median of 18 GHS assessments per woman (IQR\u2009=\u200910\u201323). GHS was lowest in the first 6\u2009months post\u2010diagnosis but improved gradually thereafter. GHS increased with increasing education (\n                    <jats:italic>p<\/jats:italic>\n                    \u2010value for linear trend [\n                    <jats:italic>p<\/jats:italic>\n                    <jats:sub>t<\/jats:sub>\n                    ]\u2009&lt;\u2009.0001), breast cancer awareness (adjusted\u2010odds ratio: 1.32; 95% confidence interval 1.22\u20131.42), surgical treatment (1.90; 1.53\u20132.37), family support (1.46; 1.24\u20131.71) and maintaining pre\u2010diagnosis employment (1.54; 1.41\u20131.68). In contrast, GHS decreased with increasing age at diagnosis (\n                    <jats:italic>p<\/jats:italic>\n                    <jats:sub>t<\/jats:sub>\n                    &lt;.0001), rural residence (0.76; 0.70\u20130.82), advanced tumour stage at diagnosis (\n                    <jats:italic>p<\/jats:italic>\n                    <jats:sub>t<\/jats:sub>\n                    &lt;.0001) and having non\u2010HIV comorbidities (0.74; 0.60\u20130.92). GHS was not affected by HIV status, but it was higher during COVID\u201019 lockdowns than pre\u2010\/post\u2010lockdown (1.27; 1.09\u20131.49). These patterns were similar at young and older ages, and in the short\u2010 and long\u2010term. The potentially modifiable factors associated with GHS are known to influence breast cancer survival in SSA. Addressing them could improve survivorship and survival from this cancer in the region.\n                  <\/jats:p>","DOI":"10.1002\/ijc.70350","type":"journal-article","created":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T14:21:11Z","timestamp":1769696471000},"page":"78-91","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Longitudinal changes in health\u2010related quality of life after a breast cancer diagnosis in sub\u2010Saharan Africa: Evidence from the prospective\n                    <scp>ABC<\/scp>\n                    \u2010\n                    <scp>DO<\/scp>\n                    cohort"],"prefix":"10.1002","volume":"159","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3771-8425","authenticated-orcid":false,"given":"Shamsudeen","family":"Mohammed","sequence":"first","affiliation":[{"name":"Department of Non\u2010Communicable Diseases Epidemiology London School of Hygiene and Tropical Medicine  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moses","family":"Galukande","sequence":"additional","affiliation":[{"name":"Department of Surgery, School of Medicine Makerere University  Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allen","family":"Naamala","sequence":"additional","affiliation":[{"name":"Department of Surgery, School of Medicine Makerere University  Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Groesbeck","family":"Parham","sequence":"additional","affiliation":[{"name":"UNC Zambia  Lusaka Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leeya","family":"Pinder","sequence":"additional","affiliation":[{"name":"UNC Zambia  Lusaka Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelica","family":"Anele","sequence":"additional","affiliation":[{"name":"Federal Medical Centre  Owerri Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shadrach Awa","family":"Offiah","sequence":"additional","affiliation":[{"name":"Abia State University Teaching Hospital  Aba Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annelle","family":"Zietsman","sequence":"additional","affiliation":[{"name":"AB May Cancer Centre Windhoek Central Hospital  Windhoek Namibia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joachim","family":"Sch\u00fcz","sequence":"additional","affiliation":[{"name":"Environment and Lifestyle Epidemiology Branch International Agency for Research on Cancer  Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7397-3442","authenticated-orcid":false,"given":"Valerie","family":"McCormack","sequence":"additional","affiliation":[{"name":"Environment and Lifestyle Epidemiology Branch International Agency for Research on Cancer  Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel","family":"dos\u2010Santos\u2010Silva","sequence":"additional","affiliation":[{"name":"Department of Non\u2010Communicable Diseases Epidemiology London School of Hygiene and Tropical Medicine  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,1,29]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21660"},{"key":"e_1_2_12_3_1","unstructured":"FerlayJ ErvikM LamF et al.Global Cancer Observatory: cancer today. 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