Title

To Determine the Factors Responsible for Diagnostic Delay of Breast Cancer Among Women

Document Type

Article

Department

Medicine

Abstract

Background: Breast cancer is the most common cancer among women throughout the world. Early diagnosis of this cancer is important for its early treatment and favorable outcome. The diagnostic pathway is divided into patient, doctor and system interval. This study will look into the reasons for delay in diagnosis.

Objectives: To determine the frequency of diagnostic delay (patient, doctor and system delay) of breast cancer among adult women (≥ 18 years) and factors responsible for it.

Study design, settings and duration: Hospital based cross-sectional study conducted at Oncology/ Radiotherapy unit of Jinnah Post Graduate Medical Centre, Karachi from February 2015 to December 2015.

Subjects and Methods: Adult women (≥ 18 years) diagnosed with breast cancer and reporting at Oncology/Radiotherapy unit of Jinnah Post Graduate Medical Centre, Karachi were enrolled. Convenient sampling was used, sample size was 288 women with breast cancer. Variables included age strata, socio-demographic characteristics, age at menarche, parity and breast feeding history (if applicable), intervals of diagnostic pathway (patient, doctor and system) and reasons of delay. Questionnaire based instrument was used for data collection. SPSS version 16 was used for data analysis and descriptive frequencies.

Results: The mean age of the patients was 42 years (range 21-80 years). Breast lump was the main presenting symptom (90%). Complete physical and breast examination was performed by health care provider in 97% cases. Median patient, doctor and system interval was 90, 45 and 35 days respectively. Median diagnostic pathway (patient+ doctor+ system) was 165 days (5.5 months) and ranged from 2- 405 days (13.5 months). It was further found that after confirmation of the diagnosis, median interval to report to oncology/radiotherapy unit was 18 months. First consultation with the health care provider was delayed due to carelessness in 57%, due to financial reasons in 55%, due to fear of cancer in 23% and due to time constraints to visit hospital by the family members in 13% cases. Univariate regression analysis showed that late presentation to first health care provider by the patient (patient interval) was mostly seen in women having children who were less educated (illiterate/ primary) without any ethnic group being specific. Univariate regression analysis showed that delay in reporting to oncology/ radiotherapy unit was seen in women without any ethnic group been specific and those having children. Multivariate regression analysis showed that delay in reporting to oncology/ radiotherapy units was mostly seen in women aged between 18-25 years who had children and belonged to either Sindhi, Baluchi or Pushto origin.

Conclusion: Delay in the diagnosis of breast cancer among adult women attending the tertiary care public sector hospital was not due to doctor or system interval but was due to fear of cancer.

Policy statement: Awareness campaigns should be used to communicate to women folks that breast cancer is curable if diagnosed and treated early.

Publication

Pakistan Journal of Medical Research.