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Reasons for Patient's Delay in Diagnosis of Breast Carcinoma in Pakistan

  • Published : 2013.12.31

Abstract

Background: Delay in diagnosis of breast cancer is associated with a poorer survival and a pivotal contribution to this delayed diagnosis comes from patient delay in presenting at a clinic. Reasons involved must be evaluated in order to decrease this reducible delay. Objectives: i) To evaluate the reasons for patient delay in diagnosis of breast cancer; ii) to investigate any association with other variables. Materials and Methods: A 6 month cross sectional study (from July 2012 to Dec 2012), was carried out in Surgical and Oncology Units of Civil Hospital, Karachi. A total of 100 females diagnosed with breast cancer of any histological type were interviewed after informed consent and relevant data were collected. Due ethical clearance was obtained. Results: Mean age was $47.5{\pm}12.1$ years with a range from 25-77 years. Mean duration of delay was $5.13{\pm}4.8$ months, from shortest 1 month to longest 36 months. Duration of delay was observed to be no delay (<1 month) in 28%, short delay (1-3 months) in 30% and long delay (>3 months) in 42% of patients. Considering the symptoms as "harmless" (39%) was the most frequent reason of delay followed by "temporary" (20%) and the "use of traditional methods" (12%). Most common reason for later approaches was an increase in the size of the lump (41%). Statistically significant association (p-value <0.05) of longer patient delay was obtained with being single, being illiterate, painless breast lump as the first symptom, negative family history of breast cancer and vague attribution of the symptoms. Conclusions: Significant delay in approach to health care facility was observed in our study due to variable reasons given by women. Sufficient awareness regarding breast cancer, its symptoms and favorable effects of a timely diagnosis on prognosis must be imparted to our general population.

References

  1. Gilani GM, Akhter AS, Kamal S (2003). A Differential Study of Breast Cancer Patients in Punjab, Pakistan. JPMA, 53, 478.
  2. Gilani S.I, Khurram M, Mazhar T, et al (2010). Knowledge, attitude and practice of a Pakistani female cohort towards breast cancer. JPMA, 60, 205.
  3. Hackett TP, Casscm NH, Racker JW (1973). Patient Delay in cancer. N Engl J Med, 289, 14-20 https://doi.org/10.1056/NEJM197307052890104
  4. Harirchi, Ebrahimi M, Zamani N, et al (2000). Breast cancer in Iran: a review of 903 case records. Public Health, 114, 143-5
  5. Harirchi I, Ghaemmaghami F, Karbakhsh M, et al (2005). Patient delay in women presenting with advanced breast cancer: an Iranian study, Public Health, 119, 885-91 https://doi.org/10.1016/j.puhe.2004.11.005
  6. Hussain MA, Ali S, Tyagi SP, et al (1994). Incidence of cancer breast at Aligarh, J Indian Med Assoc, 92, 296-7
  7. Ibrahim EM, al-Mulhim FA, aI-Amri A, et al (1998). Breast cancer in the eastern province of Saudi Arabia. Med Oncol, 15, 241-7. https://doi.org/10.1007/BF02787207
  8. Kumari PBVR, Goonewardena CSE (2011). Delay among women reporting symptoms of breast cancer. J Coll Community Physicians of Sri Lanka, 16, 17-22. https://doi.org/10.4038/jccpsl.v16i1.3867
  9. Caplan LS, Helzlsouer KJ, Shapiro S, et al (1996). Reasons for delay in breast cancer diagnosis elsevier. Prev Med, 25, 218-24 https://doi.org/10.1006/pmed.1996.0049
  10. Facione NC (1993). Delay versus help seeking for breast cancer symptoms: a critical review of the literature on patient and provider delay. Soc Sci Med, 36, 1521-34 https://doi.org/10.1016/0277-9536(93)90340-A
  11. Lodhi FB, Ahmad B, Shah SIH, et al (2010). Determinants of delayed presentation in breast cancer. APMC, 4, 9-16.
  12. Malik IA, Khan NA, Khan W (2000). Use of unconventional methods of therapy by cancer patients in Pakistan. Eur J Epidemiol, 16, 155-60 https://doi.org/10.1023/A:1007621104789
  13. Abdel-Fatah M, Anwar M, Mari E, et al (1999). Patient and system related diagnositic delay in breast cancer. Eur J Public Health, 9, 15-9 https://doi.org/10.1093/eurpub/9.1.15
  14. Adams SA, Homer JK, Vessey MP (1980). Delay in treatment for breast cancer. Community Med, 2, 195-201
  15. Afzelius P, Karin Z, Hanne S, et al (1994). Patient's and doctor's delay in primary breast cancer: prognostic implications. Acta Oncol, 33, 345-51 https://doi.org/10.3109/02841869409098427
  16. Ali R, Mathew A, Rajan B (2008). Effects of socio-economic and demographic factors in delayed reporting and late-stage presentation among patients with breast cancer in a major cancer hospital in South India. Asian Pac J Cancer Prev, 9, 703-7
  17. Anyanwu SN (2008).Temporal trends in breast cancer presentation in the third world. J Exp Clin Cancer Res, 27, 17 https://doi.org/10.1186/1756-9966-27-17
  18. Arndt V, Sturmer T, Stegmaier C, et al (2002). Patient delay and stage of diagnosis among breast cancer patients in Germany a population based study. Br J Cancer, 86, 1034-40. https://doi.org/10.1038/sj.bjc.6600209
  19. Bish A, Ramirez A, Burgess C, Hunter M (2005). Understanding why women delay in seeking help for breast cancer symptoms. J Psychosom Res, 58, 321-6 https://doi.org/10.1016/j.jpsychores.2004.10.007
  20. Burgess CC, Ramirez AJ, Richards MA, et al (1988). Who and what influences delayed presentation in breast cancer? Br J Cancer, 77, 1343-8
  21. Malik I. A. (2002) .Clinico-pathological Features of Breast Cancer in Pakistan, Eur J Epidemiol, 52, 100.
  22. Malik IA, Gopalan S (2003). Use of CAM results in delay in seeking medical advice for breast cancer. Eur J Epidemiol, 18, 817-22.
  23. Montazeri A, Ebrahimi M, Mehrdad N, et al (2003). Delayed presentation in breast cancer: a study in Iranian women. BMC Women's Health, 3, 4 https://doi.org/10.1186/1472-6874-3-4
  24. Montella M, Crispo A, D'Aiuto G, et al (2001). Determinant factors for diagnostic delay in operable breast cancer patients. Eur J Cancer Prev, 10, 53-9. https://doi.org/10.1097/00008469-200102000-00006
  25. Norsa'adah B, Rampal KG, Rahmah MA, et al (2011). Diagnosis delay of breast cancer and its associated factors in Malaysian women, BMC Cancer, 11, 141 https://doi.org/10.1186/1471-2407-11-141
  26. Norsa'adah B, Rahmah M A, Rampal K J, et al (2012). Understanding Barriers to Malaysian Women with Breast Cancer Seeking Help. Asian Pac J Cancer Prev, 13, 3723-30 https://doi.org/10.7314/APJCP.2012.13.8.3723
  27. Nosarti C, Crayford T, Roberts J V, et al (2000). Delay in presentation of symptomatic referrals to a breast clinic: patient and system factors. Br J Cancer, 82, 742-8 https://doi.org/10.1054/bjoc.1999.0990
  28. Pineros M, Sanchez R, Cendales R (2009). Patient delay among Colombian women with breast cancer. Salud Publica Mex. 51, 372-80.
  29. Ramirez AJ, Westcombe AM, Burgess CC, et al (1999). Factors predicting delayed presentation of symptomatic breast cancer: a systematic review. The Lancet, 353, 1127-31 https://doi.org/10.1016/S0140-6736(99)02142-X
  30. Rashid M, Rafi CM, Mamoon N (1996). Late presentation of carcinoma breast in Pakistani women. Pak Armed Forces Med J, 46, 11-5.
  31. Sharma K, Costas A, Shulman LN, Meara JG. (2012). A Systematic Review of Barriers to Breast Cancer Care in Developing Countries Resulting in Delayed Patient Presentation. J Oncol, 2012, 121873
  32. Talpur AA, Ansari AG, Ghumro AA, et al (2011). Late presentation of breast cancer: A dilemma. J Pak Med Assoc, 61, 662-6.
  33. Thongsuksai P, Chongsuvivatwong V, Sriplung H (2000). Delay in breast cancer care: a study in thai women. Med Care, 38, 108-14. https://doi.org/10.1097/00005650-200001000-00012
  34. Ukwenya AY, Yusufu LM, Nmadu PT, Garba ES, Ahmed A (2008). Delayed treatment of symptomatic breast cancer: the experience from Kaduna, Nigeria. S Afr J Surg, 46, 106-10

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