Delayed Presentation of Self-discovered Breast Cancer Symptoms in Iranian Women: A Qualitative Study

  • Khakbazan, Zohreh (Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences) ;
  • Taghipour, Ali (Health Sciences Research Center, Department of Biostatistics and Epidemiology, School of Health, Mashhad University of Medical Sciences) ;
  • Roudsari, Robab Latifnejad (Evidence-Based Care Research Centre, Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences) ;
  • Mohammadi, Eesa (Department of Nursing, Medical Sciences Faculty, Tarbiat Modares University) ;
  • Omranipour, Ramesh (Cancer Research Centre, Department of Surgical Oncology, Tehran University Of Medical Science)
  • Published : 2014.11.28


Background: Delayed presentation of symptomatic breast cancer is a public health issue in Iran, making a major contribution to low survival. Despite the importance of this problem, current knowledge is insufficient to inform interventions to shorten patient delay. The aim of this study was to explore factors influencing patient delay in Iranian women with self-discovered breast cancer symptom. Materials and Methods: This qualitative study was conducted during 2012-2013. Purposeful sampling was used to recruit 20 Iranian women with self-discovered symptoms of breast cancer who attended the Cancer Institute of Tehran University of Medical Sciences, Tehran, Iran. Data were collected through semi-structured in-depth audiotaped interviews, which were transcribed and analyzed using conventional content analysis with MAXqda software version 10. Findings: Content analysis of the data revealed four main themes related to the delay in seeking medical help including: 1) attributing symptoms to the benign conditions; 2) conditional health behavior; 3) inhibiting emotional expression; and 4) barriers to access to health care systems. Conclusions: These results suggest that patient delay is influenced by complex and multiple factors. Effective intervention to reduce patient delay for breast cancer should be developed by focusing on improvement of women's medical knowledge, managing patients' emotional expression and reform of the referral system.



  1. Alhurishi S, Lim JN, Potrata B, West R (2011). Factors influencing late presentation for breast cancer in the Middle East: a systematic review. Asian Pac J Cancer Prev, 12, 1597-600.
  2. Andersen BL, Cacioppo JT, Roberts DC (1995). Delay in seeking a cancer diagnosis: Delay stages and psychophysiological comparison processes. BrJ Soc Psychol, 34, 33-52.
  3. Arndt V, Sturmer T, Stegmaier C, et al (2001). Sociodemographic factors, health behavior and late-stage diagnosis of breast cancer in germany: a population-based study. J Clin Epidemiol, 54, 719-27.
  4. Babu GR, Samari G, Cohen SP, et al (2011). Breast cancer screening among females in Iran and recommendations for improved practice: a review. Asian Pac J Cancer Prev, 12, 1647-55.
  5. Benson JR, Jatoi I (2012). The global breast cancer burden. Future Oncol, 8, 697-702.
  6. Burgess C, Hunter MS, Ramirez AJ (2001). A qualitative study of delay among women reporting symptoms of breast cancer. Br J Gen Pract, 51, 967-71.
  7. Chang G, Chan CW, Hartman M (2011). A commentary on delayed presentation of breast cancer in Singapore. Asian Pac J Cancer Prev, 12, 1635-9.
  8. De Nooijer J, Lechner L, De Vries H (2001). A qualitative study on detecting cancer symptoms and seeking medical help; an application of andersen's model of total patient delay. Patient Educ Coun, 42, 145-57.
  9. Dye TD, Bogale S, Hobden C, et al (2012). Experience of initial symptoms of breast cancer and triggers for action in Ethiopia. Int J Breast Cancer, 2012, 908547.
  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.
  11. Graneheim UH, Lundman B (2004). Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today, 24, 105-12.
  12. Harirchi I, Ghaemmaghami F, Karbakhsh M, Moghimi R, Mazaherie H (2005). Patient delay in women presenting with advanced breast cancer: an Iranian study. Publ Health, 119, 885-91.
  13. Heidari Z, Mahmoudzadeh-Sagheb H, Sakhavar N (2008). Breast cancer screening knowledge and practice among women in southeast of iran. Acta Medica Iranica, 46, 321-8.
  14. Lam W, Tsuchiya M, Chan M, et al (2009). Help-seeking patterns in Chinese women with symptoms of breast disease: a qualitative study. J Publ Health, 31, 59-68.
  15. Lu M-H, Lin H-R, Lee M-D (2010). The experiences among older taiwanese women facing a new diagnosis of breast cancer. Canc Nurs, 33, 398-405.
  16. Noroozi A, Tahmasebi R (2011). Factors influencing breast cancer screening behavior among Iranian women. Asian Pac J Cancer Prev, 12, 1239-44.
  17. Norsa'adah B, Rahmah MA, Rampal KG, Knight A (2012). Understanding barriers to malaysian women with breast cancer seeking help. Asian Pac J Cancer Prev, 13, 3723-30.
  18. Nosarti C, Crayford T, Roberts J, Elias E, Mckenzie K, David A (2000). Delay in presentation of symptomatic referrals to a breast clinic: Patient and system factors. Br J Cancer, 82, 742.
  19. O'Mahony M, Hegarty J (2009). Help seeking for cancer symptoms: a review of the literature. Oncol Nurs Forum, 36, 178-84.
  20. Ott J, Ullrich A, Mascarenhas M, Stevens G (2010). Global cancer incidence and mortality caused by behavior and infection. J Public Health, 33, 223-33.
  21. Petrie KJ, Weinman J (2003). More focus needed on symptom appraisal. J Psychosom Res, 54, 401-3.
  22. Ramirez A, Westcombe A, Burgess C, et al (1999). Factors predicting delayed presentation of symptomatic breast cancer: a systematic review. The Lancet, 353, 1127-31.
  23. Rastad H, Khanjani N, Khandani BK (2012). Causes of delay in seeking treatment in patients with breast cancer in Iran: a qualitative content analysis study. Asia Pac J Cancer Prev, 13, 4511-5.
  24. Shulman LN, Willett W, Sievers A, Knaul FM (2010). Breast cancer in developing countries: opportunities for improved survival. J Oncol, 2010, 595167.
  25. Smith LK, Pope C, Botha JL (2005). Patients' help-seeking experiences and delay in cancer presentation: a qualitative synthesis. Lancet, 366, 825-31.
  26. Taib NA, Yip C-H, Low W-Y (2011). Recognising symptoms of breast cancer as a reason for delayed presentation in Asian women-the psycho-socio-cultural model for breast symptom appraisal: opportunities for intervention. Asian Pac J Cancer Prev, 12, 1601-8.
  27. Teel CS, Meek P, McNamara AM, Watson L (1997). Perspectives unifying symptom interpretation. J Nurs Scholarsh, 29, 175-81.
  28. Tfayli A, Temraz S, Abou Mrad R, Shamseddine A (2010). Breast cancer in low-and middle-income countries: an emerging and challenging epidemic. J Oncol, 2010, 490631.
  29. Unger-Saldana K, Infante-Castaneda CB (2011). Breast cancer delay: a grounded model of help-seeking behaviour. Soc Sci Med, 72, 1096-104.
  30. World Health Organization (2014). Breast cancer: prevention and control. Available from:
  31. Yusuf A, Ab Hadi IS, Mahamood Z, Ahmad Z, Keng SL (2013). Understanding the breast cancer experience: A qualitative study of Malaysian women. Asian Pac J Cancer Prev, 14, 3689-98.

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