Presentation Delay in Breast Cancer Patients, Identifying the Barriers in North Pakistan

  • Published : 2015.02.04


Background: There is strong evidence that delayed diagnosis of breast cancer is associated with poor survival. Our objectives were to determine the frequency of breast cancer patients with delayed presentation, the reasons of delay and its association with different socio-demographic variables in our North Pakistan setting. Materials and Methods: We interviewed 315 histologically confirmed breast cancer patients. Delay was defined as more than 3 months from appearance of symptoms to consultation with a doctor. Questions were asked from each patient which could reflect their understanding about the disease and which could be the likely reasons for their delayed presentation. Results: 39.0 % (n=123) of patients presented late and out of those, 40.7% wasted time using alternative medicines; 25.2 % did not having enough resources; 17.1 % presented late due to painless lump; 10.6% felt shyness and 6.5% presented late due to other reasons. Higher age, negative family history, < 8 school years of education and low to middle socio-economic status were significantly associated with delayed presentation (p< 0.05). Education and socioeconomic status were two independent variables related to the delayed presentation after adjustment for others (OR of 2.26, 2.29 and 95%CI was 1.25-4.10, 1.06-4.94 respectively). Conclusions: Significant numbers of women with breast cancer in North Pakistan experience presentation delay due to their misconceptions about the disease. Coordinated efforts with public health departments are needed to educate the focused groups and removing the barriers identified in the study. Long term impact will be reduced overall burden of the disease in the region.


  1. 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.
  2. Bhurgri Y, Kayani N, Faridi N, et al (2007). Patho-epidemiology of breast cancer in Karachi '1995-1997'. Asian Pac J Cancer Prev, 8, 215-20.
  3. Brzozowska A, Duma D, Mazurkiewicz T, Brzozowski W, Mazurkiewicz M (2014). Reasons for delay in treatment of breast cancer detected due to breast self-examination in women from the Lubelskie region. Ginekol Pol, 85, 14-7.
  4. Caplan L (2014). Delay in breast cancer: implications for stage at diagnosis and survival. Front Public Health, 2, 87.
  5. Gullatte MM, Brawley O, Kinney A, Powe B, Mooney K (2010). Religiosity, spirituality, and cancer fatalism beliefs on delay in breast cancer diagnosis in African American women. J Relig Health, 49, 62-72.
  6. Innos K, Padrik P, Valvere V, et al (2013). Identifying women at risk for delayed presentation of breast cancer: a crosssectional study in Estonia. BMC Public Health, 13, 947.
  7. Jamal S, Atique M, Khadim MT (2014). Changing pattern of malignancies: analysis of histopathology based tumour registry data and comparison of three decades at Armed Forces Institute of Pathology, Rawalpindi, Pakistan. J Pak Med Assoc, 64, 24-7.
  8. Jones CE, Maben J, Jack RH, et al (2014). A systematic review of barriers to early presentation and diagnosis with breast cancer among black women. BMJ Open, 4, 4076.
  9. Khurshid A, Faridi N, Arif AM, Naqvi H, Tahir M (2013). Breast lesions in adolescents and young women in Pakistan--a 5 year study of significance of early recognition. Asian Pac J Cancer Prev, 14, 3465-7.
  10. Kothari A, Fentiman IS (2003). Diagnostic delays in breast cancer and impact on survival. Int J Clin Pract, 57, 200-3.
  11. Li WW, Lam WW, Wong JH, et al (2012). Waiting to see the doctor: understanding appraisal and utilization components of consultation delay for new breast symptoms in Chinese women. Psychooncology, 21, 1316-23.
  12. Moore MA, Ariyaratne Y, Badar F, et al (2010). Cancer epidemiology in South Asia - past, present and future. Asian Pac J Cancer Prev, 11, 49-66.
  13. Naeem M, Khan N, Aman Z, Nasir A, Samad A, Khattak A (2008). Pattern of breast cancer: experience at Lady Reading Hospital, Peshawar. J Ayub Med Coll Abbottabad, 20, 22-5.
  14. 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.
  15. O'Mahony M, McCarthy G, Corcoran P, Hegarty J (2013). Shedding light on women's help seeking behaviour for self discovered breast symptoms. Eur J Oncol Nurs, 17, 632-9.
  16. Poum A, Promthet S, Duffy SW, Parkin DM (2014). Factors associated with delayed diagnosis of breast cancer in northeast Thailand. J Epidemiol, 24, 102-8.
  17. Richards MA, Smith P, Ramirez AJ, Fentiman IS, Rubens RD (1999). The influence on survival of delay in the presentation and treatment of symptomatic breast cancer. Br J Cancer, 79, 858-64.
  18. Richards MA, Westcombe AM, Love SB, Littlejohns P, Ramirez AJ (1999). Influence of delay on survival in patients with breast cancer: a systematic review. Lancet, 353, 1119-26.
  19. Ruddy KJ, Gelber S, Tamimi RM, et al (2014). Breast cancer presentation and diagnostic delays in young women. Cancer, 120, 20-5.

Cited by

  1. Delay in Presentation, Diagnosis, and Treatment for Breast Cancer Patients in Jordan vol.22, pp.2, 2015,
  2. Prevalence and Risk Factors for Patient Delay Among Women With Breast Cancer in Rural India vol.28, pp.1, 2016,
  3. A systematic review of associations between non-communicable diseases and socioeconomic status within low- and lower-middle-income countries vol.8, pp.2, 2018,