Abstract
To describe the risk factors for late detection and advanced-stage diagnosis among patients who detected their BC early. Using secondary data, we analyzed the impact of socio-demographic factors, premorbid experience, BC knowledge, and health-seeking pattern on the risk of late detection and advanced-stage diagnosis after early BC detection. Test of statistical significance in SPSS and EasyR was set at 5% using Sign-test, chi-square tests (of independence and goodness of fit), odds ratio, or risk ratio as appropriate. Most socio-demographic factors did not affect detection size or risk of disease progression in the 405 records analyzed. High BC knowledge, p-value = 0.001, and practicing breast self-examination (BSE) increased early detection, p-value = 0.04, with a higher probability (OR 1.6 (95% CI 1.1-2.5) of detecting <2cm lesions. Visiting alternative care (RR 1.5(95% CI 1.2-1.9), low BC knowledge (RR 1.3(95% CI 1.1-1.9), and registering concerns for hospital care increased the risk of advanced-stage diagnosis after early detection (64% (95% CI 55-72)). Adhering to the monthly BSE schedule reduced the risk of advanced-stage diagnosis by -25% (95% CI -49, -1.1) in the presence of socioeconomic barriers. Strategies to increase BC knowledge and BSE may help BC downstaging, especially among women with common barriers to early diagnosis.
Highlights
High breast cancer (BC) knowledge, p-value = 0.001, and practicing breast self-examination (BSE) increased early detection, p-value = 0.04, with a higher probability
Downstaging symptomatic breast cancer (BC) through early detection and diagnosis is a topical issue in sub-Saharan Africa (SSA) because socioeconomic barriers and lack of infrastructure make asymptomatic population-based screening impractical
Fifty-five percent of the patients reported practicing breast self-examination (BSE), with only 17% maintaining the standard monthly schedule (Table 1)
Summary
Downstaging symptomatic breast cancer (BC) through early detection and diagnosis is a topical issue in sub-Saharan Africa (SSA) because socioeconomic barriers and lack of infrastructure make asymptomatic population-based screening impractical. Promoting early detection practices and following through with early diagnosis and timely treatment will improve BC outcomes in Africa [1]. Most breast cancers are incidental selfdetection in Africa, and up to 80% are diagnosed at stage III or IV, with most patients delaying treatment for more than six months. Reports on advanced-stage diagnosis failed to distinguish tumors already advanced at the time of detection or recognition from those progressing after early detection. Our previous research showed that late detection and progressing to advanced disease after an early detection contributed differently to advanced-stage diagnosis and challenges of managing BC. 10% of tumors detected inadvertently were already advanced, while 30–70% of those detected early progressed to advanced-stage before diagnosis [7]
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