Diagnostic and treatment delays in breast cancer in association with multiple factors in Pakistan.

Abstract

Breast cancer has the highest incidence rate among all types of cancer worldwide. There is strong evidence that delay in presentation to an oncologist may lead to a decrease in survival. This study explores factors causing diagnostic and treatment delays among the breast cancer patients enrolled in Jinnah Hospital, Lahore, from 2016 to 2018. Data from 372 patients were collected, including tumour characteristics, first symptoms, knowledge and experience of breast cancer, first visit to a doctor, etc. We calculated the patient, physician, treatment, system and total delay intervals. Breast cancer cases showed longer mean patient delay in older women (> 50 years) in comparison with younger women. Women with painless lump as the initial symptom showed the longest delay with median total delay 280 days (25th and 75th percentiles 140 and 410 days respectively). Initial symptoms were correlated with total delay (P = 0.036). Educated women showed shorter delay in treatment compared with illiterate women (P = 0.068). Rural residence showed significant delay (P = 0.007). Lump size showed correlation with delay (P = 0.039). Patients with low household income (< Rs 10 000) had greater delay in diagnosis (P = 0.027) and actively employed women showed shorter delay (P < 0.0001). Unmarried women were diagnosed earlier than married (P < 0.001). Women showed delay in presentation due to lack of resources and lack of awareness about the disease. They presented late due to fear of surgery and chemotherapy. Using traditional treatment methods leads to diagnosis of the disease at more advanced stages.