Abstract
BackgroundTypically, women in South Africa (SA) are diagnosed with breast cancer when they self-present with symptoms to health facilities. The aim of this study was to determine the pathway that women follow to breast cancer care and factors associated with this journey.MethodsA cross-sectional study was conducted at a tertiary hospital in the Western Cape Province, SA, between May 2015 and May 2016. Newly diagnosed breast cancer patients were interviewed to determine their socio-demographic profile; knowledge of risk factors, signs and symptoms; appraisal of breast changes; clinical profile and; key time events in the journey to care. The Model of Pathways to Treatment Framework underpinned the analysis. The total time (TT) between a woman noticing the first breast change and the date of scheduled treatment was divided into 3 intervals: the patient interval (PI); the diagnostic interval (DI) and the pre-treatment interval (PTI). For the PI, DI and PTI a bivariate comparison of median time intervals by various characteristics was conducted using Wilcoxon rank-sum and Kruskal-Wallis tests. Cox Proportional-Hazards models were used to identify factors independently associated with the PI, DI and PTI.ResultsThe median age of the 201 participants was 54 years, and 22% presented with late stage disease. The median TT was 110 days, with median patient, diagnostic and pre-treatment intervals of 23, 28 and 37 days respectively. Factors associated with the PI were: older age (Hazard ratio (HR) 0.59, 95% CI 0.40–0.86), initial symptom denial (HR 0.43, 95% CI 0.19–0.97) and waiting for a lump to increase in size before seeking care (HR 0.51, 95% CI 0.33–0.77). Women with co-morbidities had a significantly longer DI (HR 0.67, 95% CI 0.47–0.96) as did women who mentioned denial of initial breast symptoms (HR 4.61, 95% CI 1.80–11.78). The PTI was associated with late stage disease at presentation (HR 1.78, 95% CI 1.15–2.76).ConclusionThe Model of Pathways to Treatment provides a useful framework to explore patient’s journeys to care and identified opportunities for targeted interventions.
Highlights
Women in South Africa (SA) are diagnosed with breast cancer when they self-present with symptoms to health facilities
In 2012 the majority (53%) of new breast cancer cases were among women living in low- and middleincome countries (LMICs) [1, 2], where the shift toward more affluent lifestyles, those associated with dietary and reproductive risk factors, has been associated with a rising burden of cancers
A total of 216 women were approached to participate in the study: 8 refused (1 due to time constraints, 1 did not feel emotionally ready, 5 were not interested in the research study) and 7 were ineligible
Summary
Women in South Africa (SA) are diagnosed with breast cancer when they self-present with symptoms to health facilities. The aim of this study was to determine the pathway that women follow to breast cancer care and factors associated with this journey. Women with breast symptoms self-present to primary health care facilities and are referred to secondary or tertiary level health facilities if further diagnostic work-up and treatment is required [4]. Minimizing time to diagnosis is dependent on timely presentation to primary health care providers by women with symptoms suggestive of breast cancer; appropriate assessment at the primary health care level and; timely access to referral and treatment centres.
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