Abstract
BackgroundSurvival from breast cancer remains lower in Estonia than in most other European countries. More advanced stage and larger tumors that have impact on survival may be a result of delay in seeking help for breast cancer symptoms. The aim of this study was to identify determinants of delayed presentation among breast cancer patients in Estonia.MethodsThe study population included women with primary breast cancer diagnosed in Estonia in 2008–2010. All data were collected using structured personal interviews carried out by trained nurses in the hospital setting. Only patients with self-discovered symptoms were included in this analysis. Patient delay was measured as time elapsing from symptom self-discovery to first medical consultation. The effect of different factors on the likelihood of prolonged delay (>90 days) was evaluated using logistic regression.ResultsAmong 703 eligible patients, median patient delay was 16 days (interquartile range 5–54 days). Seventeen percent of the patients had their first medical consultation more than three months after self-detection of symptoms. In multivariate analysis, the risk of prolonged delay was significantly associated with age 65 years and over (OR 2.27, 95% CI 1.23–4.20), current smoking (OR 2.09, 95% CI 1.21–3.61), symptoms other than painless breast lump or breast pain (OR 1.84, 95% CI 1.08–3.16), no history of mammograms (OR 1.83, 95% CI 1.13–2.95), having received no information on breast cancer during past year (OR 1.77, 95% CI 1.05–2.99), and previous benign breast problems (OR 1.65, 95% CI 1.01–2.67). Non-significant risk increase was seen with lower education.ConclusionsThis study provides evidence that factors associated with delayed presentation of breast cancer in Eastern Europe are similar to those observed in Western countries. The results suggest that educational messages to general population should aim at increasing awareness of “non-lump” symptoms of breast cancer and encouraging women of all ages to present in a timely manner. Women at risk for delayed presentation such as smokers and women with no history of mammograms could be identified in the primary care setting.
Highlights
Survival from breast cancer remains lower in Estonia than in most other European countries
A recent review showed that longer delay by patients with Breast cancer (BC) symptoms was associated with sociodemographic factors such as older age, lower level of education and ethnic origin, symptom type and non-recognition of symptom seriousness, while social support/advice had an opposite effect [8]
After the exclusion of 166 cases detected by screening mammography, 61 prophylactic mammography cases, 68 physician-detected cases, 12 cases whose cancer diagnosis was not confirmed morphologically after surgery, 6 cases with known previous BC, and 10 cases with missing data on patient delay, 703 self-detected cases were included in this analysis
Summary
Survival from breast cancer remains lower in Estonia than in most other European countries. More advanced stage and larger tumors that have impact on survival may be a result of delay in seeking help for breast cancer symptoms. The aim of this study was to identify determinants of delayed presentation among breast cancer patients in Estonia. One possible reason for more advanced stage and larger tumors is delay in seeking help for BC symptoms. Studies in European countries have shown that between 17–20% of patients with BC symptoms delay their presentation for three months or more [5,6,7]. A recent review showed that longer delay by patients with BC symptoms was associated with sociodemographic factors such as older age, lower level of education and ethnic origin, symptom type and non-recognition of symptom seriousness, while social support/advice had an opposite effect [8]. Other studies have reported associations with the history of benign breast problems and health care utilization [5,9,10]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
