Late diagnosis of breast cancer in a hospital setting in Ouagadougou in 2024: patient characteristics and associated factors

Breast cancer is a public health issue in Botswana. Associations of patient-level factors with late breast cancer diagnosis are not well understood. This may explain why there are many cases of late diagnosis. We assessed patient-level factors associated with late breast cancer diagnosis among women in Botswana. The study was conducted at four designated cancer public health facilities in Botswana. A cross-sectional hospital-based survey questionnaire was administered to 211 adult women (15 September 2023 - 15 December 2023). Descriptive statistics, Chi-square/Fisher's exact test and logistic regression were performed using StataNow 18 SE to analyse the association of patient factors with late diagnosis for breast cancer. Forty-six per cent (n= 90) of women studied presented with advanced cancer at the first stage of diagnosis. Occupation (χ2= 9.0342;p= 0.029) and age at first full-term pregnancy (χ2= 6.3287;p= 0.042) were associated with late diagnosis at bivariate analysis. With univariate analysis, being single (odds ratio [OR]: 0.184, 95% confidence interval [CI]: 0.036-0.932) and formally employed (OR 3.395, 95% CI: 1.467-7.860) were associated with late diagnosis. Multivariate analysis identified second-degree family history as a major predictor of late cancer diagnosis among women (adjusted odds ratio [AOR]: 0.340, 95% CI: 0.129-0.893). Almost half (45.91%,n= 90) of the study participants presented with advanced stages of breast cancer at the time of initial diagnosis. While we did not study all women in Botswana, the geographical spread of our sample reflects a countrywide problem. We recommend scaling-up cancer awareness campaigns for improved benefits of early breast cancer screening and diagnosis.Contribution:We identified patient level factors associated with late breast cancer diagnosis among women studied in Botswana. Thus, our study informs an awareness campaign for reducing cases of breast cancer late diagnosis.

BackgroundMost women with breast cancer in Ethiopia are diagnosed at an advanced stage of the disease, but the reasons for this have not been systematically investigated. This study, therefore, aimed to explore the main reasons for diagnosis of advanced stage breast cancer from the perspective of patients, family members, and health care providers.MethodsA qualitative study with in-depth interviews was conducted with 23 selected participants at Tikur Anbessa Specialized Hospital, Oncology Clinic using a semi-structured interview guide. These participants were 13 breast cancer patients, 5 family members, and 5 health care providers. Data were transcribed into English, coded and analyzed using thematic analysis.ResultsAwareness about the causes, risk, initial symptoms, early detection methods, and treatment of breast cancer were uncommon, and misconceptions about the disease prevailed among breast cancer patients and family members. There was a sense of hopelessness and uncertainty about the effectiveness of conventional medicine amongst patients and family members. Consequently, performing spiritual acts (using holy water) or seeking care from traditional healers recurred amongst the interviewees. Not taking initial symptoms of breast cancer seriously by the patients, reliance on traditional medicines, competing priorities, financial hardship, older age, fear of diagnosis of cancer, and weak health systems (e.g., delay in referral and long waiting period for consultation) were noted as the main contributors to late diagnosis. In contrast, persuasion by family members and friends, higher educational attainment, and prior experience of neighboring women with breast cancer were mentioned to be facilitators of early diagnosis of breast cancer.ConclusionsThe causes of late diagnosis of breast cancer in Ethiopia are multi-factorial and include individual, cultural, and health system factors. Interventions targeting these factors could alleviate the misconceptions and knowledge gap about breast cancer in the community, and shorten waiting time between symptom recognition and diagnosis of breast cancer.

Factors Contributing to Late Breast Cancer Diagnosis at the Brazzaville University Hospital in 2020, Congo: A Cross-Sectional Analytic Study.

BackgroundBreast cancer is the most frequently diagnosed cancer in women worldwide. The objective of this study was to identify factors associated with late diagnosis of breast cancer in Togolese women.MethodsWe conducted a prospective cross-sectional study with descriptive and analytical purposes on cases of breast cancer in women in 2021, in Togo. The patients included in this study were women followed in the gynecology department for stages III and IV breast cancer.ResultsWe included 62 cases of breast cancer. The average age of the patients was 38.6 ± 12.5 years with extremes of 17 and 76 years. The breast nodule was the most common reason for consultation in 75.8% of cases. The histological types diagnosed were invasive carcinoma of non-specific type (58; 93.55%), mucinous carcinoma (3; 4.84%) and lobular carcinoma (1; 1.61%). For the stage of the cancer, 43 patients were stage III (69.4%) and 19 stage IV (30.6%).In multivariate analysis, the factors associated with late diagnosis of breast cancer were: fear of diagnosis (aOR = 1.29; p = 0.0014), long delay in diagnosis (aOR = 2.62; p = 0.0001) and failure to perform breast self-examination (aOR = 1.68; p = 0.0022).ConclusionThe fear of the diagnosis, the absence of self-examination of the breasts and the use of traditional treatment and self-medication in first intention constituted the essential factors of the late diagnosis of breast cancer. Strategies should be put in place at the national level to impact on these factors for an early diagnosis of breast cancer.

My altered self: cancer

BackgroundBreast cancer remains a significant public health issue worldwide, with late diagnosis leading to poorer outcomes. In Tanzania, many women are diagnosed with advanced stages of breast cancer. The aim of this study was to identify reasons for late presentations from the patient’s perspective.MethodsEmploying a qualitative study design, in-depth interviews were conducted with breast cancer patients. Purposeful sampling was used to recruit patients from inpatient and outpatient settings in the Cancer Care Center of the Kilimanjaro Christian Medical Centre. Eligible patients who were at least 18 years old, and with diagnosed breast cancer were invited for the interview immediately after their medical follow-up visit. Interview transcripts were analysed thematically.ResultsTwenty patients (ten rural and ten urban) participated in the study. The average age was 54.05 years (SD = 9.46). Three women had stage 2, three had stage 3, and 14 had stage 4 breast cancer. Factors that were mentioned for late diagnosis of breast cancer were thematically grouped on three levels: the patient, community, and healthcare system. On the patient level, common reasons reported were a misunderstanding of breast cancer (n = 19, 95%), including lack of knowledge and awareness of breast cancer signs and symptoms, as well as the costs for transportation to the healthcare centre (10, 50%). On the community level, the reasons mentioned were experiencing stigma (n = 19, 95%) initially seeking care from traditional healers (n = 18, 90%), a burdensome spousal relationship (n = 15, 75%) and having faith in God (n = 19). On the health system level, patients (n = 13, 65%) expressed concerns regarding the high costs of cancer treatment, which limited their access to health care.ConclusionOur findings show that, from the patient’s perspective, the main reasons for delayed diagnosis of breast cancer can be grouped at the patient, the community, and the healthcare levels. Themes at the patient level are a lack of knowledge of breast cancer signs and symptoms and lack of awareness of having those symptoms. Community level themes were stigma, seeking initial care from traditional healers, and interacting with religious leaders, and themes related to healthcare included costs of cancer treatment, and negative attitudes of healthcare providers.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12905-025-04213-0.

Purpose: In Tanzania, women are diagnosed at advanced breast cancer stages. The reasons for this are multifactorial and have not been systematically investigated in the Kilimanjaro Region. This study aimed to identify reasons for advanced stage breast cancer at time of diagnosis. Methods: Four focus group discussions and 8 semi- structured in-depth interviews were conducted among health care providers (HCP) and traditional healers from five health care facilities (1 regional and 2 district hospitals) and two urban and rural communities in Kilimanjaro, Tanzania. Thematic coding via grounded theory technique was done by two independent reviewers. Results: Twenty HCP (10 doctors and 10 nurses) and 8 traditional healers participated in the study. The average ages for doctors were 38, nurses 33, and traditional healers 50. Among HCP, the most common reasons for advanced stage breast cancer at time of diagnosis were patients initially seeking care from traditional healers, and patient distrust of conventional medicine. Among traditional healers, the most common reasons were: delayed initiation of biomedical treatment due to long turnaround of pathology results, inability to pay for diagnostic workup and treatment, and transportation issues. Both groups stated lack of patient breast cancer knowledge. Conclusions: There was agreement that lack of adequate breast cancer knowledge and awareness as a very common reason for advanced disease presentation among HCP and traditional healers. Community health education must be designed to adopt socio-cultural and religious doctrines to alleviate the misconceptions and knowledge gap. Health system interventions are also needed to facilitate access to timely, affordable, and quality breast cancer diagnosis and treatment Citation Format: Elizabeth F. Msoka, Lily Gutnik, Agnes M. Cyril, Brenda C. Kitali, Vivian F. Saria, Jackline C. Kwayu, Adellaida A. Kavishe, Perry C. Msoka, Ayesiga Herman, Furaha Serventi, Gilleard G. Masenga, Oluwadamilola Fayanju, Laura Fish, Blandina Th. Mmbaga. Health Care Providers and Traditional Healers Perspectives on Late Diagnosis of Breast Cancer in Tanzania: A Qualitative Study [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 77.

Providers Respond to USPSTF Report on Screening for Breast Cancer

Breast cancer is the first cancer in women in terms of incidence and mortality. In Morocco, it is a public health problem. Its prognosis is strongly linked to the stage at which it is diagnosed. It is a pathology for which diagnosis means are highly developed today, ranging from early detection to the demonstration of infra-clinical lesions, which has markedly improved the prognosis in developed countries. This work aims to identify the factors that lead patients to consult at an advanced stage in our daily practice. It is a retrospective study carried out from January 2018 to December 2018 including 525 patients with breast cancer followed in the medical oncology department of the Mohammed VI University Hospital in Marrakech. The average age was 54. The average time for consultation was 10.3 months. 63% of patients were from rural areas. Delayed diagnosis affected women above 35 years of age (80%). The most common method of detection was self-examination in 74% of cases. Inflammation (2.66%), ulceration (1.14%), signs of metastases (17.14%), and isolated breast nodes (79.4%) were other reasons for consultation. 82.2% of patients were locally advanced at the time of diagnosis. The time for treatment in our study was 3.7 weeks. In our practice, it is the conjunction of ignorance, poverty, socio-cultural habits, and difficult geographical access that are the essential factors in the late diagnosis of breast cancer.

Purpose: In Tanzania, women often present with advanced stage breast cancer leading to treatment delays and poor outcomes. Factors influencing late hospital presentation of breast cancer have not been investigated. In this study, we aimed to explore patient perception of factors contributing to the late diagnosis of breast cancer. Methods: Women diagnosed with late- stage breast cancer in an outpatient cancer care center were identified by clinic nurses and recruited for study participation. Semi-structured interviews were conducted by a single proctor. Interviews were recorded, transcribed verbatim, and coded by three independent reviewers using NVivo 12. Themes were identified using a grounded theory approach. Results: Twenty patients (10 rural and 10 urban) participated in the interviews. The average age was 56; 11 (55%) completed primary education, 10 (50%) were unemployed, and 5 (25%) were married. Fourteen (70 %) of the patients had stage 4 breast cancer, 3 (15%) had stage 3, and 3 (15%) had stage 2. Nineteen (95%) of our respondents misunderstood the etiology of breast cancer as well as its causes, signs, and symptoms. Misconceptions led to experiences of stigma in 19 (95%) participants. One participant stated: “…I failed to tell people because… once I tell them that I have problem they will start to run away from me and even if you ask for assistance they think that I cannot pay them back because they think they might help me today and I die tomorrow before I pay them back…” Fifteen (75%) of the participants experienced rejection from their partners. Thirteen (65%) participants expressed financial concerns and eighteen (90%) participants were initially treated by a traditional healer, both of which lead to delays in hospital presentation. Conclusion: Lack of knowledge about breast cancer among patients, societal stigma, lack of spousal support, financial barriers, and initial treatment by traditional healers all contribute to delays in diagnosis and treatment of breast cancer in Northern Tanzania. Stigma reduction and educational interventions may reduce these delays, and further research is needed to improve access to cancer care in this population. Citation Format: Elizabeth Msoka-Bright, Mackenzie Abraham, Polina Zmijewski, Furaha Serventi, Perry Cyril, Brenda Kitali, Vivian Saria, Jackline Kwayu, Adelide Kavishe, Gileard Masenga, Blandina Mmbaga, Lily Gutnik. Perceived Factors for Late Diagnosis in Women With Advanced Breast Cancer in Northern Tanzania [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 67.

INTRODUCTION: Breast cancer is the first cancer of women in Burkina Faso. There remains a relatively late diagnosis and a reserved prognosis. The main aim of this study is to study the causes, therapeutic and prognostic impacts of late diagnosis of breast cancer at Yalgado Ouédraogo University Hospital. MATERIALS AND METHODS: This was a descriptive and prospective study from May 1st to October 31, 2013. The departments of surgery, gynecology and anatomy-pathology served as a framework for our study. All consenting breast cancer patients with a height greater than at least 5 cm (>T2), suspicious or metastatic satellite lymphadenopathy was included. The data analysis was done using Epi-info© software version 7.2.2.6, with the use of the Khi2, Fisher-exact and Student tests. RESULTS: We collected 70 patients with an average age of 46.1 years. In 95.7% of cases, our patients had consulted a traditional therapist or at least one medical center before being referred to the Yalgado Ouédraogo University Hospital. The consultation was less than 6 months in 52.9% of cases. Diagnostic time was statistically associated with source and monthly income with a p-value of 0.03 and 0.05 respectively. Stage III accounted for 62.8% of cases. Surgery was performed in 48.6% of cases, including 23.5% palliative surgery. Chemotherapy was neo-adjuvant in 22%, adjuvant in 48.8% and palliative in 14.6%. The average duration of follow-up was 2.7 months. We had found 20.6% of recidivism and 22% of deaths. CONCLUSION: Poverty, ignorance, socio-cultural constraints and lack of staff reduce patients' access to early diagnosis, which is responsible for expensive complex treatment and a poor prognosis. Equitable financial and geographic access will reduce diagnostic delays and mortality from breast cancer. KEYWORDS: Breast cancer; Late diagnosis; Causes; Treatment; Prognosis.

Breast cancer has become the most common cancer diagnosed in women. This paper reviews key literature on breast cancer covering various aspects including breast cancer and self-examination, awareness level of breast cancer among women, psychological stress of breast cancer patients, causes of breast cancer and preventive measures for breast cancer. This paper sheds light to urban and young women that self-screening is one of the important yardsticks to prevent late diagnosis of breast cancer and after-math of breast cancer treatment. DOI: 10.5901/mjss.2015.v6n4s3p256

Review question/objective What are the psychosocial experiences of women with breast cancer across the lifespan, including similarities and differences in the psychosocial experiences of younger, middle-aged and older women with breast cancer? Inclusion criteria Types of participants This review will consider studies that include women with a breast cancer diagnosis of any type or stage, with the exception of a cancer recurrence. Women with a recurrence will be excluded since the experience of recurrence has been shown, through research, to be dissimilar to the experience of the first diagnosis and treatment of the disease. The experience of women in all treatment modalities will be included (i.e. lumpectomy, mastectomy of all types with or without breast reconstruction, chemotherapy, radiation therapy and hormone therapy). This review will consider studies that include age as a primary area of interest in the study design. That is, the study will focus on: 1) younger women or older women, or 2) a psychosocial issue and compare it across the lifespan from younger to older. The definition of “younger” and “older” will not be described by the reviewers prior to the review because no consensus has been reached in the literature about defining “young” and “old” in cancer. However, this will be observed in the studies and reported on in the analysis. Therefore, studies that identify the participants as “young” and/or “old”, and provide a range of ages of the participants, will be included. Studies will be excluded if they do not define their population(s) by age or if they combine younger and older populations together. Phenomenon of interest The phenomenon of interest is women’s psychosocial experience of breast cancer, including the social, psychological, emotional, spiritual and quality-of-life aspects of cancer. Context This review will include women from all geographical regions. It will also include all cancer care contexts (e.g. acute care hospital, ambulatory care setting, home care, primary health care).

Background: Breast cancer is the leading malignancy in females in Serbia with incidence and mortality rates constantly increasing in the last several decades. Materials and methods: Current situation and activities for the improvement of breast cancer control in Serbia are presented. Results. Breast cancer is a leading cancer in females with a 25% share in cancer incidence, age adjusted rate of 60 per 100,000 and median age of 56 years. In the last three decades, there was an almost 4-fold increase in the crude mortality rate and the 2, 4-fold increase in the age adjusted rate. Only 40% of women are diagnosed with a localized disease. Clinically, less then quarter of patients are diagnosed with a small tumor (<2cm). There is only 1% of non-invasive tumors. Sparing surgical procedures are performed in only one third of breast cancer patients. Main reasons for late diagnosis of breast cancer are: lack of diagnostic capacities, inadequate professional education, low breast cancer awareness and the absence of a screening program. In order to improve the situation, the Breast cancer working group was established by the Ministry of Health, with a task to develop a national program for breast cancer prevention and control. Guidelines for breast cancer screening were developed. Several mammographs were purchased but more than twice new machines are still needed. Education of other health professionals will be carried out through a continuous medical education developed as a part of accreditation and licensing system by the Ministry of Health. Conclusion: National program for breast cancer prevention and control is regarded as a healthcare priority in Serbia.

Breast cancer is the most common cause of mortality in females globally and affects the lives of millions of women. It is a leading cause of mortality worldwide, but the dynamics have been changed because of advanced screening and treatment protocols [1]. In the United States, breast cancer has been ranked second most common cause of cancer-related death in women, with the most common being lung cancer [2]. To improve cancer screening, a personalized approach has been discussed, but its implication over large populations can be difficult and require expertise. Early detection leads to a good prognosis whereas the late diagnosis of breast cancer is a challenge for both patient and doctor [3]. Breast cancer became the most prevalently diagnosed cancer worldwide as of 2021 accounting for 12% of new annual cases worldwide, according to the World Health Organization. In2020, there were 2.3 million women diagnosed with breast cancer and 685 000 deaths globally. Multigene panel testing has identified various genes predisposed to breast cancer development. These genes have different penetrance abilities. BRCA1 and BRCA2 genes are the best known high penetrance gene of hereditary breast cancer. Their discovery has revolutionized the effect in cancer assessment. Tumors from BRCA1 and BRCA2 show distinctive clinicopathological characteristics as compared with other genes causing tumors. Beyond BRCA1 and BRCA2, advances in molecular technique have led to the identification of other genes associated with breast cancer. Some other the high penetrance genes are TP53, PTEN, STK11, and CDH1. Besides high pentrance gene, moderate to low penetrance genes are also recognized as a cancer predisposing genes: PALB, BRIP1, ATM, CHEK2, BARD1, NBN, NF1, RAD51C, RAD51D. Along with risk of breast cancer development these genes also predispose to other malignancies, as well as some genetic disorders.