Modifiable patient-related barriers and their association with breast cancer detection practices among Ugandan women without a diagnosis of breast cancer.

Jake W Sharp,Gertrude Nakigudde,John R Scheel,Yamile Molina,Zeridah Muyinda,Benjamin O Anderson,Daniel S Hippe,Yonglan Zheng

doi:10.1371/journal.pone.0217938

Abstract

Most women with breast cancer in sub-Saharan Africa (SSA) are diagnosed with late-staged disease. The current study assesses patient-related barriers among women from a general SSA population to better understand how patient-related barriers contribute to diagnostic delays. Using convenience-based sampling, 401 Ugandan women without breast cancer were surveyed to determine how prior participation in cancer detection practices correlate with patient-related barriers to prompt diagnosis. In a predominantly poor (76%) and rural population (75%), the median age of the participants was 38. Of the women surveyed, 155 (46%) had prior exposure to breast cancer education, 92 (27%) performed breast self-examination (BSE) and 68 (20%) had undergone a recent clinical breast examination (CBE), breast ultrasound or breast biopsy. The most commonly identified barriers to prompt diagnosis were knowledge deficits regarding early diagnosis (79%), economic barriers to accessing care (68%), fear (37%) and poor social support (24%). However, only women who reported knowledge deficits—a modifiable barrier—were less likely to participate in cancer detection practices (p<0.05). Women in urban and rural areas were similarly likely to report economic barriers, knowledge deficits and/or poor social support, but rural women were less likely than urban women to have received breast cancer education and/or perform BSE (p<0.001). Women who have had prior breast cancer education (p<0.001) and/or who perform BSE (p = 0.02) were more likely to know where she can go to receive a diagnostic breast evaluation. These findings suggest that SSA countries developing early breast cancer detection programs should specifically address modifiable knowledge deficits among women less likely to achieve a diagnostic work-up to reduce diagnostic delays and improve breast cancer outcomes.

Highlights

When patients present with late stage breast cancer, the treatment is more resource-intensive and less likely to result in a cure
We evaluated barriers Ugandan women without breast cancer encounter with different breast cancer detection practices as a proxy for understanding the barriers women with breast cancer who are less likely to achieve a diagnosis may encounter along the path to diagnosis
Previous studies showed multiple largely socially determined sociodemographic factors and infrastructure barriers associated with delays in diagnosis, we showed that knowledge deficits—a modifiable factor- was the only barrier associated with participating in breast cancer detection practices

Summary

Introduction

When patients present with late stage breast cancer, the treatment is more resource-intensive and less likely to result in a cure. While breast self-examination (BSE) is associated in the patient interval and clinical breast examination (CBE), breast ultrasound and biopsy are important in the diagnostic interval, breast cancer education is essential throughout the patient pathway for early diagnosis, in countries where the referral pathways are not established, such as in sub-Saharan Africa. Given the strong association between delays in the patient pathway for early diagnosis and poor outcomes,[1, 3] shortening the patient and/or diagnostic intervals has potential to improve breast cancer survival

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Results

Conclusion