Patient Delay in Breast Cancer Diagnosis, Its Associated Factors and Stage of Breast Cancer at First Presentation

Abstract

Background: Patients with breast cancer in Pakistan commonly present with advanced disease. An understanding of the factors influencing delays is important to formulate strategies and shorten delays. Aim: The objective of the current study was to evaluate the frequency and magnitude of patient delay in women of Karachi with a diagnosis of breast, and in addition to provide a detailed assessment of the reasons for this delay of breast cancer patients in seeking medical treatment and if there was a relationship between delays and disease stage. Methods: 533 newly diagnosed cases of breast cancer were enrolled and interviewed during the period from Feb 2015 to Aug 2016. Patient delay in breast cancer diagnosis was defined as time from first symptoms until first medical consultation. Results: The mean age of women was 48.2 ± 12.3 years. The mean consultation time was 7 months. The factors associated with delay were welfare hospital (OR= 2.73, 95% CI: 1.85- 4.01), education level of less than grade 8 (OR= 2.97; 95% CI: 1.86- 4.75), poor SES (OR= 4.32, 95% CI: 2.45-7.60), and breast cancer at stage 4 (OR= 6.53, 95% CI: 2.22-19.18). Patient delay was due to lack of awareness about breast cancer (58.1%) thinking that the lump was harmless. There were misconceptions, embarrassment, shame and fears related to treatment and diagnosis of breast cancer among 86 (16.1%) patients. 49 (9.2%) women wasted time in complementary alternative medicine (CAM)/traditional treatment and had other factors like husband reaction to BC, family commitments, financial constraints. Conclusion: Diagnosis delay is very serious problem in Pakistan. Patient delay was significantly associated with the consequent diagnosis of breast cancer at an advanced stage and consequently with a very poor prognosis. This is a preventable problem which if addressed would have a significant impact on reducing the morbidity and mortality of breast cancer in Pakistan. There is an urgent need for intensive and comprehensive breast cancer education, addressing myths and misconceptions, related to breast cancer. there is no conflict of interest