Abstract
BackgroundLittle is known about the presentation, help seeking behaviour for breast cancer in Singapore. Nor was there a study exploring the experience of patients in their breast cancer journey.MethodsA qualitative interview study with thematic analysis, conducted with 36 patients.ResultsThere is no clear pattern of presentation for breast cancer by cancer stage at diagnosis, age and ethnicity in the cancer journey of this group of patients. Patients were diagnosed with early to advanced stages cancer regardless of when they presented or took up treatment in their cancer journey. The reasons patients sought medical attention also did not appear to differ between the stages of cancer diagnosed, ethnic and age. Without setting a measure to define early and late presentation, we found that women shared similar experience in their breast cancer journey, regardless of age, ethnicity and stage of cancer at diagnosis. Poor knowledge of breast cancer (symptoms and causes); few practised regular BSE; denial of symptom; fear of hospitalisation, diagnosis and treatment; worries and stress over financial burden of treatment; misinformation in magazine and online sources; diet; stress; caring responsibility; support network; and use of alternative medicine before and after diagnosis were identified in patients’ narratives. Strong social support; fear of being an emotional and financial burden for the family; and financial worries during treatment were also the recurring themes after diagnosis.ConclusionA measure of breast cancer presentation - that accounts for the patient’s experience in the cancer journey, the time interval and tumour biology – that is meaningful to patients, clinicians and researchers is needed. For research on late and delayed presentation, details on BSE practice – how often, when and was it done correctly – will improve the accuracy of time delay interval. For the public, concerted efforts to improve knowledge of breast cancer, survival and prognosis for early-diagnosed cancer, and the importance of regular and correct technique to perform BSE, are critical and urgent to address the rising breast cancer incidence in the country.
Highlights
Little is known about the presentation, help seeking behaviour for breast cancer in Singapore
These findings suggest that a need for a definition or measure of late/delayed presentation that is meaningful for patients, clinicians and researchers [44] – one that accounts for time interval, the cancer journey as experienced by the patients, and the tumour biology
Regardless of when they presented and/or took up treatment in their cancer journey, patients could still be diagnosed with advanced stage cancer
Summary
Little is known about the presentation, help seeking behaviour for breast cancer in Singapore. Nor was there a study exploring the experience of patients in their breast cancer journey. Across Southeast Asia, Singapore has the highest incidence rate of breast cancer. Singapore continues to observe a significant increase in breast cancer incidence over the years [1]. Breast cancer is the leading cancer among Singaporean women, accounting for 20% of all female cancers, with an age-adjusted standardised rate (ASR) for mortality of 15.5 per 100,000. While the mortality rate has decreased, the incidence rate has rapidly increased for women over 50 years old. The incidence of breast cancer is on the rise at a rate of 3%, and the ASR on incidences has increased from 59.8 per 100, 000 (2009) to 65.7 per 100,000 (2012). Over 22% of advanced stages cancer have been reported: 22.3% (14.4% stage III and 7.9% stage IV) (1995–2007 Singapore-Malaysia Breast Cancer Hospital-based Registry) [2] and 29% (19% stage III and 10% stage IV) according to SEER data for 1975–2013 [3]
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