Abstract
Background Breast cancer is a major public health problem and the first leading cause of cancer deaths among females in Palestine. Early diagnosis of breast cancer contributes to reduction of morbidity and mortality rates. This study aimed to explore system-related factors affecting the timely diagnosis of breast cancer in the Gaza Strip. Method and Materials A mixed method, sequential explanatory design was employed. A quantitative study was conducted first, and it was cross-sectional in nature, followed by a qualitative study. An interviewed questionnaire and an abstraction sheet were used to collect necessary quantitative data among 122 females diagnosed with breast cancer. A purposive sample of five medical specialists were selected for in-depth interview. Descriptive and inferential analyses were used to find differences between variables. Odds ratio and confidence interval at 95% were presented, and P < 0.05 was considered statistically significant. Results Around 12.3% of women experienced diagnostic delay for 3 months and more, and 6.6% reported a delay in referral for more than 2 weeks. Regarding imaging delay, around 8.2% and 2.7% of women had reported a delay in performing mammography and ultrasound, respectively. Moreover, one-fourth reported delay in performing biopsy for more than 14 days, and 46.3% reported delay more than 14 days in getting histopathology report. In addition, 9% missed the follow-up after benign findings of the previous breast imaging and no national protocols are available for the diagnosis of breast cancer in the Gaza strip. Conclusion There is a long appointment time for diagnostic tools especially in biopsy. The nonmalignant findings from mammography or ultrasound could affect diagnosis time. It is an urgent need to have a national protocol for diagnosis and management of breast cancer and to adopt screening, diagnostic, and follow-up programs under the supervision of the Ministry of Health.
Highlights
Breast cancer (BC) is a major public health problem especially among females in both developed and developing countries [1,2,3,4]
In Palestine, 503 new BC cases were reported in the West Bank during 2017 which constituted around 17.2% of all registered cancer cases [8]
Access to medical care is limited and the diagnosis is made late when the disease is in advance stages, and mortality from BC increases [26]. e study showed that 12% of women experienced diagnostic delay three months and more
Summary
Breast cancer (BC) is a major public health problem especially among females in both developed and developing countries [1,2,3,4]. E 5-year survival rate was reported to be 60–65% among Jordanian and Saudi Arabian women [11], 65.1% in the Gaza Strip [12], and 70% in Iran [13]. It is better in developed countries: 82% in Europe [14] and 89% in the USA [15]. It is an urgent need to have a national protocol for diagnosis and management of breast cancer and to adopt screening, diagnostic, and follow-up programs under the supervision of the Ministry of Health
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