Late Diagnosis Of Breast Cancer Research Articles

Factors linked to the late diagnosis of breast cancer and the initiation of treatment.

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.

The prevalence and predictors of clinical breast cancer screening in Sub-Saharan African countries: a multilevel analysis of Demographic Health Survey.

Despite a higher rate of breast cancer in sub-Saharan Africa (SSA), efforts to treat the disease through breast cancer screening are suboptimal, resulting in late diagnosis of breast cancer and poor outcomes. Several studies have been conducted in SSA countries about screening uptake, yet they addressed country or sub-country level data and did not consider both individual and beyond-individual factors related to screening. Hence, pooled prevalence as well as multilevel correlates of screening in the region is sparse, which have been addressed by this study using the most recent data among women with SSA. This study was conducted using the Demographic Health Survey data (2013-2022) from six countries, and a total weighted sample of 95,248 women was examined. STATA version 16 was used for the data analysis. Multilevel mixed-effects logistic regression was performed and significant predictors were reported using adjusted odds ratios (aOR) with 95% confidence intervals (95% CI). The overall weighted prevalence of clinical breast cancer screening was 14.23% (95% CI: 13.97-14.75), with Namibia and Tanzania having the highest (24.5%) and lowest (5.19%) screening rates, respectively. Higher breast cancer screening uptake was observed among women of advanced age (35-49) [aOR = 1.78; 95% CI: 1.60, 1.98], had higher educational levels [aOR = 1.84; 95% CI: 1.66, 2.03], cohabited [aOR = 1.37; 95% CI: 1.21, 1.55], in the richest wealth quintile [aOR = 2.27; 95% CI: 1.95, 2.64], urban residents [aOR = 1.21; 95%CI: 1.10, 1.33], multiparous [aOR = 1.47; 95% CI: 1.30, 1.68], visited health facilities [aOR = 1.64; 95% CI: 1.52, 1.76], and read newspapers [aOR = 1.78; 95%CI: 1.60, 2.15]. The prevalence of clinical breast cancer screening was low (14%). Strengthening awareness campaigns, improving healthcare infrastructure, health education, universal health coverage, and screening program access, with a focus on rural areas, women who lack formal education, and low socioeconomic status, are critical to increasing breast cancer screening rates and equity. Scale-up local and regional collaborations and the involvement of media agencies in the implementation of screening programs, advocacy, dissemination of information, and integration of screening programs with their routine care, such as perinatal care, can boost the screening. The existing health service delivery points also need to focus on integrating breast cancer screening services with routine care such as perinatal care.

Diagnostic and therapeutic profile of patients treated for breast cancer in a radiotherapy unit: case of Dalal Jamm Hospital, Senegal

Objective: Describe the epidemiological, diagnostic and therapeutic profile of breast cancer in Senegal. Patients and Methods: One hundred and sixty patients with histological confirmation of breast cancer, treated consecutively between June 2018 and December 2020, were retrospectively included. Predefined clinical data were extracted from medical records containing patient demographic information, medical history, diagnostic features, and different treatment types. Data were collected, entered and analyzed using SPSS version 23.0 software. Results: The median age of the participants was 48 years with extremes of 27 and 81 years. The average consultation time was 4 (± 2.6) months. Breast cancer was mainly discovered to clinical signs (91.3%). Screening mammography revealed only 5% of cases. The vast majority of patients had a tumor larger than 3 cm (78.2%). Molecular characterization by immunohistochemistry was studied in 87 patients (54.3%) with a predominance of the triple negative profile (36.8%). Neoadjuvant chemotherapy was performed in 111 patients (74%). One hundred and thirty-five patients (92.5%) had undergone a mastectomy with modified Patey type dissection and only 11 patients (7.5%) had conservative treatment. The histological complete response rate after neoadjuvant chemotherapy was 17.1%. The median time between surgery and radiotherapy was 6 months. All patients in the series received radiotherapy. It was adjuvant in 142 patients and exclusive for palliative purposes in 18 patients. It was moderately hypofractionated in 105 patients (65.6%); classic in 52 patients (32.5%). Acute toxicities of radiotherapy were mainly represented by grade 1 radiodermatitis (22.5%). Conclusion: The descriptive analysis of these results shows the young age of the patients, the late diagnosis of breast cancer in our context and a treatment which is essentially based on neo-adjuvant chemotherapy and radical mastectomy.

Providers Respond to USPSTF Report on Screening for Breast Cancer

Providers Respond to USPSTF Report on Screening for Breast Cancer

Abstract 67: Perceived Factors for Late Diagnosis in Women With Advanced Breast Cancer in Northern Tanzania

Abstract 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.

Knowledge, attitude, and practice towards breast cancer and breast cancer screening among women in Homa Bay County, Kenya

Background: Late diagnosis of breast cancer lowers survival rates in resource-poor nations like Kenya. Due to a lack of screening programs, breast cancer awareness, and modern cancer treatment treatments. Rural areas, where most poor people live, are worse. The study examined breast cancer knowledge, attitude, and practice among Homa Bay County women. Methods: A cross-sectional study included 340 samples from two sub counties chosen for their rural nature. 170 women were randomly selected from from each sub county. Questionnaires collected data. Four significant informants were interviewed. Only descriptive statistics were used in data analysis. Results: The results showed lower level of breast cancer screening of 9.7%. Average knowledge was 44.39%. The average score in attitude was 1.7 showing a positive attitude towards breast cancer. The mean age of the participants was 44.30±14.32 in Ndhiwa and 45.16±14.35 in Kasipul. The general knowledge for breast cancer screening was considerably poor. Majority scored below 60% was considered low. In in terms of attitude, women had a positive attitude towards breast cancer screening and thought these was contradicted by key informant who said most had negative attitude. In terms of practice toward breast cancer screening services, only a paltry 9.7 % had gone for screening. Conclusions: Clinical breast examination was preferred over mammography. This study will educate Kenyan public health implementers on ways to improve screening for rural women. Education on early screening towards breast cancer can help in improving breast cancer screening uptake. Breast cancer awareness was considerably lower. Health policymakers can use this findings to improve on cancer management.

Factors associated with late diagnosis of breast cancer in women in Togo, Sub-Saharan Africa

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.

Сontrast enhanced spectral mammography as a tool for accurate diagnosis of cancer on the background of the dense breast tissue

Introduction. Differential diagnosis of some pathological processes in the breast is difficult on the background of dense breast tissue. This often leads to false conclusions and to late diagnosis of breast cancer (BC) or unreasonable biopsy in a benign process. 50% of breast cancers detected less than 12 months after elective mammography were associated with high density of breast tissue. An important advantage of contrast enhanced spectral mammography (CESM) is that it does not depend on the size of the lesions and the X-ray density of the breast tissue. Objective. To compare the diagnostic performance of CESM and digital mammography (DM) in detection of breast cancer in a group of women with dense breast tissue.Materials and methods. The data of 438 patients with suspected breast cancer examined from August 2018 to January 2021 were analyzed in the study. The mean age of women was 50 ± 11 years (from 21 to 86 years). In the study group 154 (35%) malignant and 284 (65%) benign lesions were identified. All lesions were histologically verified. Breast tissue density corresponded to types A and B in 161 patients and corresponded to C and D types in 277 patients according to the ACR classification. 154 cases of breast cancer were identified, including 49 patients with density A and B and 105 patients with density C and D types.Results. Sensitivity, specificity and overall accuracy of DM were 85.7%, 87.3%, 86.8%, respectively. Diagnostic performance of CESM significantly higher than of DM with sensitivity, specificity and accuracy of 96.8% (p < 0.001), 93.3% (p = 0.015), 94.5% (p < 0.001), respectively. CESM had high positive and negative predictive values of 88.7% (p = 0.012) and 98.1% (p < 0.001), which exceeded those of DM – 78.6% and 91.9%, respectively. The diagnostic performance of DM and CESM were comparable in women with normal breast density (types A and B according to ACR), but in patients with high breast density (types C and D according to ACR), CESM was significantly more sensitive in detecting breast cancer.Conclusion. Thus, diagnostic efficiency of CESM in detecting breast cancer significantly higher in comparison with digital mammography.

Diagnostic tardif des cancers du sein au Centre Hospitalier Universitaire Yalgado Ouédraogo (CHU/YO) : Causes, impacts thérapeutiques et pronostiques. A propos de 70 cas

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.

Urban and Rural Patients Perspectives on Late Diagnosis of Breast Cancer in Tanzania: A Qualitative Study

PURPOSE In Tanzania, women are diagnosed at an advanced stages of breast cancer. The aim of this study is to identify reasons for this finding from the patient perspective. METHODS Semi-structured in-depth interviews were conducted in inpatient and outpatient settings in the Kilimanjaro Cancer Care Center. Thematic coding via grounded theory technique was done by two independent reviewers. RESULTS Ten 10 patients (five rural and five urban) participated in the study. The average ages was 48. Seven (70.0%) were Christian. Eight (80.0%) patients had primary education, six (60.0%) were married, and eight (80.0%) were not employed. Two women (20.0%) had stage 2, four women (40.0%) had stage 3, and 4 (40.0%) had stage 4. The most common reasons reported by patients for advanced stage breast cancer at time of diagnosis are initially seeking care from traditional healers (n = 6, 60.0%), lack of breast cancer sign and symptoms knowledge (n = 8, 80.0%), misconceptions about breast cancer treatment especially mastectomy (n = 5, 50.0%), distrust of conventional medicine (n = 4, 40.0, seeking support from the religious leaders (n = 6, 60.0%). Furthermore, we found that, almost all (n = 9, 90.0%) of the patients express their concern regarding financial challenges to access care and treatment for cancer. For example (n = 3, 30.0%) said payment for cancer treatment is too costly and six patients (60.0%) stated that lack of money for transportation. CONCLUSION Lack of adequate breast cancer knowledge and awareness, patient provider relationships, and access to care are the most common mentioned reasons for advanced disease at time of diagnose among breast cancer patients. Engagement with the community through cultural sensitive public health campaigns and interventions must be designed to alleviate the misconceptions and knowledge gap in these communities. System level change is needed to improve access to care.

Role of Moderate Risk Suseptibilty Genes in Development of Breast Cancer

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.

Delayed Diagnosis of Breast Cancer as a Cause of Crippling Radical Treatment of Elderly Patients

The volume of surgical treatment of breast cancer depends largely on the size of the primary hearth. Malignant neoplasms diagnosed at the initial stage of the disease make it possible to carry out organpreserving operational interventions, which is particularly important in the treatment of elderly patients with concomitant somatic diseases. Clinical observation is presented, which demonstrates the importance of the timely identified and consequences of the late diagnosis of breast cancer in the patient of the elderly, in the form of a crumpled radical operation that affects the quality of life of the patient.

Abstract 77: Health Care Providers and Traditional Healers Perspectives on Late Diagnosis of Breast Cancer in Tanzania: A Qualitative Study

Abstract 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.

Knowledge And Awareness Of Breast Cancer And Mammography Among Women In Klang, Selangor.

Breast cancer (BC) is considered as one of the most common cancers among women and almost 2.1 million women are diagnosed with it each year around the world. The high mortality rate by breast cancer is mainly because of the late diagnosis of breast cancer which is because of the lack of awareness and knowledge about breast cancer itself and its screening methods among women. The gradually increasing mortality rate can be decreased by early detection of breast cancer. A validated questionnaire was adopted from a similar study that was done in Shah Alam, Selangor. The questionnaire consists of three sections namely sociodemographic status, knowledge about breast cancer and awareness of mammography. Most of the respondents (84.1%) stated that breast cancer is the most common cancer in Malaysia. In terms of risk factors, the majority (96.2%) of the respondents stated that genetic and family history is a risk of breast cancer while only 3.8% of them did not. 15 respondents received knowledge scores of which are less than 8 (very poor), 46 respondents have obtained scores from 8 to 11 (poor), 56 respondents have obtained scores from 12 to 16 (moderate) and 15 respondents have obtained scores from 17 to 20 (good). None of the respondents obtained scores of more than 20 (very good). This study shows that the respondents have very poor to moderate level of breast cancer knowledge. Mammography awareness was acceptable among the respondents as more than half of them knew about it.

Factors Associated with Late-Stage Breast Cancer Diagnosis in an Urban Safety-net Hospital.

Late diagnosis of breast cancer is associated with lower survival. This study determines the factors associated with late-stage breast cancer diagnosis in an urban safety-net hospital (SNH) with excess late-stage disease. Single-institution retrospective study of all early-stage vs. late-stage breast cancer cases diagnosed or treated at the primary SNH in the Kansas City, Missouri area between January 2011-July 2018. Multiple logistic regression was performed to determine the variables that contributed most to late stage at diagnosis. The most significant factor associated with late-stage diagnosis was lack of screening mammogram within two years of diagnosis (p<.0001, OR 7.5, CI = 3.6, 15.3). Patients referred from within the SNH compared with those presenting from community health centers were significantly less likely to present with late-stage disease (p=.04, OR 0.50, CI = 0.25, 0.98). Screening mammography ought to be actively promoted in SNH settings with excess late-stage diagnosis.

Educational Opportunities for Down-Staging Breast Cancer in Low-Income Countries: an Example from Tanzania

While more than 90% of breast cancer patients in western countries survive for at least 5years, the survival rate in Tanzania is less than 45% because of late stage at presentation. The aim of this study was to identify patient and health system factors related to early or late stages of a breast cancer diagnosis. The study was conducted at the Ocean Road Cancer Institute (ORCI) in Dar es Salaam, Tanzania, and included interviews with 196 breast cancer patients diagnosed with early (stage I/II, n= 44) or late (stage III/IV, n= 152) stage who were referred to ORCI from January 2016 to August 2018. The questionnaire elicited information regarding disease history, sociodemographics, barriers to navigating the health system, and patient attitudes towards breast cancer. More early-stage patients (54.5%) stated history of previous breast examinations before their initial diagnosis compared to late-stage patients (19.7%) (p= < 0.001). Financial restraints were cited more often as barriers to diagnosis among late-stage presentation patients (55.7%) compared to early-stage patients (35.5%) (p= 0.047). Patients who were diagnosed at late-stage (47.5%) were also more likely to state time restraints as significant barriers to their diagnosis than early-stage patients (25.8%) (p= 0.041). Although the late diagnosis of breast cancer will take immense efforts of policy workers to resolve, this study offers significant opportunities for making immediate health system changes through patient and physician education that can aid in reducing diagnosis delay in Tanzania other low-income developing countries, and low-income communities within the USA.

Perspectives of patients, family members, and health care providers on late diagnosis of breast cancer in Ethiopia: A qualitative study.

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.

The Effect of Counseling on Breast Cancer Awareness in Rural Iranian Women: a Randomized Controlled Clinical Trial.

In a community such as Iran where late presentation is predominant and the majority of breast cancer patients are diagnosed at advanced stages of the disease, there is an urgent need for improving the level of awareness about breast cancer and early detection measures. Given that rural residents are at higher risk for late diagnosis of breast cancer because they have less education, income, and access to advanced screening technologies, this study was conducted to determine the effect of counseling on breast cancer awareness of rural Iranian women. This randomized clinical trial was conducted on 60 rural women from the Abish Ahmad area in northwestern Iran in 2017. The randomized cluster method was used for sampling. From 20 rural health houses and centers, about one third were selected randomly. From the six selected clusters, three were randomly allocated as the control group and three as the intervention group. Using convenience sampling, 30 women between the ages of 40 and 69 were selected from the control group and 30 from the intervention group. The intervention group attended six group counseling sessions. Data was gathered using a demographic and obstetrical information questionnaire and breast cancer awareness measures. The chi-square, independent t test and ANCOVA by controlling for the baseline scores were used to analyze the data. After counseling, the mean knowledge about breast cancer score was significantly higher in the intervention group than in the control group (adjusted mean difference, 17.02; confidence interval (CI) 95%, 15.44 to 18.59; p < 0.001). The mean barriers to breast cancer screening score showed a significant decrease in the intervention group compared to the control group (AMD, - 1.74; 95% CI - 3.12 to - 0.36, p < 0.001). After intervention, the frequency of breast self-exam showed a significant difference between groups (p < 0.001); but for confidence about noticing breast changes, no significant difference was observed between groups (p = 0.08). Group counseling had a significant effect on enhancing breast cancer awareness of rural Iranian women, except for confidence about noticing breast changes.

Prevalence and Factors Contributing to Late Diagnosis of Breast Cancer among Women Attending Tikur Anbessa Specialized Hospital, Oncology Unit, Addis Ababa, Ethiopia, 2017

Prevalence and Factors Contributing to Late Diagnosis of Breast Cancer among Women Attending Tikur Anbessa Specialized Hospital, Oncology Unit, Addis Ababa, Ethiopia, 2017

Breast cancer screening in Brazil. Barriers related to the health system.

Identify factors related to the health system that lead to a late diagnosis of breast cancer in Brazil. We performed a systematic review in the PubMed and LILACS databases using as keywords "Breast cancer," "system of health" and "Brazil or Brasil." We evaluated the content of the articles using the PRISMA methodology based on PICTOS. The final date was 12/16/2015. We were able to identify 94 publications in PubMed and 43 publications in LILACS. After assessing the title and summary, and excluding 21 repeated publications, we selected 51 publications for full evaluation. At this stage, we excluded 21 articles, with 30 publications remaining for study. The population coverage is low, and there are problems related to the quality of mammography. Patients with lower income, nonwhite and less educated are more vulnerable. We observed punctual and initial experiences in breast cancer screening. Diagnosis and treatment flows must be improved. The inequality in mortality reflects the differences related to screening structure and treatment. Better results are observed in well-structured services. There are several barriers in the health system leading to advanced stage at diagnosis and limiting the survival outcomes. The establishment of a rapid and effective order for diagnosis and treatment, based on hierarchical flow, are important steps to be improved in the public health context.