Identifying the reasons for delayed presentation of Pakistani breast cancer patients at a tertiary care hospital

Faisal Gulzar, Muhammad Shoaib Akhtar, Rafshan Sadiq, Sajid Bashir, Sajida Jamil, Shahid Mahmood Baig, Faisal Gulzar, Muhammad Shoaib Akhtar, Rafshan Sadiq, Sajid Bashir, Sajida Jamil, Shahid Mahmood Baig

Abstract

Background: Delay in seeking health care by breast cancer patients is associated with advanced stage of disease at presentation and poor survival rates. This study aimed to identify the reasons for delayed presentation and their association with various sociodemographic variables.

Methods: A total of 200 female patients with abnormal clinical findings, ie, lump or palpable mass, were consecutively invited for this study. Diagnostic delay was defined as a consultation with a health care provider more than 3 months from the appearance of the first symptoms. Sociodemographic variables, presenting symptoms, knowledge about diseases and its symptoms, time between seeking medical attention after appearance of symptoms and causes of delayed presentation were investigated. Chi-squared and logistic regression tests for significance and associations were used.

Results: Among 125 women with breast cancer fulfilling the inclusion criteria, aged 24-75 years, 88.8% (n=111) presented late (≥3 months) and 59% presented with advanced stage of disease (stage III/IV). The majority (65.6%) were older than 40 years of age, 99.2% were married, 60.8% had <8 years of education, 67.2% had poor social status, and 64.8% had a negative family history of any cancer type. Almost all patients (96%) complained about the presence of a painless lump in their breast. Ignorance of disease or the presence of painless lumps in the breast and low financial resources for therapy (81.1%) were the main variables associated with delayed presentation. Educational factors (P<0.001, OR 4.682) and social status (P<0.001, OR 1.8) were also associated with delayed presentation.

Conclusion: Our study highlighted the variables associated with delayed presentation in Pakistani breast cancer patients. A significant number of patients presented late owing to misconceptions and poor knowledge about the disease and its symptoms, while illiteracy and poor social status were the major contributing factors for delayed presentation, resulting in an advanced presentation of disease and ultimately a decreased survival rate.

Keywords: breast cancer; illiteracy; painless lump; social status; survival rate.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flow diagram of the patients included in this study. Abbreviations: No, Patients included at the start of the study; N1, data on the patients analyzed and presented in this study.
Figure 2
Figure 2
Distribution of patients according to the duration of delay before consulting a physician.
Figure 3
Figure 3
Percentage of patients with reasons for delayed presentation. Note: Patients highlighted more than one barrier to presentation, so the totals do not add up to 100%.

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