Delayed presentation and diagnosis of breast cancer in African women: a systematic review

Abstract

PurposeAfrica has low breast cancer incidence rates but high mortality rates from this disease due to poor survival. Delays in presentation and diagnosis are major determinants of breast cancer survival, but these have not been comprehensively investigated in Africa.MethodsMEDLINE, Embase, and Global Health were searched to identify studies reporting on delays in presentation and/or diagnosis of breast cancer published between January 1, 2000 and May 31, 2016. Data were synthesized in narrative, tabular, and graphical forms. Meta-analyses were not possible due to between-study differences in the way delays were reported.ResultsTwenty-one studies were included in the review. Study-specific average times between symptom recognition and presentation to a health care provider ranged from less than 1 to 4 months in North Africa and from less than 3 to greater than 6 months in sub-Saharan Africa. Study-specific average times from presentation to diagnosis were less than 1 month in North Africa but ranged from less than 3 to greater than 6 months in sub-Saharan Africa. Reported reasons for these delays included patient-mediated (e.g., socioeconomic factors) and health system–mediated factors (e.g., referral pathways).ConclusionsThis systematic review revealed marked delays in presentation and diagnosis of breast cancer in Africa. Identification of their drivers is crucial to the development of appropriate control strategies in the continent.

Breast cancer survival in sub‐Saharan Africa by age, stage at diagnosis and human development index: A population‐based registry study

“…Some reasons for late presentation in SSA include low breast cancer awareness, difficult access to healthcare (both physical and economic), fear, distrust of conventional medicine and belief in alternative sources of healing . Additionally, pathways within the healthcare system often hinder early diagnosis .…”

“…27 Some reasons for late presentation in SSA include low breast cancer awareness, 28 difficult access to healthcare (both physical 29 and economic), fear, distrust of conventional medicine and belief in alternative sources of healing. 23,30 Additionally, pathways within the healthcare system often hinder early diagnosis. 31,32 Unfavorable tumor biology such as triplenegative disease or the luminal-B-like phenotype may also be associated with late stage presentation, 33 as these tumors generally grow faster leading to late stage at diagnosis.…”

Breast cancer early detection: A phased approach to implementation

“…Ineffective and redundant referral pathways cause system delays and are a major contributor to cancer disparities worldwide 36 . Delays from symptom onset to diagnosis range from weeks to many months in Sub‐Saharan Africa 37 . Less than one‐half of cancer plans recently surveyed elaborate the role of primary care physicians and referral pathways in early breast cancer diagnosis 31 .…”

Breast cancer stigma among Indonesian female: a case study breast cancer patient.

“…Breast cancer has a second highest on incidence rate across all types of cancers and rank as the fifth cause of cancer deaths overall (15). Delays in presentation and diagnosis are major determinants of breast cancer survival (16). Perception towards breast cancer screening and diagnose have an important role due to early diagnose of breast cancer.…”