Delays in Breast Cancer Presentation and Diagnosis at Two Rural Cancer Referral Centers in Rwanda

Abstract

Background. Breast cancer incidence is increasing in low-and middle-income countries (LMICs). Mortality/incidence ratios in LMICs are higher than in high-income countries, likely at least in part because of delayed diagnoses leading to advanced-stage presentations. In the present study, we investigated the magnitude, impact of, and risk factors for, patient and system delays in breast cancer diagnosis in Rwanda. Materials and Methods. We interviewed patients with breast complaints at two rural Rwandan hospitals providing cancer care and reviewed their medical records to determine the diagnosis, diagnosis date, and breast cancer stage. Results. A total of 144 patients were included in our analysis. Median total delay was 15 months, and median patient and system delays were both 5 months. In multivariate analyses, patient and system delays of $6 months were significantly

Breast Cancer in Sub-Saharan Africa: Challenges and Opportunities to Reduce Mortality

“…A growing number of small studies have examined the diagnostic and treatment delays and barriers to care experienced by breastcancer patients in LMICs, including in sub-Saharan Africa [16][17][18][19][20][21]; these demonstrate that patients experience long delays between initial symptoms and presentation at a health facility (patient delay) and then between first presentation and definitive diagnosis or treatment (provider delay). At two facilities in Rwanda, delay between initial development of symptoms and ultimate receipt of a diagnosis was 15 months; patient and provider delays were equally long, and both appeared to contribute to late-stage disease [21]. Reasons for patient delays cited in studies from sub-Saharan Africa include patients' lack of awareness of breast cancer symptoms and their seriousness [20][21][22][23], fear of a cancer diagnosis [21,23], use of traditional healers [21][22][23], and financial concerns about treatment [20,21].…”

“…At two facilities in Rwanda, delay between initial development of symptoms and ultimate receipt of a diagnosis was 15 months; patient and provider delays were equally long, and both appeared to contribute to late-stage disease [21]. Reasons for patient delays cited in studies from sub-Saharan Africa include patients' lack of awareness of breast cancer symptoms and their seriousness [20][21][22][23], fear of a cancer diagnosis [21,23], use of traditional healers [21][22][23], and financial concerns about treatment [20,21]. Provider delays have been less extensively investigated in LMICs, including in sub-Saharan Africa, but lack of breast cancer experience and knowledge among primary care clinicians and limited access to tertiary centers are some of the probable contributors.…”

“…Given that diagnostic delays occur between the development of symptoms and first presentation at a health facility, and between first presentation and diagnosis or treatment, barriers at both the community and health system levels must be addressed [16,18,21]. Interventions to reduce these delays would ideally increase the proportion of patients with breast cancer that is potentially curable and ultimately reduce breast cancer mortality while minimizing expense, inefficiency, and potential harms (for example, false-positive results and unnecessary biopsies).…”

Effect of care-delivery delay on the survival of Mexican women with breast cancer

“…41 In contrast, a study that reported factors associated with patient delay found that self-examination was not associated with this delay (OR=0.73 95% CI 0.31-1.74). 42 However, these studies did not associate self-examination with survival.…”

Introducing Digital Mammography in a Resource Constrained Setting: Spectrum of Imaging Findings and Diagnostic Value in Ado-Ekiti, South Western Nigeria

“…Reasons adduced for that include poor knowledge of breast cancer risk factors, signs and symptoms [22,23]; lack of awareness coupled with poor attitude to preventive practice [24][25][26][27][28] and late presentation at an advanced stage of the disease [29,30]. Lack of effective national screening programmes against a backdrop of poor socioeconomic status also contribute to the breast cancer burden in resource constrained settings.…”