Determinants of delay in diagnosis and end stage at presentation among breast cancer patients in Iran: a multi-center study

Abstract

One of the reasons for high mortality of breast cancer (BC) is long delay in seeking medical care and end stage at presentation. This study was designed to measure the association between a wide range of socio-demographic and clinical factors with diagnostic delay in BC and stage at presentation among Iranian patients. From June 2017 to December 2019, 725 patients with newly diagnosed BC in Shiraz and Kermanshah were selected and information on BC diagnosis delay was obtained from the patient’s medical record. Data on socio-economic status was obtained via a structured interview. Our findings suggest that 45.8% of the patients were diagnosed at a late stage (stage 3 or higher). A total of 244 (34%) patients had more than 3 months delay in diagnosis. We found a significant association between stage at diagnosis and place of residence (adjusted odds ratio (aOR rural vs. urban = 1.69, 95% CI 1.49–1.97), marital status (aOR 1.61, 95% CI 1.42–1.88), family history of BC (aOR 1.46, 95% CI 1.01–2.13), and history of benign breast disease (BBD) (aOR 1.94, 95% CI 1.39–2.72) or unaware of breast self-examination (BSE) (aOR 1.42, 95% CI 1.42–1.85), delay time (aOR 3.25, 95% CI 1.04–5.21), and left breast tumor (aOR right vs. left 2.64, 95% CI 1.88–3.71) and smoking (aOR no vs. yes 1.59, 95% CI 1.36–1.97). Also, delay in diagnosis was associated with age, family income, health insurance, place of residence, marital status, menopausal status, history of BBD, awareness of breast self-examination, type of first symptoms, tumor histology type, BMI and comorbidity (p < 0.05 for all). Factors including history of BBD, awareness of BSE, and suffering from chronic diseases were factors associated with both delay in diagnosis and end stage of disease. These mainly modifiable factors are associated with the progression of the disease.

Delays in the presentation and diagnosis of women with breast cancer in Yogyakarta, Indonesia: A retrospective observational study

“…Similar policies have been introduced across countries including Denmark and Norway [ 38 , 39 ]. Furthermore, a family history of cancer is also associated with an increased risk of diagnosis delay in our local cohort, supporting other reports [ 40 , 41 ]. Fear of treatment and its side effects that may have been witnessed in other family members could be a reason for delaying diagnosis and requires further exploration.…”

Global patterns of breast cancer incidence and mortality: A population‐based cancer registry data analysis from 2000 to 2020

“…However, the benefits of mammography in China have not yet been observed, but the effects may manifest in the future. Limited financial support given to health expenditure in low-income countries led to the majority of breast cancer patients diagnosed with advanced-stage diseases unable to receive timely treatment, let alone women seeking early medical intervention were also reasons of the poor prognosis in these countries [54,55]. For example, 45.8% breast cancer patients in Iran were diagnosed with stage III or IV during 2009 and 2010, but 34% of them could not get proper treatment [55].…”

Determinants of late detection and advanced-stage diagnosis of breast cancer in Nigeria

“…Recently, the implication of laterality is becoming more apparent. A report in India [ 21 ] found right-sided tumors were diagnosed at later stages compared to left-sided tumors, suggesting the impact of handedness. It is reassuring in this study that tumor laterality did not appear to diminish the effect of BSE on detecting small tumors.…”

“…Simple assumptions or over-generalization of research findings should be avoided in rolling out interventional programs or policies because of unexpected and counterintuitive findings. For instance, family history of BC and history of benign lesions were associated with increased risk of endstage disease [ 21 ], negating the expected positive effect of prior knowledge in an Iranian study. Our findings showed significant use of alternatives and a higher proportion of disease progression among those living close to referral centers, thus negating the expected effect of distance.…”