Diagnosis delay in Libyan female breast cancer

Abstract

AimsTo study the diagnosis delay and its impact on stage of disease among women with breast cancer on Libya.Methods200 women, aged 22 to 75 years with breast cancer diagnosed during 2008–2009 were interviewed about the period from the first symptoms to the final histological diagnosis of breast cancer. This period (diagnosis time) was categorized into 3 periods: <3 months, 3–6 months, and >6 months. If diagnosis time was longer than 3 months, the diagnosis was considered delayed (diagnosis delay). Consultation time was the time taken to visit the general practitioner after the first symptoms. Retrospective preclinical and clinical data were collected on a form (questionnaire) during an interview with each patient and from medical records.ResultsThe median of diagnosis time was 7.5 months. Only 30.0% of patients were diagnosed within 3 months after symptoms. 14% of patients were diagnosed within 3–6 months and 56% within a period longer than 6 months. A number of factors predicted diagnosis delay: Symptoms were not considered serious in 27% of patients. Alternative therapy (therapy not associated with cancer) was applied in 13.0% of the patients. Fear and shame prevented the visit to the doctor in 10% and 4.5% of patients, respectively. Inappropriate reassurance that the lump was benign was an important reason for prolongation of the diagnosis time. Diagnosis delay was associated with initial breast symptom(s) that did not include a lump (p < 0.0001), with women who did not report monthly self examination (p < 0.0001), with old age (p = 0.004), with illiteracy (p = 0.009), with history of benign fibrocystic disease (p = 0.029) and with women who had used oral contraceptive pills longer than 5 years (p = 0.043). At the time of diagnosis, the clinical stage distribution was as follows: 9.0% stage I, 25.5% stage II, 54.0% stage III and 11.5% stage IV.Diagnosis delay was associated with bigger tumour size (p <0.0001), with positive lymph nodes (N2, N3; p < 0.0001), with high incidence of late clinical stages (p < 0.0001), and with metastatic disease (p < 0.0001).ConclusionsDiagnosis delay is very serious problem in Libya. Diagnosis delay was associated with complex interactions between several factors and with advanced stages. There is a need for improving breast cancer awareness and training of general practitioners to reduce breast cancer mortality by promoting early detection. The treatment guidelines should pay more attention to the early phases of breast cancer. Especially, guidelines for good practices in managing detectable of tumors are necessary.

Cancer incidence, mortality, and survival in Eastern Libya: updated report from the Benghazi Cancer Registry

“…With respect to developed countries, it affected a younger population (median age of 45 years), presents mostly in stage III or IV because of diagnostic delay, lack of screening programs and therefore results in a poorer outcome. Of note, a study showed that signs and symptoms of breast cancer presentation tend to be underestimate not only by the patients but also by the physicians; still, the absence of mammography or other screening programs for early detection of breast cancer also contribute to postpone the diagnosis [20]. With the aim of improving the prognosis of patients, it may be worthwhile to encourage strategies for early detection, including breast selfexamination and mammographic screening in high-risk patients, as well as improve breast cancer awareness among the population and the general practitioners.…”

Impact on the quality of life of women with breast cancer undergoing chemotherapy in public and private care

“…Stage III was the most expressive, with a diagnosis time of more than six months, which potentially results in high mortality rates. (18) The late diagnosis is focused on several factors related to the population's characteristics, low educational and socioeconomic level, and tracking policies, which make the access to early diagnosis difficult, worsens the prognosis, and leads to more aggressive treatments with impact on women's survival and QoL. Health professionals' interventions should be performed at all levels of care to provide agile assistance and according to their reality.…”

Cancer Presentation in a Developing Nation: The 3:1 Ratio

“…This was corroborated by Abdulraheem who, in addition, showed a high level of attrition even after presentation [22]. Patronage of traditional herbalists, home therapies, misguided proclamations of the ills of hospital -based care, poverty, illiteracy, and cultural beliefs are some of the reasons for phase I delays in SSA [7,8,10,20,22,23]. Some reports make reference to the contributions of phase II delays as well [12,20].…”

“…A phase I delay is that caused by the patient's reluctance to seek medical attention [4]. Late presentation is the order of the day in Sub-Saharan Africa for a multitude of pathologies [5][6][7], with phase I delays being implicated in a substantial number of articles [8][9][10][11]. The outcome of many diseases is a function of the delay in presentation [5].…”