Factors Associated with Delay in Breast Cancer Presentation at the Only Oncology Center in North East Ethiopia: A Cross-Sectional Study

Abstract

Background: Female breast cancer is becoming an emerging public health problem which accounts for 33% of all cancers in women and 23% of all cancer cases in Ethiopia. The majority of women with breast cancer are diagnosed at later stages due to delayed presentation to seek treatment. Objective: To determine the prevalence and factors associated with patient delay at presentation among breast cancer patients at Dessie Referral Hospital, the only oncology center in North East Ethiopia. Methods: We conducted an institution-based cross-sectional study among 204 female patients with pathology-confirmed breast cancer at the only oncology center of North East Ethiopia from January to June 2020. An interviewer administered questionnaire and a medical record data extraction tool were used to address the objective of the study. Patients were said to be delayed for diagnosis if the time duration between first clinical presentations to first clinical consultation was more than 3 months. Then, bivariable and multivariable logistic regression was employed to analyze the association between dependent and independent variables. Results: Among a total of 209 eligible participants, 5 refused to participate with a response rate of 97.6%. The proportion of patients with delayed presentation was 103 (50.5%), with the median time taken to visit a healthcare provider after recognition of the first symptom was 4 months. Age above 40 years (AOR=4.81; 95% CI=1.26-18.65) P<0.024, college and above educational status (AOR=0.05; 95% CI=0.01-0.77) p<0.036, government employee (AOR=0.19, 95% CI=0.03-0.91) P<0.002, urban residence (AOR= 0.21; 95% CI=0.01-0.82) p<0.001, visit traditional healer (AOR=0.38; 95% CI=0.2-0.69) P<0.0037, and no lump in under armpit (AOR= 9.05; 95% CI=1.14-22.69) P<0.002 were associated with delayed presentation. Conclusion: Delays to seek treatment is generally high in our study. Age, educational status, occupation, residence, visiting traditional healer, and absence of lump in under armpit were significant factors for delayed presentation. Intervention programs focusing on reducing delayed presentation should be employed.

Prevalence and Factors Associated With Delay in Presentation of Breast Cancer Patients in Ethiopia: A Cross-Sectional Institution-Based Study

“…Women living in rural areas may have difficulties with transportation to health facilities and oncology hospitals which are set in urban settings. The finding is consistent with the studies done in South Africa (34) and Ethiopian cities Dessie (14), Gondar, and Bahir Dar (15). In our study, patients who had not noticed breast pain were nine times more likely to delay than their counterparts.…”

“…The Ethiopian national cancer control plan of 2016-2020, based on the world health organization's global cancer control strategy, has been promoting steps to reducing cancer morbidity and mortality in Ethiopia since 2016. However our study among others (29) (14) (38) points the high amount of delayed diagnosis and numbers of breast cancer patients seeking care. This emphasizes the need of further improvements and the implementation of effective strategies to increase awareness and promote first signs of BC for an early detection of BC.…”

“…Reports from other LMICs have found delays as high as 45.9% in Karachi, Pakistan (12) and 31.7% in Iran (13). In Ethiopia, available data ranged from 50.5% (North East Ethiopia) (14) of BC patient seeking health care with a delay of more than three months to 75.5% (Gondar town, North West Ethiopia) (15).Sociodemographic factors linked to delayed presentation of BC are advanced age (16) (17) (18), being divorced or widowed (19) (17), lower education level (20) (21) (15) (14), travel distance >5 km (17), living in rural areas (15) (14), initial uptake of traditional medicine (18) (22), negative history of family BC (23), previous history of benign breast disease, other co-morbidities (24) and limited knowledge on screening practices like breast selfexamination (25) are clinical and health-related factors associated to delayed presentation.…”

“…Sample size calculation was done using Epi Info software using a 95% confidence interval (CI) and 5% margin of error and an assumed proportion of patients with delayed presentation of 50.5% (from a comparable study from Dessie referral hospital oncology center, Ethiopia (14)) and resulted in a sample size of n=137 patients. Assuming a non-responder-rate of approximately 10%, 150 patients were recruited.…”

“…In Ethiopia, available data ranged from 50.5% (North East Ethiopia) (14) of BC patient seeking health care with a delay of more than three months to 75.5% (Gondar town, North West Ethiopia) (15). Socio-demographic factors linked to delayed presentation of BC are advanced age (16)(17)(18), being divorced or widowed (19)(17), lower education level (20)(21)(15)(14), travel distance >5 km (17), living in rural areas (15)(14), initial uptake of traditional medicine (18)(22), negative history of family BC (23), previous history of benign breast disease, other co-morbidities (24) and limited knowledge on screening practices like breast self-examination (25) are clinical and health-related factors associated to delayed presentation. The Ethiopian national cancer control plan published in 2015 outlines an aspiring strategy for improving early diagnosis of BC by promoting awareness and breast examination for women coming to health institutions (26).…”