Factors associated with time to first healthcare visit, diagnosis and treatment, and their impact on survival among breast cancer patients in Mali

Abstract

ObjectiveTo analyse patient and healthcare system related factors influencing the time to first healthcare visit, diagnosis and treatment of breast cancer patients in sub-Saharan Africa and the impact on survival in order to advise on early detection strategies.MethodsA prospective hospital cohort study was conducted at the only pathology department in Mali, at the University Hospital in Bamako. All the female patients with a breast cancer diagnosis between January and April 2016 were interviewed with a structured questionnaire (N = 64) to gather information about breast symptom recognition and first healthcare visit. Information on beginning of treatment and survival were collected at 18-months follow-up. Simple Cox regression analyses were performed.ResultsThe median time to first healthcare visit was 4.8 months, from first healthcare visit to diagnosis was 0.9 months and for the patients who started treatment (N = 46) the time from diagnosis to treatment was 1.3 months. Knowledge of breast-self-examination and correct symptom interpretation increased the chance of an earlier healthcare visit. Prolonged time to diagnosis was found with shorter duration to first healthcare visit, for working women compared to housewives and for those living within Bamako. Living outside Bamako and smaller tumour size (T1/T2) prolonged time to treatment. Visit of a traditional healer and larger tumour size (T3/T4) shortened survival time, whereas time to first healthcare visit and subsequent time to diagnosis had no influence on survival.ConclusionsDown-staging strategies are only useful if the continuum of breast cancer care is warranted for the majority of patients.

Time intervals experienced between first symptom recognition and pathologic diagnosis of breast cancer in Addis Ababa, Ethiopia: a cross-sectional study

“…Similarly, compared with studies in sub-Saharan African countries, the median patient interval in our study (30 days) was considerably shorter than those reported from Rwanda (150 days)24 and Mali (144 days),34 but comparable with that reported from South Africa (23 days) 35. As expected, compared with findings from countries outside of sub-Saharan Africa, however, our finding of median patient interval is generally longer 36 37…”

“…Our finding of median diagnostic interval (69 days) was lower than that reported in Rwanda (150 days)24 but longer than those reported in Mali (27 days)34 and South Africa (28 days) 35. Sixty-nine percent of the patients in our study waited for >30 days, and 18% for over a year to receive diagnostic confirmation following first medical consultation for their disease.…”

“…Thirteen percent of our study participants’ immediate response to the first breast cancer symptoms was using traditional medicines, which was significantly associated with increased prevalence of patient delay. This practice has been shown to affect patients’ decision to seek timely medical care35 38 and to prolong patient interval in Ethiopia16 17 44 and other parts of Africa 24 34 45. This is partly due to the belief that cancer is fatal and incurable by conventional medical treatment 44 46…”

Breast cancer subtypes: implications for the treatment and survival of patients in Africa—a prospective cohort study from Mozambique

“…Despite the fact that we included patients from the three largest hospitals in Mozambique, detailed follow-up data were only available for patients treated at the MCH. Yet, this single-centre subcohort is similar to other African series in terms of young age at diagnosis, 40 high prevalence of HIV infection, 15 long delays between symptoms and diagnosis 41 and a large proportion of stage III/IV. 3 The limited staging options available (chest X-ray and abdominal ultrasound) may have led to an underestimation of the real incidence of stage IV disease, which may partly explain the low survival of our patients.…”

Underestimation of hepatocellular carcinoma incidence resulting from a competition between modern and traditional medicine: the case of Gabon

“…33 Elsewhere in Africa, and notably, in West Africa, the appraisal of the role of the healers in cancer care is far less favorable and it is often considered that they contribute to the late diagnosis and care process implementation or to the absconsion of patients. [34][35][36][37] Recent medical literature from Africa drew the attention of the medical community on this problem and it is possible that Africa will enter soon in a period of medical history already observed in Europe where modern medical power installation conducted to the elimination of "illegal" healers. 38 Given the importance of liver diseases in SSA (often >10% of the general population is concerned in most countries), the common practice of tradi- tional healers is, of course, often dedicated to patients affected with chronic hepatitis ie at risk to develop terminal complications such as liver cirrhosis or PLC.…”