Factors contributing to delays in diagnosis of breast cancers in Ghana, West Africa

Abstract

Background Late diagnoses and poor prognoses of breast cancer are common throughout Africa. Methods To identify responsible factors, we utilized data from a population-based case-control study involving 1,184 women with breast malignancies conducted in three hospitals in Accra and Kumasi, Ghana. Interviews focused on potential breast cancer risk factors as well as factors that might contribute to presentation delays. We calculated odds ratios (OR) and 95% confidence intervals (CI) comparing malignances with biopsy masses larger than 5 cm. (62.4% of the 1,027 cases with measurable lesions) to smaller lesions. Results In multivariate analyses, strong predictors of larger masses were limited education (OR=1.96, 95% CI 1.32–2.90 <primary vs. ≥senior secondary school), being separated/divorced or widowed (1.75, 1.18–2.60 and 2.25, 1.43–3.55, respectively, vs. currently married), delay in care seeking after onset of symptoms (2.64, 1.77–3.95 for ≥12 vs. ≤2 months), care having initially been sought from someone other than a doctor/nurse (1.86, 0.85–4.09), and frequent use of herbal medications/treatment (1.51, 0.95–2.43 for ≥3x/day usage vs. none),. Particularly high risks associated with these factors were found among less educated women; for example, women with less than junior secondary schooling who delayed seeking care for breast symptoms for 6 months or longer were at nearly 4-times the risk of more educated women who promptly sought assistance. Conclusions Our findings suggest that additional communication, particularly among less educated women, could promote earlier breast cancer diagnoses. Involvement of individuals other than medical practitioners, including traditional healers, may be helpful in this process.

Drivers of advanced stage at breast cancer diagnosis in the multicountryAfrican breast cancer – disparities in outcomes (ABC‐DO) study

“…Many of these findings are consistent with previous work in SSA. Low levels of education have, not surprisingly, been found to be associated with advanced stage BC in many studies in the region . Long delays between first symptom recognition and diagnosis are also consistent with previous SSA research, and were associated with more visits to health care provider facilities .…”

“…Low levels of education have, not surprisingly, been found to be associated with advanced stage BC in many studies in the region. [24][25][26] Long delays between first symptom recognition and diagnosis are also consistent with previous SSA research, 24 and were associated with more visits to health care provider facilities. 25 Reducing delays to three months is a reasonable target in SSA, as it is difficult to show any worsening of outcome when treatment is initiated after that time; delays longer than one year should be considered extreme in any system.…”

“…25 Reducing delays to three months is a reasonable target in SSA, as it is difficult to show any worsening of outcome when treatment is initiated after that time; delays longer than one year should be considered extreme in any system. Previous studies have found that women who were not married at the time of BC diagnosis were more likely to be advanced stage or have long delays before seeking help 24,26 ; in this study, this association was accounted for by their lower SEP. Overweight and obesity did not emerge as being related to more advanced stage, in contrast to other Western settings, 27,28 even though the prevalence of overweight and obesity was relatively high in the ABC-DO study (60%).…”

Fear of Mastectomy Associated with Delayed Breast Cancer Presentation Among Ghanaian Women

“…Prior studies have identified patient and system factors associated with late presentation among breast cancer patients in SSA [11]. The largest study conducted in Ghana identified low level of education and delayed care-seeking behavior as risk factors for presenting with tumors larger than 5 cm [8]. Similarly, other smaller studies have identified limited knowledge [11][12][13][14][15][16], stigma associated with a cancer diagnosis, lack of social and financial support, and seeking alternative treatment from traditional healers as risk factors for delayed presentation [11][12][13][14][15][16][17][18][19][20][21][22][23].…”

Breast Cancer in Low- and Middle-Income Countries

“…16 A significant proportion of breast biopsies for palpable masses in a large cohort of breast cases in Ghana and a retrospective analysis of breast presentations in Rwanda was benign. 9,16 Thus, it is unethical and unsafe to offer mastectomy, cytotoxic chemotherapy, or other systemic therapy to a woman without having a pathologically confirmed diagnosis of breast cancer at the onset, and optimal treatment depends on the elucidation of both the stage of disease and the biologic markers, hormone receptors, and Human epidermal growth factor receptor 2 (HER2).…”