Patient Delay in Breast Cancer Diagnosis in Two Hospitals in Karachi, Pakistan: Preventive and Life-Saving Measures Needed

Abstract

PURPOSE Patients with breast cancer in Pakistan commonly present with advanced disease. The objectives of this study were to evaluate the frequency and length of delays in seeking medical consultation and to assess the factors associated with them. METHODS Four hundred ninety-nine patients with newly diagnosed breast cancer were enrolled and interviewed over the period from February 2015 to August 2017. Information on sociodemographic factors, delay to medical consultation, stage of breast cancer at presentation, and tumor characteristics of the breast cancer were collected through face-to-face interviews and medical file review. RESULTS The mean (standard deviation) age of patients with breast cancer was 48.0 (12.3) years. The mean (standard deviation) patient delay was 15.7 (25.9) months, with 55.2% of women detecting a breast lump but not seeking a medical consultation because of a lack of awareness about the significance of the lump. A total of 9.4% of the women decided to seek treatment initially using complementary and alternative medicine and traditional treatment; 9.4% of the women presented to a health care provider with a breast lump but no action was taken, and they were wrongly reassured about the lump without mammography or biopsy. For 26% of the women, the delay in presentation was caused by anxiety, fears and misconceptions regarding diagnosis and treatment, and other social factors including possible adverse effects on their relationship with their husband. Multivariable analysis showed a strong association of lower socioeconomic status (odds ratio [OR], 8.11 [95% CI, 2.46 to 26.69]) and late stage of breast cancer (OR, 4.83 [95% CI, 1.74 to 13.39]) with a patient delay of ≥ 3 months. CONCLUSION Patient delay is a serious problem in Pakistan. There is an urgent need for intensive and comprehensive breast cancer education that addresses the myths and misconceptions related to breast cancer.

Sporadic Creutzfeldt-Jakob Disease: Diagnosing Typical and Atypical Presentations under Limited Circumstances

“…In our study, the clinical manifestations of the disease matched those described in international literature, however, it is noteworthy that memory decline, myoclonus, extrapyramidal features, behavioral changes, and drowsiness were found more prevalent in our study as compared to literature (Table 3) [4]. The reason for this difference could be due to the behavior of delaying seeking medical attention for subtle symptoms in Pakistan [11]. A pivotal feature of diagnosis is rapid memory decline.…”

Fears and barriers: problems in breast cancer diagnosis and treatment in Pakistan

“…This response is similar to reports from both African American and Asian American women who believed that their future was in God's hands as God has more control over the development of cancer [ 32 , 33 ]. Consequently, consulting spiritual and traditional healers may result into treatment delay [ 34 ].…”

Factors Associated With Treatment Delay in Breast Cancer: A Prospective Study

“…Gulzar et al in their study found that 96% of the females presented late because they ignore the symptoms and painless lump in the breast, 81% had fear related to treatment expenses, 73% were shy to be treated by a male doctor, 71% had prior use of traditional methods, 65% had a social stigma, 61% were used to visit spiritual healers and 37% women had inaccessibility to healthcare [ 7 ]. A study by Shamsi et al found patients presented late due to lack of awareness (58.1%), he also found 16.1% of the patients had embarrassment, misconceptions, fears, and shame related to the treatment of BC and 9.2% of the females were delay due to alternative medicine/ traditional method and had other reasons like financial constraints, family commitments and husband reaction to BC [ 20 ].…”