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

Abstract

ObjectivesThis study aimed to estimate the magnitude of patient and diagnostic delays and associated factors among women with breast cancer in Addis Ababa.DesignThis is a cross-sectional study.Settings and participantsAll women newly diagnosed with breast cancer in seven major healthcare facilities in Addis Ababa (n=441) were included in the study.Main outcomes and measuresPatient interval (time from recognition of first symptom to medical consultation) and diagnostic interval (time from first consultation to diagnosis). Patient intervals >90 days and diagnostic intervals >30 days were considered delays, and associated factors were determined using multivariable Poisson regressions with robust variance.ResultsThirty-six percent (95% CI [31.1%, 40.3%]) of the patients had patient intervals of >90 days, and 69% (95% CI [64.6%, 73.3%]) of the patients had diagnostic intervals of >30 days. Diagnostic interval exceeded 1 year for 18% of patients. Ninety-five percent of the patients detected the first symptoms of breast cancer by themselves, with breast lump (78.0%) as the most common first symptom. Only 8.0% were concerned about cancer initially, with most attributing their symptoms to other factors. In the multivariable analysis, using traditional medicine before consultation was significantly associated with increased prevalence of patient delay (adjusted prevalence ratio (PR) = 2.13, 95% CI [1.68, 2.71]). First consultation at health centres (adjusted PR = 1.19, 95% CI [1.02, 1.39]) and visiting ≥4 facilities (adjusted PR = 1.24, 95% CI [1.10, 1.40]) were associated with higher prevalence of diagnostic delay. However, progression of symptoms before consultation (adjusted PR = 0.73, 95% CI [0.60, 0.90]) was associated with decreased prevalence of diagnostic delay.ConclusionsPatients with breast cancer in Addis Ababa have prolonged patient and diagnostic intervals. These underscore the need for public health programme to increase knowledge about breast cancer symptoms and the importance of early presentation and early diagnosis among the general public and healthcare providers.

Why women with breast cancer presented late to health care facility in North-west Ethiopia? A qualitative study

“…This misconception might also be the result of very low awareness and a sense of not being vulnerable. The result is in line with other qualitative findings in Ethiopia and other African countries [ 29 , 38 , 39 ].…”

“…Several other studies have similarly found that lumps are the dominant symptom noticed by women with breast cancer and that most women find lumps as their primary symptom. Studies also indicate that women in low-resource areas delay seeking care longer than women in other parts of the world, with delays of a year or more from detection of symptom to seeking advice [ 12 , 26 , 29 , 38 ]. Most women with breast cancer in African face significant delays in accessing care through overburdened health care systems and with limited resources; adding more than a year of delay from noticing a symptom to action increases the chances that their disease will progress significantly before care initiates [ 13 , 18 ].…”

Determinants of delay in diagnosis and end stage at presentation among breast cancer patients in Iran: a multi-center study

“…Regarding signs of BC, our results showed that discharge and pain were associated with end-stage diagnosis compared to those with a lump. It was reported that a considerable proportion of patients ignored the clinical significance of the early symptoms and attributed these symptoms to other nonspecific conditions, and that breast mass was the first symptom associated with shorter detection and delay in diagnosis 44 , 45 .…”

Prevalence and determinants of breast cancer screening in four sub-Saharan African countries: a population-based study

“…19 20 A study conducted by Gebremariam et al indicated that patients with breast cancer in Addis Ababa had prolonged patient and diagnostic intervals. 21 In addition to these contributing factors, the prevalence of breast cancer is underreported in most SSA countries and is not a true reflection of the burden of the disease. 16 18 To tailor strategies to increase the uptake of breast cancer screening among women of reproductive age in SSA, it is important to understand regional-specific and country-specific variations in the prevalence of breast cancer screening.…”