Understanding pathways to breast cancer diagnosis among women in the Western Cape Province, South Africa: a qualitative study

Abstract

ObjectivesThe aim of this study was to explore and understand women's pathways to breast cancer diagnosis and factors influencing this journey.Design and settingIndepth interviews were conducted with clients at a tertiary level breast cancer clinic in Cape Town, South Africa. A thematic analysis was performed underpinned by the theoretical concepts of the Model of Pathways to Treatment framework.Participants20 women were interviewed within 1 week of being diagnosed with breast cancer.ResultsThe average time between discovery of bodily changes to breast cancer diagnosis was 8.5 months. Deficits in breast self-awareness and knowledge of breast cancer symptoms delayed women's interpretation of bodily changes as being abnormal. All women first noticed breast lumps; however, many did not perceive it as abnormal until additional symptoms were present. General good health, attribution of symptoms to ageing, and past benign breast disease resulted in women being complacent about bodily changes. Disclosure to family members served as a trigger to seek healthcare. The initial type of primary level care services women accessed was influenced by perceptions of care each service provided, finances, structural factors, and personal safety related to the physical location of services.ConclusionsSymptom appraisal and interpretation contributed significantly to delayed presentation. To improve timely diagnosis of breast cancer, interventions that increase women's confidence in detecting breast changes, improve knowledge of breast cancer symptoms, address myths, and encourage prompt help-seeking behaviour are required.

Why Do Women with Breast Cancer Get Diagnosed and Treated Late in Sub-Saharan Africa Perspectives from Women and Patients in Bamako, Mali

“…You don't want to live anymore.' (Patient 3) The association of breast cancer with death was reported in several studies from sub-Saharan Africa [18,27]. It also clearly came up in the discussions with the women in the communities, but some women were aware that there are long-term survivors.…”

“…(Patient 7) Women in the community highlighted their mistrust in health care workers: they have no knowledge nowadays, make wrong diagnoses, and often prescribe medicine that does not help. Other studies have also reported problems of wrong diagnosis and treatment [18,19] among breast cancer patients in sub-Saharan Africa.…”

“…I talked to my husband who said that I have nothing and that I talk too much.' (Patient 5) Use of traditional medicine and low level of breast cancer knowledge among breast cancer patients [17][18][19]23] have been reported in different studies from sub-Saharan Africa. Also, low breast cancer awareness among the general female population [24] and among female health care workers [25] were reported.…”

“…That's why I am using traditional medicine.' (Woman 5, Group 1) Financial hardship [18,22] and the possibility to easily access a health care practitioner [19] were reported elsewhere to influence immediate medical care among breast cancer patients in sub-Saharan Africa.…”

“…Only a number of studies have used qualitative methods to capture the patients' internal processes (individual perception and interpretation through social interaction) during the different time intervals [15]. Studies analyzing the pathway of women with breast [17][18][19] and cervical [20] cancer in sub-Saharan Africa were published only recently. Most studies are limited by the fact that they only include diagnosed patients.…”