Presentation Delay in Breast Cancer Patients, Identifying the Barriers in North Pakistan

Background: There is strong evidence that delayed diagnosis of breast cancer is associated with poor survival.Our objectives were to determine the frequency of breast cancer patients with delayed presentation, the reasonsof delay and its association with different socio-demographic variables in our North Pakistan setting. Materialsand
Methods: We interviewed 315 histologically confirmed breast cancer patients. Delay was defined as morethan 3 months from appearance of symptoms to consultation with a doctor. Questions were asked from eachpatient which could reflect their understanding about the disease and which could be the likely reasons for theirdelayed presentation.
Results: 39.0 % (n=123) of patients presented late and out of those, 40.7% wasted timeusing alternative medicines; 25.2 % did not having enough resources; 17.1 % presented late due to painlesslump; 10.6% felt shyness and 6.5% presented late due to other reasons. Higher age, negative family history, <8 school years of education and low to middle socio-economic status were significantly associated with delayedpresentation (p< 0.05). Education and socioeconomic status were two independent variables related to the delayedpresentation after adjustment for others (OR of 2.26, 2.29 and 95%CI was 1.25-4.10, 1.06-4.94 respectively).
Conclusions: Significant numbers of women with breast cancer in North Pakistan experience presentation delaydue to their misconceptions about the disease. Coordinated efforts with public health departments are needed toeducate the focused groups and removing the barriers identified in the study. Long term impact will be reducedoverall burden of the disease in the region.