Factors Associated with Diagnostic Delays among Tunisian Breast Cancer Patients

Document Type : Research Articles


1 Faculty of Medicine of Tunis, Department of Epidemiology and Public Health, Street DjabelLakhdar, 1002, Tunis, Tunisia.

2 Department of Biostatistics and Epidemiology, Cancer Registry North of Tunisia, Salah Azaiz Institute, Tunis, Tunisia.


Background: Breast cancer (BC) remains one of the most common and deadliest cancer among women worldwide and in Tunisia. The lethality of BC is particularly high in developing countries, such as Tunisia, due to late diagnosis in the majority of cases. The objective of this study was to analyze factors associated with delayed presentation among women followed at the Salah Azaiez institute of Tunis during the year 2021. Methods: It was a retrospective cohort study, including patients with primary BC, consulting at the Salah Azaeiz institute of Tunis over a period of six months, from january 1st to june, 30th, 2021. The total diagnostic interval (DI) was divided into patient interval (PI) and healthcare system interval (HSI). Diagnosis delay due to patient (PD) was defined as a delay more than three months between the discovery of symptoms and the first medical consultation. Data were collected using a valid questionnaire “the breast cancer questionnaire delay” and from patients’ medical records. The calculation of crude and adjusted Odds Ratios using a stepwise descending binary logistic regression model was performed to measure the association of the studied factors with the delayed presentation. Results: A total, 146 patients were included. The mean age of the patients was 50.1 ± 10.9 years.  More than a half of patients had a primary education (56.8%). Majority of patients were married (86.3%) and unemployed (90.4%).  The median of patient interval (PI) and HSI were 31 days [IQR: 12.5-151.5] and 53 days [IQR: 33.0-88.7] respectively. About three quarter of patients (76.4%) presented a healthcare system delay (HSD). After univariate analysis, factors significantly associated with PD were the low level of education (illiterate/primary) (RR: 2.7; 95% CI [1.1-6.4]; p=0.02) and the lack of knowledge about BC symptoms by patients (RR: 15.0; 95% CI [6.0-37.4]; p<10-3). The only variable that remained associated with PD, after multivariate analysis, was lack of initial knowledge of symptoms (OR: 15.0; 95% CI [6.0-37.4]; p<10-3). Conclusion: Lack of knowledge of symptoms was the main factor associated with delayed presentation among BC women.This study shows the need to inform women about performing breast self-examination as well as clinical signs of BC.


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