Background
Methods
Population and study sites
Data collection
Patient and system delay
Statistical analysis
Results
Study population
N (%) | ||
---|---|---|
Age at presentation (years) | Mean (±SD) | 48.3 ± 10.4 |
Area of residence | Rural | 48 (35) |
Urban | 89 (65) | |
Marital status | Single | 26 (19) |
Married | 77 (56.2) | |
Widowed or Divorced | 34 (24.8) | |
Occupation | No occupation | 23 (16.8) |
House wife | 102 (74.5) | |
Full time employed | 10 (7.3) | |
Part time employed | 2 (1.5) | |
Patient educational level | Illiterate | 115 (83.9) |
Primary | 14 (10.2) | |
Secondary/Higher | 8 (5.8) | |
Spouse educational level (n = 77) | Illiterate | 49 (63.6) |
Primary | 20 (26) | |
Secondary/Higher | 8 (10.4) | |
Number of dependent children | None | 52 (38) |
1–3 | 51 (37.2) | |
≥4 | 34 (24.8) | |
Number of dependents | None | 35 (25.5) |
1–2 | 86 (62.8) | |
≥3 | 16 (11.7) | |
Distance from basic health center (km) | <5 | 101 (73.7) |
≥5 | 36 (26.3) | |
Distance from specialized care (km) | <100 | 76 (55.5) |
≥100 | 61 (44.5) |
N (%) | ||
---|---|---|
First clinical presentations | Lump | 90 (65.7) |
Skin changes | 21 (15.3) | |
Breast pain | 16 (11.7) | |
Nipple discharge | 6 (4.4) | |
Bone pain | 4 (2.9) | |
Breast self-examination | No | 115 (83.9) |
Yes | 22 (16.1) | |
Family history of breast cancer | No | 109 (79.6) |
Yes | 28 (20.4) | |
Consultation time or patient delay (months) | Median [IQR] | 6[4, 12] |
Diagnosis time or system delay (months) | Median [IQR] | 1[1, 3] |
Total diagnosis delay (months) | Median [IQR] | 10[5.7, 13] |
Tumor characteristics | ||
Tumor size (n = 117) | ≤2 cm | 3 (2.6) |
3–5 cm | 23 (19.7) | |
>5 cm | 91 (77.8) | |
TNM classification | ||
T | T2 | 5 (3.6) |
T3 | 71 (51.8) | |
T4 | 61 (44.5) | |
N | N0 | 48 (35) |
N1 | 51 (37.2) | |
N2 | 18 (13.1) | |
N3 | 20 (14.6) | |
M | M0 | 114 (83.2) |
M1 | 23 (16.8) |
Diagnosis delay and associated factors
N (%) | |
---|---|
Causes of Diagnosis Delay (n = 137) | |
Cause related to patient | 96 (70.1) |
Cause related to health system | 19 (13.9) |
Cause related to patient and system | 22 (16.1) |
Factors related to patient delay (n = 118) | |
Symptoms not attributed to cancer | 66 (55.9) |
Lack of information | 49 (41.5) |
Symptoms related to breastfeeding | 12 (10.2) |
Symptoms related to benign breast disease | 5 (4.2) |
Use of traditional methods | 15 (12.7) |
Fear of cancer diagnosis and/or treatment | 14 (11.9) |
Financial constraints | 8 (6.8) |
Competing life priorities | 8 (6.8) |
Embarrassment about having a breast examination | 7 (5.9) |
Factors related to system delay (n = 41) | |
Negative physical breast examination | 10 (24.4) |
Non-specific medical treatment without control | 8 (19.5) |
A negative fine-needle aspiration biopsy | 8 (19.5) |
Appointment delay | 8 (19.5) |
Mammography misinterpreted | 4 (9.8) |
Surgical excision without pathological examination | 1 (2.4) |
Lack of information | 2 (4.9) |
Symptoms not attributed to cancer (n = 53) | Traditional methods (n = 13) | Fear of cancer (n = 11) | System delay (n = 19) |
P value | ||
---|---|---|---|---|---|---|
Social demographic characteristics of the patients | ||||||
Age at presentation (years) | Mean (±SD) | 47.74 ± 9.77 | 45.46 ± 9.56 | 44 ± 11.19 | 47.47 ± 10.4 | 0.852 |
Area of residence | Rural | 18 (34) |
12 (92.3)
| 1 (9.1) | 4 (21.1) |
0.001
|
Urban |
35 (66)
| 1 (7.7) |
10 (90.9)
|
15 (78.9)
| ||
Marital status | Single | 10 (18.9) | 3 (23.1) | 5 (45.4) | 5 (26.3) | 0.535 |
Married | 30 (56.6) | 9 (69.2) | 5 (45.4) | 10 (52.6) | ||
Widowed/Divorced | 13 (24.5) | 1 (7.7) | 1 (9.1) | 4 (21.1) | ||
Occupation | No occupation | 9 (17) | 3 (23.1) | 4 (36.4) | 4 (21.1) | 0.234 |
House wife | 41 (77.4) | 10 (76.9) | 5 (45.5) | 12 (63.2) | ||
Employed | 3 (5.7) | 0 (0.0) | 2 (18.2) | 3 (15.8) | ||
Patient educational level | Illiterate | 45 (84.9) | 13 (100) | 8 (72.7) | 15 (78.9) | 0.222 |
Literate | 8 (15.1) | 0 (0.0) | 3 (27.3) | 4 (21.1) | ||
Spouse educational level | Illiterate | 19 (63.3) | 9 (100) | 3 (60) | 5 (50) | 0.077 |
Literate | 11 (36.7) | 0 (0.0) | 2 (40) | 5 (50) | ||
Number of dependent children | None | 20 (37.7) | 5 (38.5) | 7 (63.6) | 8 (42.1) | 0.813 |
1–3 | 21 (39.6) | 5 (38.5) | 2 (18.2) | 8 (42.1) | ||
≥4 | 12 (22.6) | 3 (23.1) | 2 (18.2) | 3 (15.8) | ||
Number of dependents | None | 13 (24.5) | 3 (23.1) | 4 (36.4) | 5 (26.3) | 0.895 |
1–2 | 35 (66) | 9 (69.2) | 5 (45.5) | 12 (63.2) | ||
≥3 | 5 (9.4) | 1 (7.7) | 2 (18.2) | 2 (10.5) | ||
Distance from basic health center (km) | <5 |
42 (79.2)
| 3 (23.1) |
9 (81.8)
|
15 (78.9)
|
0.001
|
≥5 | 11 (20.8) |
10 (76.9)
| 2 (18.2) | 4 (21.1) | ||
Distance from specialized care (km) | <100 |
33 (62.3)
| 0 (0.0) |
8 (72.7)
|
14 (73.7)
|
<0.001
|
≥100 | 20 (37.7) |
13 (100)
| 3 (27.3) | 5 (26.3) | ||
Medical history of the patients | ||||||
First clinical presentations | Lump | 31 (58.5) | 10 (76.9) | 7 (63.6) | 13 (68.4) | 0.655 |
Other | 22 (41.5) | 3 (23.1) | 4 (36.4) | 6 (31.6) | ||
Breast self-examination | No |
50 (94.3)
|
13 (100)
|
9 (81.8)
| 7 (36.8) |
<0.001
|
Yes | 3 (5.7) | 0 (0.0) | 2 (18.2) |
12 (63.2)
| ||
Family history of breast cancer | No |
50 (94.3)
|
12 (92.3)
| 2 (18.2) |
11 (57.9)
|
<0.001
|
Yes | 3 (5.7) | 1 (7.7) |
9 (81.8)
| 8 (42.1) |
Diagnosis delay | Bivariated analysis | Multivariated analysis | |||||||
---|---|---|---|---|---|---|---|---|---|
≤6 months (n = 39) | >6 months (n = 98) | OR | 95 % CI |
P value | OR | 95 % CI |
P value | ||
Social demographic characteristics of the patients | |||||||||
Age at presentation (years) | Mean (±SD) | 47.7 ± 10.39 | 48.53 ± 10.47 | 1.00 | 0.972–1.04 | 0.699 | |||
Area of residence | Rural | 2 (5.1) | 46 (46.9) |
16.36
|
3.74–71.69
|
<0.001
|
9.73
|
1.17–80.93
|
0.035
|
Urban | 37 (94.9) | 52 (53.1) | 1(Ref) | ||||||
Marital status | Single | 9 (23.1) | 17 (17.3) | 1(Ref) | |||||
Married | 17 (43.6) | 60 (61.2) | 1.87 | 0.71–4.93 | 0.207 | ||||
Widowed/Divorced | 13 (33.3) | 21 (21.4) | 0.85 | 0.29–2.48 | 0.773 | ||||
Occupation | No occupation | 8 (20.5) | 15 (15.3) | 1(Ref) | |||||
House wife | 26 (66.7) | 76 (77.6) | 1.56 | 0.59–4.10 | 0.368 | ||||
Employed | 5 (12.8) | 7 (7.1) | 0.75 | 0.18–3.13 | 0.689 | ||||
Patient educational level | Illiterate | 17 (43.6) | 98 (100) | 9 109
| 0–< 0.001 | 0.999 | |||
Primary | 14 (35.9) | 0 (0.0) | 1 | 0–< 0.001 | 1.000 | ||||
Secondary/Higher | 8 (20.5) | 0 (0.0) | 1(Ref) | ||||||
Spouse educational level (n = 77) | Illiterate | 5 (29.4) | 44 (73.3) | 5.28 | 0.96–29.02 | 0.056 | |||
Primary | 9 (52.9) | 11 (18.3) | 0.73 | 0.14–3.94 | 0.718 | ||||
Secondary/Higher | 3 (17.6) | 5 (8.3) | 1(Ref) | ||||||
Number of dependent children | None | 17 (43.6) | 35 (35.7) | 1(Ref) | |||||
1–3 | 13 (33.3) | 38 (38.8) | 1.42 | 0.60–3.34 | 0.422 | ||||
≥4 | 9 (23.1) | 25 (25.5) | 1.35 | 0.52–3.51 | 0.540 | ||||
Number of dependents | None | 11 (28.2) | 24 (24.5) | 1(Ref) | |||||
1–2 | 22 (56.4) | 64 (65.3) | 1.33 | 0.56–3.16 | 0.513 | ||||
≥3 | 6 (15.4) | 10 (10.2) | 0.76 | 0.22–2,64 | 0.670 | ||||
Distance from basic health center (km) | <5 | 34 (87.2) | 67 (68.4) | 1(Ref) | |||||
≥5 | 5 (12.8) | 31 (31.6) |
3.15
|
1.12–8.82
|
0.029
|
0.09
|
0.01–0.90
|
0.040
| |
Distance from specialized care (km) | <100 | 37 (94.9) | 39 (39.8) | 1(Ref) | |||||
≥100 | 2 (5.1) | 59 (60.2) |
27.99
|
6.38–122.85
|
<0.001
|
32.77
|
4.42–242.92
|
0.001
| |
Medical history of the patients | |||||||||
First clinical presentations | Lump | 27 (69.2) | 63 (64.3) | 1(Ref) | |||||
Other | 12 (30.8) | 35 (35.7) | 1.25 | 0.56–2.77 | 0.583 | ||||
Breast self-examination | No | 27 (69.2) | 88 (89.8) |
3.91
|
1.52–10.05
|
0.005
| 1.20 | 0.37–3.89 | 0.765 |
Yes | 12 (30.8) | 10 (10.2) | 1(Ref) | ||||||
Family history of breast cancer | No | 23 (59) | 86 (87.8) |
4.99
|
2.07–12.00
|
<0.001
|
4.46
|
1.39–14.32
|
0.012
|
Yes | 16 (41) | 12 (12.2) | 1(Ref) |