DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20174605

Delay in diagnosis of breast cancer in a developing country: a single centre observational study in a tertiary care hospital in North Kerala, India

Manikandan Lakshmanan, Ramesan Chayampurath, Ramalingam Trivikraman, Selvam Paramasivam, Sasi M. P.

Abstract


Background: Around the world breast cancer is the most common cancer in women. In India, peak incidence is between 45-50 years of age. Early diagnosis improves survival, hence reducing diagnostic delay in breast cancer will have major social and economic implications besides improving the quality of life. This observational study aims to decipher various factors influencing diagnostic delay so that early treatment can be instituted.

Methods: We interviewed 212 consecutive patients who attended the twice weekly breast clinic conducted by Department of general surgery and department of radiotherapy, government medical college, Kozhikode between September 2014 and February 2015. All patients with primary breast cancer were included in the study. Exclusion criteria included recurrence, second primaries, history of partial treatment and incomplete records. Finally, we interviewed 202 patients with the help of a pretested semi-structured questionnaire.

Results: In present study, the commonest age group was 40-50 years with 62.4% participants presenting with early breast cancer and 37.6% having advanced breast cancer. Most of present study subjects were educated up to high school and unemployed. Awareness about breast cancer was 74.25% but many were ignorant of its symptomatology. Practice of breast self-examination (BSE) was low at 32.1%. Side and quadrant were statistically significant factor.

Conclusions: In present study religion, educational status, marital status, breast cancer awareness, practice of BSE and location of tumor were statistically significant factors influencing delay in diagnosis. There was a general lack of knowledge about the importance of self-examination in breast cancer which needs health education and need for active social propaganda in print and electronic media regarding its importance. In future institution of a screening programme will hasten diagnosis and improve survival of breast cancer patients.


Keywords


Breast cancer, Diagnostic delay, Screening

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References


Morrow M, Burnstein HJ, Harris JR. Malignant Tumors of the Breast. In: Devita VT, Lawrence TS, Rosenberg SA, Eds. Cancer: Principles and Practice of Oncology, 10th Ed. Walters Kluwer Publication; 2015:1117.

National Cancer Registry Programme. Chapter 10. Female Breast. In: Consolidated Report of Hospital Based Cancer Registries: 2007-2011. Available at http://www.ncrpindia.org/ALL_NCRP_REPORTS/HBCR_REPORT_2007_2011/ALL_CONTENT/ALL_PDF/Chapter10.pdf.

Montazeri A, Ebrahimi M, Mehrdad N, Ansari M, Sajadian A. Delayed presentation in breast cancer: a study in Iranian women. BMC Women's Health. 2003;3(1):4.

Richards MA, Westcombe AM, Love SB, Littlejohns P, Ramirez AJ. Influence of delay on survival in patients with breast cancer: a systematic review. Lancet. 1999;353(9159):1119-26.

Richards MA, Stockton D, Babb P, Coleman MP. How many deaths have been avoided through improvements in cancer survival? BMJ. 2000;320(7239):895-8.

Edge S, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A. AJCC Cancer Staging Manual 7th Edition: Springer, 2010.

National Cancer Institute. SEER Stat Fact Sheets: Breast Cancer. Available at http://seer.cancer.gov/statfacts/html/breast.html.

Cancer Network. Cancer Management. Stage III and IV Breast Cancer. Available at http://www.cancernetwork.com/cancer-management/stages-iii-and-iv-breast-cancer.

Hunt KK, Green MC, Buchholz TA. Diseases of the breast. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice, 19th ed. Elsevier Saunders Publication; 2012:865.

Burgess C, Hunter MS, Ramirez AJ. A qualitative study of delay among women reporting symptoms of breast cancer. British J General Practice. 2001;51:967-71.

Norsa’adah B, Rampal KG, Rahmah MA, Naing NN, Biswal BM. Diagnosis delay of breast cancer and its associated factors in Malaysian women. BMC Cancer. 2011;11:141.

Ibrahim NA, Oludara MA. Sociodemographic factors and reasons associated with delay in breast cancer presentation: a study of Nigerian women. Breast. 2012;21:416-8.

Porta M, Gallen M, Malats N, Planas J. Influence of “diagnostic delay” upon cancer survival: an analysis of five tumor sites. J Epidemiol Community Health. 1991;45:225-30.

Neal RD. Do diagnostic delays in cancer matter? Br J Cancer. 2009;101:S9-12.