116 Background: In Tanzania majority of women are diagnosed with advanced stage of breast cancer. Factors influencing delay in diagnosis resulting in advance stage have not being investigated in the region, particularly as it relates to rural and urban patients. This study aims to explore the experience of breast cancer diagnosis amongst rural and urban patients. Methods: Women diagnosed and confirmed with breast cancer in outpatients setting in a Cancer Care Centre were identified by clinic nurse and introduced to the study. Semi-structured interviews were conducted and transcribed verbatim. Thematic coding using a grounded theory approach was done by two independent researchers using NVivo 12 Mac. Results: Twenty patients (10 rural and 10 urban) participated in the interviews. The average age was 56; 5 (25%) were married, 11 (55%) had primary education, and 10 (50%) were not employed. The majority (70%) had stage IV breast cancer, 15% had stage III and 15% had stage II breast cancer. Seventeen respondents (85%) sought care from traditional healers prior to diagnosis and treatment at the cancer center. Women largely described this pattern of care due to family or community recommendations and pressures to first seek care with traditional healers, as noted by one woman “... neighbours who took me to the traditional healer they told me that, it is the same healer who treated the man who cured from cancer. During my visit to the healer the man who get cured used his medication also I use to see him attending to this traditional healer.’’. All the participants regretted this decision at time of interview due to ineffective and costly treatment which ultimately delayed their hospital presentation and ability to receive quality treatment. One women stated, “...t he medicine cost me one thousand and fifty thousand Tanzanian shillings [75$]. The traditional healer initially want a patient to pay one hundred thousand Tanzanian shillings [50$] then the rest of the money to be paid once a patient complete the dose. I paid only hundred thousand but when used and found there are no any good progress didn’t continue to take it...’’ Rural patients emphasized. ‘‘... no they cannot cure cancer. They just waste people’s time there, while the disease is growing. I am saying this because when I call the traditional healer and tell him that, I am feeling sicker, instead of telling me to go and see him for the change of treatment. Instead he tells me go to hospital it means they cannot cure cancer. They took our money, waste our time and when disease goes bad they tell you to go to the hospital. I don’t belief on them at all.’’. Conclusions: Traditional healers are a critical part of the cancer delivery system in Northern Tanzania yet may contribute to delays in cancer care. Culturally sensitive interventions targeting these providers are necessary to promote early detection, decrease delay in presentation, and improve timely access to care.

PURPOSE In Tanzania, women are diagnosed at an advanced stages of breast cancer. The aim of this study is to identify reasons for this finding from the patient perspective. METHODS Semi-structured in-depth interviews were conducted in inpatient and outpatient settings in the Kilimanjaro Cancer Care Center. Thematic coding via grounded theory technique was done by two independent reviewers. RESULTS Ten 10 patients (five rural and five urban) participated in the study. The average ages was 48. Seven (70.0%) were Christian. Eight (80.0%) patients had primary education, six (60.0%) were married, and eight (80.0%) were not employed. Two women (20.0%) had stage 2, four women (40.0%) had stage 3, and 4 (40.0%) had stage 4. The most common reasons reported by patients for advanced stage breast cancer at time of diagnosis are initially seeking care from traditional healers (n = 6, 60.0%), lack of breast cancer sign and symptoms knowledge (n = 8, 80.0%), misconceptions about breast cancer treatment especially mastectomy (n = 5, 50.0%), distrust of conventional medicine (n = 4, 40.0, seeking support from the religious leaders (n = 6, 60.0%). Furthermore, we found that, almost all (n = 9, 90.0%) of the patients express their concern regarding financial challenges to access care and treatment for cancer. For example (n = 3, 30.0%) said payment for cancer treatment is too costly and six patients (60.0%) stated that lack of money for transportation. CONCLUSION Lack of adequate breast cancer knowledge and awareness, patient provider relationships, and access to care are the most common mentioned reasons for advanced disease at time of diagnose among breast cancer patients. Engagement with the community through cultural sensitive public health campaigns and interventions must be designed to alleviate the misconceptions and knowledge gap in these communities. System level change is needed to improve access to care.