To describe factors related to timing of first contact with an allopathic medical practitioner , among patients with symptoms of breast cancer attending breast clinic at Cancer Institute, Maharagama. Method A descriptive cross sectional study was conducted among a total of 335 consecutive women who attended the clinic for the first time, during the period of survey. All the patients registered at the breast clinic for the first time were recruited. A pre-tested, interviewer administered questionnaire was used. Results Thirty eight percent (n=127) of patients had a delay in presentation which was defined as greater than 12 weeks. The mean time duration between experiencing a symptom and in seeking medical care was 11.5 weeks (SD=1.41). Factors significantly related to delayed presentation were age (elderly) [p<0.001], marital status (unmarried, divorced or widowed) [p=0.037], fertility status (women with no children) [p=0.011], ethnicity (Tamils and Muslims) [p= 0.002], an income of less than Rs. 10,000 (p= 0.002), low social class (p<0.001), first symptom not being a lump (p<0.001), a distance of > 5 km from home to medical facility (p=0.003), not attending a well woman clinic (p=0.002), assuming the condition to be a benign one (p<0.001), having undergone any kind of surgery under general anaesthesia (p =0.038) and poor knowledge on breast cancer (p<0.001). Conclusion Delay in seeking treatment for suspected breast cancer is a problem in Sri Lanka. Women may benefit from greater awareness of the benefits of early detection and expansion of diagnostic and treatment facilities for breast cancer.

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EditorialThis volume of the journal contains the oration delivered by Prof. Dulitha Fernando titled "Urbanization and health" at the inauguration of the college sessions in year 2008. There are several original research articles which are of relevance and important public health issues are addressed.The article on risk factors for spontaneous abortion will be helpful in planning preventive measures to minimize the incidence of abortion. Prevalence of betel chewing article highlights the importance of proper preventive programmes that should be carried out in order to reduce the oral carcinoma in the rural areas. The study on adolescents reports of parental socio economic status provides evidence to suggest that 15 year old adolescents in Sri Lanka could be relied on as proxies to provide accurate information about their parents occupational status. The article on suicide indicates in detail the relationship to different socio demographic variables and geographic regions with the changing trends of suicide rates in Sri Lanka. The article on access to health care focuses attention on possibilities to be considered in future policy planning which is an eye opener.The article on collaboration between preventive and curative health sectors for maternal and child health demonstrates that there are certain practical steps that can be undertaken by the health department to improve better collaboration. The short communication on LANKAPHEIN highlights its vision, mission and its objectives and the activities carried out during the year since its inception.Happy reading!

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