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

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.

Work Ability, Anxiety, and Depression among Long-Term Breast Cancer Survivors of Northern Kerala, India; A Historical Cohort Study

“…In the present study about 60% were in early stage which is consistent with other studies from Kerala [29,8], and in contrast to Northern parts of India where only 46% presented in early stages [9].…”

“…In this study, work ability is measured using the Work Ability Index (WAI) [17], a valid and well accepted tool for perceived work ability of individuals. It includes seven items, with scores ranging from 7-49 with further categorisation into poor , moderate (28)(29)(30)(31)(32)(33)(34)(35)(36), good (37)(38)(39)(40)(41)(42)(43), and excellent (44-49) [18]. The seven dimensions include current work ability compared to lifetime best, current work ability in relation to demands of the work, number of comorbidities, current work impairment due to the disease, absenteeism, own prognosis of work ability two years from now, and estimate of their mental resources.…”

The Actual Practice of Breast Self-Examination among Sample of Iraqi Patients with Breast Cancer

“…As noted in previous reports from Iraq (19,26) , it was found in this study that the greater proportion of those who practiced self-examination was observed among the highly educated and employed sector of the community. Consistent findings were recorded in previous studies (19)(20)(21)(22)26,27) . Family history of breast cancer was displayed in 46% of the studied cases and the breast was involved in 33.5%.…”

“…In the current study it was observed that only 5.5% of the patients had performed regular BSE on monthly basis before they were diagnosed with the disease, 57.5% had practiced that method randomly while 37% revealed no history of previous experience with that technique. In another observational study carried out on breast cancer patients treated in a tertiary care hospital in India it was found that 32% have practiced BSE (21) . A recently published survey was organized by the INCRC to assess the baseline needs for breast cancer awareness, correlating the findings among patients affected by breast cancer during the treatment phase with the corresponding healthy controls to address their level of knowledge, beliefs and behavior towards the disease.…”

Opportunities and Barriers to Breast Cancer Screening in a Rural Community in Coastal Karnataka, India: A Qualitative Analysis

“…Awareness about the disease however, 2570 so on (Unger-Saldaña, 2014). This finding has been further reiterated through numerous studies conducted in India (Babu et al, 2013;Sathwara et al, 2017;Lakshmanan et al, 2017). In addition to the lack of an organised screening programme in the country, numerous sociocultural barriers seem to play an important role in further dissuading women from getting timely screening or treatment (Singh et al, 2015;Yip, 2016).…”