From symptom discovery to treatment - women's pathways to breast cancer care: a cross-sectional study

Moodley, Jennifer; Cairncross, Lydia; Naiker, Thurandrie; Constant, Deborah

doi:10.1186/s12885-018-4219-7

Cited by 79 publications

(111 citation statements)

References 33 publications

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“…Raising satisfaction derived in the hospital for treatment of other minor illnesses might build confidence and enduring relationship between potential breast cancer patients and the clinicians. 16 and then in a subsequent study of 201 patients; they reported a higher proportion of long delays in the system's interval 24 . Roy et al 25 in Bangladesh and Maghous et al 26 in Morocco, both reported that doctors were complicit in a third of long interval situations 25,26 .…”

Section: Discussionmentioning

confidence: 90%

Presentation Intervals And The Impact Of Delay On Breast Cancer Progression In A Black African Population

Agodirin

Olatoke

Rahman

et al. 2020

Preprint

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BACKGROUND: The help-seeking interval or the primary-care interval are points of delays in breast cancer presentation. To inform future breast cancer down-staging intervention, we described the contribution of each interval to the delay and the impact of delay on tumor progression. METHOD: Multicentered survey from June 2017 to May 2018. We hypothesized that most patients visited the First Healthcare Provider within 60days of tumor detection. Inferential statistics were by ttest, chi-square test, and Wilcoxon-Signed Rank test at p-value 0.05 or 95% confidence limits. Timeto-event was by survival method. Multivariate analysis was by logistic regression.RESULTS: Respondents were females between 24 and 95 years (n=420). Most respondents visited FHP within 60 days of detecting symptoms (230(60%, 95% CI 53-63). Most had long primary-care(237 of 377(64% 95%CI 59-68) and detection-to-specialist(293 (73% (95%CI 68-77)) intervals. The primary care interval(median 106days) was longer than the help-seeking interval( median 42days )Wilcoxon signed-rank test p= 0.001. There was strong correlation between length of primary care interval and the detection-to-specialist interval(r= 0.9, 95%CI 0.88-0.92). Patronizing the hospital, receiving the correct advice, and having a big tumor(>5cm) were associated with short intervals. Tumors were detected early, but most became advanced before arriving at the specialist clinic. The difference in tumor size between detection and arriving at a specialist clinic was 5.0±4.9cm(95%CI 4.0-5.0). The instantaneous hazard of progressing from early to locally advanced disease was least in the first 30days(3%). The hazard was 31% in 90days.CONCLUSION: Most respondents presented early to the first healthcare provider, but most arrived late at a specialist clinic. The primary care interval was longer than the help-seeking interval. Most tumors were early at detection but locally advanced before arriving in a specialist clinic. Interventions aiming to shorten the primary care interval will have the most impact on time to breast cancer presentation for specialist oncology care in Nigeria. BackgroundBreast cancer(BC) patients in low and middle-income countries(LMICs) and black patients in developed countries harbor symptoms for up to 8-12 months 1 − 5 before diagnosis and treatment

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Section: Discussionmentioning

confidence: 90%

Presentation Intervals And The Impact Of Delay On Breast Cancer Progression In A Black African Population

Agodirin

Olatoke

Rahman

et al. 2020

Preprint

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“…Harirchi in Tehran 23 and Yau et al in Hong Kong 24 reported a higher proportion of patients with help-seeking delay. Moodley et al rst reported a higher proportion of delay in the patient interval among 20 patients in South Africa 16 and then in a subsequent study of 201 patients; they reported a higher proportion of long delays in the system's interval 25 . Roy et al 26 in Bangladesh and Maghous et al 27 in Morocco, both reported that doctors were complicit in a third of long interval situations 26,27 .…”

Section: Discussionmentioning

confidence: 97%

Presentation Intervals and the Impact of Delay on Breast Cancer Progression in a Black African Population

Agodirin

Olatoke

Rahman

et al. 2020

Preprint

View full text Add to dashboard Cite

BACKGROUND: The help-seeking interval and primary-care interval are points of delays in breast cancer presentation. To inform future intervention targeting early diagnosis of breast cancer, we described the contribution of each interval to the delay and the impact of delay on tumor progression. METHOD: We conducted a multicentered survey from June 2017 to May 2018 hypothesizing that most patients visited the first healthcare provider within 60 days of tumor detection. Inferential statistics were by t-test, chi-square test, and Wilcoxon-Signed Rank test at p-value 0.05 or 95% confidence limits. Time-to-event was by survival method. Multivariate analysis was by logistic regression. RESULTS: Respondents were females between 24 and 95 years (n=420). Most respondents visited FHP within 60 days of detecting symptoms (230 (60%, 95% CI 53-63). Most had long primary-care (237 of 377 (64% 95% CI 59-68) and detection-to-specialist (293 (73% (95% CI 68-77)) intervals. The primary care interval (median 106 days, IQR 13-337 ) was longer than the help-seeking interval ( median 42 days, IQR 7-150 ) Wilcoxon signed-rank test p= 0.001. There was a strong correlation between the length of primary care interval and the detection-to-specialist interval (r= 0.9, 95% CI 0.88- 0.92). Patronizing the hospital, receiving the correct advice, and having a big tumor (>5cm) were associated with short intervals. Tumors were detected early, but most became advanced before arriving at the specialist clinic. The difference in tumor size between detection and arriving at a specialist clinic was 5.0±4.9cm (95% CI 4.0-5.0). The hazard of progressing from early to locally advanced disease was least in the first 30 days (3%). The hazard was 31% in 90 days. CONCLUSION: Most respondents presented early to the first healthcare provider, but most arrived late at a specialist clinic. The primary care interval was longer than the help-seeking interval. Most tumors were early at detection but locally advanced before arriving in a specialist clinic. Interventions aiming to shorten the primary care interval will have the most impact on time to breast cancer presentation for specialist oncology care in Nigeria.

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“…Length of diagnosis has been found to be associated with number of hospitals visited (Shieh et al, 2014). Study by Moodley et al, (2018) also showed that 40% of women had visited 4 or more health care visits from the time of first symptom discovery and definitive breast cancer diagnosis. Other reasons for the delay in seeking diagnosis and treatment was affordability and not suspected for the breast cancer.…”

Section: Discussionmentioning

confidence: 99%

“…The sample size was estimated to look at the sufficiency of the estimated parameter with the desired precision based on the study conducted by Moodley et al, (2018) where the overall median time from the symptom discovery to initiation of treatment was 110 days. Considering a 5% alpha error and a relative precision of 7.3%, the study required a minimum sample of 180 subjects.…”

Section: Methodsmentioning

confidence: 99%

Time Interval between Self-Detection of Symptoms to Treatment of Breast Cancer

Somanna

Srinivasa

Ramesh

et al. 2020

Asian Pac J Cancer Prev

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Background:In India breast cancer is the number one cancer among females with an incidence rate of 25.8 per 100,000 women and mortality of 12.7 per 100,000 women. India continues to have a low 5-year survival rate of breast cancer with only 66.1% as compared to 90% in developed countries. The major reason for low survival is that patients are diagnosed with cancer at high stage. The present study attempts to delineate the time interval between self-detection of breast cancer symptoms and seeking care and to find the main reasons for delay in seeking care. Methods: A cross sectional study was undertaken from October 2016 to March 2017 in a population based cancer registry (PBCR) and hospital based cancer registry (HBCR) located in south of India. Histologically confirmed breast cancer patients (N=181) were interviewed at hospital using a pre-tested semi structured questionnaire. Results: The median time interval between the self-detection of breast cancer symptoms and first contact with general physician was 60 [IQR 30-180] days. The median time to diagnosis from the first contact was 30 [IQR 10 -60] days and the overall median time span from self-detection of symptoms to treatment was 150 [IQR 95-265] days. The major reason given for not seeking medical care in time was lack of awareness in identifying the cancer symptoms both among patients and primary care providers.Conclusion: There was considerable delay from self-detection of symptoms to cancer specific primary treatment of breast cancer. We found lack of awareness among patients as well as in primary care providers to be the major concern for delay. Awareness among the target population and health care professionals would have to be improved for early diagnostics and access to care.

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From symptom discovery to treatment - women's pathways to breast cancer care: a cross-sectional study

Cited by 79 publications

References 33 publications

Presentation Intervals And The Impact Of Delay On Breast Cancer Progression In A Black African Population

Presentation Intervals And The Impact Of Delay On Breast Cancer Progression In A Black African Population

Presentation Intervals and the Impact of Delay on Breast Cancer Progression in a Black African Population

Time Interval between Self-Detection of Symptoms to Treatment of Breast Cancer

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