The Haiti Breast Cancer Initiative: Initial Findings and Analysis of Barriers-to-Care Delaying Patient Presentation

Abstract

Background. In Haiti, breast cancer patients present at such advanced stages that even modern therapies offer modest survival benefit. Identifying the personal, sociocultural, and economic barriers-to-care delaying patient presentation is crucial to controlling disease. Methods. Patients presenting to the Hôpital Bon Sauveur in Cange were prospectively accrued. Delay was defined as 12 weeks or longer from initial sign/symptom discovery to presentation, as durations greater than this cutoff correlate with reduced survival. A matched case-control analysis with multivariate logistic regression was used to identify factors predicting delay. Results. Of N = 123 patients accrued, 90 (73%) reported symptom-presentation duration and formed the basis of this study: 52 patients presented within 12 weeks of symptoms, while 38 patients waited longer than 12 weeks. On logistic regression, lower education status (OR = 5.6, P = 0.03), failure to initially recognize mass as important (OR = 13.0, P < 0.01), and fear of treatment cost (OR = 8.3, P = 0.03) were shown to independently predict delayed patient presentation. Conclusion. To reduce stage at presentation, future interventions must educate patients on the recognition of initial breast cancer signs and symptoms and address cost concerns by providing care free of charge and/or advertising that existing care is already free.

Factors influencing delayed presentation of breast cancer at a tertiary care hospital in Pakistan

“…In their multinational study, Jassem et al reported that the delay was shorter in women with an intermediate education level, in women who work, and in women who live in big towns or cities . Higher breast cancer mortality rates in low and medium‐income countries (LMICs) are thought to be due to diagnosis in advanced stages and barriers to accessing medical care . Advanced stage at presentation in LMICs and in certain racial, ethnic and low socioeconomic communities in developed world are mainly because of delay in presentation to physician from onset of symptoms .…”

The effect of beliefs about breast cancer on stage and delay to presentation: results from a prospective study in urban South Africa

“…This poor ratio of diagnosis to survival is often linked to difficulty in accessing care and poor availability of treatment options after diagnosis. [2][3][4][5] Screening and early diagnosis are limited and patients commonly present with advanced stage of disease limiting their outcomes despite treatment. Commonly cited or implied reasons for late diagnosis are often related in the literature to delay to care, both patient related delay, and provider (or system) delays.…”

Factors associated with time interval between the onset of symptoms and first medical visit in women with breast cancer

“…Previous studies suggested that longer time intervals between the onset of symptoms and the first health care visit were associated with older age, lower educational level and lower family income 11,12 , but few of such studies were performed in Brazil 13,14 , which limits the understanding of such factors regarding the breast cancer in our country.…”

“…The variable of interest was the self-referred time interval between the onset of the suggestive symptom of breast cancer and the date of the first medical visit. This variable was dichotomized -≤ 90 days and > 90 days -as this was the cut-off point used in other studies 11,16,17,18 . The presence of a palpable lump, skin and/or nipple retraction, hyperemia, bulging, abscess or pain in the breast, ulceration, nipple discharge, change in breast size, and the presence of axillary nodules were considered signs/ Cad.…”