Timeliness of diagnosis of breast and cervical cancers and associated factors in low-income and middle-income countries: a scoping review

Abstract

ObjectivesAddressing the barriers to early breast and cervical cancer diagnosis in low and middle-income countries (LMICs) requires a sound understanding and accurate assessment of diagnostic timeliness. This review aimed to map the current evidence on the time to breast and cervical cancer diagnosis and associated factors in LMICs.DesignScoping review.SourcesMEDLINE (via PubMed), Cochrane Library, Scopus and CINAHL.Eligibility criteriaStudies describing the time to diagnosis and associated factors in the context of breast and cervical cancer in LMICs published from 1 January 2010 to 20 May 2021.Study selection and data synthesisTwo reviewers independently screened all abstracts and full texts using predefined inclusion criteria. The review was reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Evidence was narratively synthesised using predefined themes.ResultsTwenty-six studies conducted across 24 LMICs were included in the review, most (24/26) of which focused on breast cancer. Studies varied considerably in their conceptualisation and assessment of diagnostic time, events, intervals and delays, with a minority of the studies reporting the use of validated methods and tools. Patient-related intervals and delays were more frequently evaluated and reported than provider-related and health system-related intervals and delays. Across studies, there were variations in the estimated lengths of the appraisal, help-seeking, patient and diagnostic intervals for both cancers and the factors associated with them.ConclusionsDespite the significant burden of breast and cervical cancer in LMICs, there is limited information on the timeliness of diagnosis of these cancers. Major limitations included variations in conceptualisation and assessment of diagnostic events and intervals. These underscore the need for the use of validated and standardised tools, to improve accuracy and translation of findings to better inform interventions for addressing diagnostic delays in LMICs.

Duration of the patient interval in breast cancer and factors associated with longer delays in low‐and middle‐income countries: A systematic review with meta‐analysis

“…The wide CI for the pooled estimates illustrate the large variation that exists in the estimated patient intervals within regions. This is in line with previous reviews have documented large variability in patient intervals, for instance, within African countries 13,15 . The diverse sensitivity analyses conducted helped partial out some of the contributors to this variability.…”

“…We coincide with the conclusions of a recent scoping review that cancer care pathway studies on breast cancer vary considerably in the use of terminology and the assessment of intervals 15 . Hence, a possible limitation of the current review is the possibility to have missed eligible articles despite the broad search criteria.…”

“…Hence, a possible limitation of the current review is the possibility to have missed eligible articles despite the broad search criteria. Our review is also limited by the inherent complexity and many possible biases in the measurement of time points and intervals in the cancer treatment pathway 8 and the low frequency of use of validated methods and tools 15 . In addition, the questionnaires used to measure the factors examined in relation to patient intervals were also often poorly described, making interpretation difficult.…”

“…Previous reviews of patient intervals in breast cancer and the associated personal, social, and psychological factors influencing delays in LMICs have shown that there is large variation not only in the duration of intervals but also in the factors associated 13–15 . It has been proposed that conflicting results may be due to the large cultural and economic diversity that exists within the developing world 14 and the low methodological quality and consistency of the evidence available 15 .…”

Global burden of ototoxic hearing loss associated with platinum-based cancer treatment: A systematic review and meta-analysis

“…Our global estimates of at-risk and exposed populations and hearing loss cases did not account for several potentially influential factors discussed above. Regional differences in timeliness to cancer treatment exist, and individuals residing in low- and middle-income countries may receive cancer treatment later than recommended [108] . However, delayed treatment in low- and middle-income countries (compared to US and UK data used in this study) could result in an underestimate of drug exposure and hearing loss cases.…”