Factors Affecting Presentation Delay to the Hospital Among Breast Cancer Patients: A Retrospective Analysis
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Abstract
Objective: Breast cancer constituted 13.5% of all reported new cancer in India, with a notable mortality rate due to late presentation. The current research aims to address the extent of delay in presentation to the hospital and the factors that contribute to delayed presentation among breast cancer patients.
Materials and methods: A descriptive cross-sectional study was conducted among 138 primary breast cancer patients aged 18 to 60 years, with a time lag of more than 2 weeks between the initial recognition of symptoms and the first medical interaction. These patients were attending the oncology Outpatient Department (OPD) of tertiary care center in Central India, where female breast cancer patients receive treatment and follow-up care. The analysis employed binary logistic regression to assess the factors significantly affecting the delayed presentation to the hospital.
Results: Most of the participants were aged between 40 and 50 years and did not have a family history of breast cancer. The median delay in presentation to the hospital was 2 months. Women having breast lump as initial breast symptom tend to present late (> 3 months) to the hospital (p=0.037) and if the breast lump was smaller, they are more likely to delay seeking medical attention compared to those with larger breast lump (p=0.012).
Conclusion: The study indicates that many patients delayed seeking help due to small breast lumps. Improved screening services are needed for early detection. Future awareness campaigns should emphasize the link between breast lumps and cancer to reduce delays and improve patient quality of life.
1. World Health Organization. Breast cancer. https://www.who.int/news-room/fact-sheets/detail/breast-cancer/, 2023.
2. International Agency for Research on Cancer. India Fact Sheets. https://gco.iarc.fr/today/data/factsheets/populations/356-india-fact-sheets.pdf/2023.
3. Verma, Mukesh. Host Susceptibility Factors. In Cancer
Epidemiology : Volume 1, 1st ed, New york, Humana Press. 2009.
4. Mehrotra R, Yadav K. Breast cancer in India: Present scenario and the challenges ahead. World
J Clin Oncol. 2022;13(3):209-218.
5. Sharma V, Giri S. Cancer control in India- A sorry state. Indian J Cancer. 2009;46(4):340.
6. Thakur NA, Humne AY, Godale LB. Delay in presentation to the hospital and factors affecting it in breast cancer patients attending tertiary care center in Central India. Indian J Cancer. 2015;52(1):102-5.
7. Dinshaw KA, Rao DN, Ganesh B, Rao DN. Tata Memorial Hospital Cancer Registry Annual Report. Science Open. 2023. Available at: https://www.scienceopen.com/document?vid=0f2f8050-2b52-4171-a21d-46ac6b2886a9 (Accessed November 2024).
8. Dinshaw K, Shastri S, Patil S. Cancer control programme in India: Challenges for the new millennium Health Administrator. https://bklwrmc.com/wp-content/uploads/2017/12/control.pdf/2005.
9. Ruddy KJ, Gelber S, Tamimi RM, Schapira L, Come SE, Meyer ME, et al. Breast cancer presentation and diagnostic delays in young women. Cancer. 2014;120(1):20-5.
10. Hassen AM, Hussien FM, Asfaw ZA, Assen HE. Factors Associated with Delay in Breast Cancer Presentation at the Only Oncology Center in North East Ethiopia: A Cross-Sectional Study. J Multidiscip Healthc. 2021;14:681-694.
11. Richards MA, Smith P, Ramirez AJ, Fentiman IS, Rubens RD. The influence on survival of delay in the presentation and treatment of symptomatic breast cancer. Br J Cancer. 1999;79(5-6):858-64.
12. Hutajulu SH, Prabandari YS, Bintoro BS, Wiranata JA, Widiastuti M, Suryani ND, et al. Delays in the presentation and diagnosis of women with breast cancer in Yogyakarta, Indonesia: A retrospective observational study. PLoS One. 2022;17(1):e0262468.
13. Polit DF, Beck CT. The content validity index: are you sure you know what's being reported? Critique and recommendations. Res Nurs Health. 2006;29(5):489-97.
14. Lynn MR. Determination and quantification of content validity. Nurs Res. 1986;35(6):382-5.
15. Faremi Y. Reliability Coefficient of Multiple-Choice and Short Answer Objective Test Items in Basic Technology: Comparative Approach. J Edu Pract. 2016;7(28):59.
16. Sharma S. Nursing Research and Statistics. 3nd ed. India: ELSEVIER, 2018.
17. Rai A, Sharda P, Aggarwal P, Ravi B. Study of
Diagnostic Delay among Symptomatic Breast Cancer Patients in Northern India: A Mixed-Methods Analysis from a Dedicated Breast Cancer Centre. Asian Pac J Cancer Prev. 2022;23(3):893-904.
18. Sharma K, Costas A, Shulman LN, Meara JG. A systematic review of barriers to breast cancer care in developing countries resulting in delayed patient presentation. J Oncol. 2012;2012:121873.
19. Barber MD, Jack W, Dixon JM. Diagnostic delay in breast cancer. Br J Surg. 2004;91(1):49-53.
20. Shreyamsa M, Singh D, Ramakant P, Anand A, Singh KR, Mouli S, et al. Barriers to Timely Diagnosis and Management of Breast Cancer: Observations from a Tertiary Referral Center in Resource Poor Setting. Indian J Surg Oncol. 2020;11(2):287-293.
21. Abo Al-Shiekh SS, Alajerami YS, Abushab KM, Najim AA, AlWaheidi S, Davies EA. Factors affecting delay in the presentation of breast cancer symptoms among women in Gaza, occupied Palestinian territory: a cross-sectional survey. BMJ Open. 2022;12(10):e061847.
22. Kumar A, Bhagabaty SM, Tripathy JP, Selvaraj K, Purkayastha J, Singh R. Delays in Diagnosis and Treatment of Breast Cancer and the Pathways of Care: A Mixed Methods Study from a Tertiary Cancer Centre in North East India. Asian Pac J Cancer Prev. 2019;20(12):3711-3721.
23. Shah P, Save M, Khadilkar R, Shah P, Kader H, Eswarawaka M. Locally advanced breast cancer: an observational study for the delay in presentation of patients. Int Surg J. 2020;7(6):1758.
24. Abdulkareem AA, Ghalib HA, Rashaan MI. Factors causing delayed presentations of breast cancer among female patients in Sulaimani Governorate, Kurdistan region, Iraq. BMC Womens Health. 2023;23(1):612.
25. Ali R, Mathew A, Rajan B. Effects of socio-economic and demographic factors in delayed reporting and late-stage presentation among patients with breast cancer in a major cancer hospital in South India. Asian Pac
J Cancer Prev. 2008;9(4):703-7.
26. J SS, Rohini AM, Thajudheen RB, Elavally S.
Determinants of Patient Delay among Women with Carcinoma Breast. Asian Pac J Cancer Prev. 2023;24(9):3109-3115.
27. Soh JY, Yahya MM, Bachok N, Wan Zain WZ, Wong MP, Zakaria Z, et al. Factors associated with delay in seeking care for breast symptoms. BMC Womens Health. 2022;22(1):316.
28. Zhang H, Wang G, Zhang J, Lu Y, Jiang X. Patient delay and associated factors among Chinese women with breast cancer: A cross-sectional study. Medicine (Baltimore). 2019;98(40):e17454.
29. Rajaram N, Jaganathan M, Muniandy K, Rajoo Y, Zainal H, Rahim N, et al. Barriers to help-seeking for Malaysian women with symptoms of breast cancer: a mixed-methods, two-step cluster analysis. BMC Health Serv Res. 2023;23(1):206.
30. Simon AE, Waller J, Robb K, Wardle J. Patient delay in presentation of possible cancer symptoms: the contribution of knowledge and attitudes in a population sample from the United Kingdom. Cancer Epidemiol Biomarkers Prev. 2010;19(9):2272-7.
31. Agarwal G, Ramakant P, Forgach ER, Rendón JC, Chaparro JM, Basurto CS, et al. Breast cancer care in developing countries. World J Surg. 2009;33(10):2069-76.
32. Schmid M, Wolf RC, Freudenmann RW, Schönfeldt-Lecuona C. Tomophobia, the phobic fear caused by an invasive medical procedure - an emerging anxiety disorder: a case report. J Med Case Rep. 2009;3:131.
33. Yadav RJ, Pandey A, Singh P. A study on acceptability of Indian system of medicine and homeopathy in India: results from the State of West Bengal. Indian J Public Health. 2007;51(1):47-9.
2. International Agency for Research on Cancer. India Fact Sheets. https://gco.iarc.fr/today/data/factsheets/populations/356-india-fact-sheets.pdf/2023.
3. Verma, Mukesh. Host Susceptibility Factors. In Cancer
Epidemiology : Volume 1, 1st ed, New york, Humana Press. 2009.
4. Mehrotra R, Yadav K. Breast cancer in India: Present scenario and the challenges ahead. World
J Clin Oncol. 2022;13(3):209-218.
5. Sharma V, Giri S. Cancer control in India- A sorry state. Indian J Cancer. 2009;46(4):340.
6. Thakur NA, Humne AY, Godale LB. Delay in presentation to the hospital and factors affecting it in breast cancer patients attending tertiary care center in Central India. Indian J Cancer. 2015;52(1):102-5.
7. Dinshaw KA, Rao DN, Ganesh B, Rao DN. Tata Memorial Hospital Cancer Registry Annual Report. Science Open. 2023. Available at: https://www.scienceopen.com/document?vid=0f2f8050-2b52-4171-a21d-46ac6b2886a9 (Accessed November 2024).
8. Dinshaw K, Shastri S, Patil S. Cancer control programme in India: Challenges for the new millennium Health Administrator. https://bklwrmc.com/wp-content/uploads/2017/12/control.pdf/2005.
9. Ruddy KJ, Gelber S, Tamimi RM, Schapira L, Come SE, Meyer ME, et al. Breast cancer presentation and diagnostic delays in young women. Cancer. 2014;120(1):20-5.
10. Hassen AM, Hussien FM, Asfaw ZA, Assen HE. Factors Associated with Delay in Breast Cancer Presentation at the Only Oncology Center in North East Ethiopia: A Cross-Sectional Study. J Multidiscip Healthc. 2021;14:681-694.
11. Richards MA, Smith P, Ramirez AJ, Fentiman IS, Rubens RD. The influence on survival of delay in the presentation and treatment of symptomatic breast cancer. Br J Cancer. 1999;79(5-6):858-64.
12. Hutajulu SH, Prabandari YS, Bintoro BS, Wiranata JA, Widiastuti M, Suryani ND, et al. Delays in the presentation and diagnosis of women with breast cancer in Yogyakarta, Indonesia: A retrospective observational study. PLoS One. 2022;17(1):e0262468.
13. Polit DF, Beck CT. The content validity index: are you sure you know what's being reported? Critique and recommendations. Res Nurs Health. 2006;29(5):489-97.
14. Lynn MR. Determination and quantification of content validity. Nurs Res. 1986;35(6):382-5.
15. Faremi Y. Reliability Coefficient of Multiple-Choice and Short Answer Objective Test Items in Basic Technology: Comparative Approach. J Edu Pract. 2016;7(28):59.
16. Sharma S. Nursing Research and Statistics. 3nd ed. India: ELSEVIER, 2018.
17. Rai A, Sharda P, Aggarwal P, Ravi B. Study of
Diagnostic Delay among Symptomatic Breast Cancer Patients in Northern India: A Mixed-Methods Analysis from a Dedicated Breast Cancer Centre. Asian Pac J Cancer Prev. 2022;23(3):893-904.
18. Sharma K, Costas A, Shulman LN, Meara JG. A systematic review of barriers to breast cancer care in developing countries resulting in delayed patient presentation. J Oncol. 2012;2012:121873.
19. Barber MD, Jack W, Dixon JM. Diagnostic delay in breast cancer. Br J Surg. 2004;91(1):49-53.
20. Shreyamsa M, Singh D, Ramakant P, Anand A, Singh KR, Mouli S, et al. Barriers to Timely Diagnosis and Management of Breast Cancer: Observations from a Tertiary Referral Center in Resource Poor Setting. Indian J Surg Oncol. 2020;11(2):287-293.
21. Abo Al-Shiekh SS, Alajerami YS, Abushab KM, Najim AA, AlWaheidi S, Davies EA. Factors affecting delay in the presentation of breast cancer symptoms among women in Gaza, occupied Palestinian territory: a cross-sectional survey. BMJ Open. 2022;12(10):e061847.
22. Kumar A, Bhagabaty SM, Tripathy JP, Selvaraj K, Purkayastha J, Singh R. Delays in Diagnosis and Treatment of Breast Cancer and the Pathways of Care: A Mixed Methods Study from a Tertiary Cancer Centre in North East India. Asian Pac J Cancer Prev. 2019;20(12):3711-3721.
23. Shah P, Save M, Khadilkar R, Shah P, Kader H, Eswarawaka M. Locally advanced breast cancer: an observational study for the delay in presentation of patients. Int Surg J. 2020;7(6):1758.
24. Abdulkareem AA, Ghalib HA, Rashaan MI. Factors causing delayed presentations of breast cancer among female patients in Sulaimani Governorate, Kurdistan region, Iraq. BMC Womens Health. 2023;23(1):612.
25. Ali R, Mathew A, Rajan B. Effects of socio-economic and demographic factors in delayed reporting and late-stage presentation among patients with breast cancer in a major cancer hospital in South India. Asian Pac
J Cancer Prev. 2008;9(4):703-7.
26. J SS, Rohini AM, Thajudheen RB, Elavally S.
Determinants of Patient Delay among Women with Carcinoma Breast. Asian Pac J Cancer Prev. 2023;24(9):3109-3115.
27. Soh JY, Yahya MM, Bachok N, Wan Zain WZ, Wong MP, Zakaria Z, et al. Factors associated with delay in seeking care for breast symptoms. BMC Womens Health. 2022;22(1):316.
28. Zhang H, Wang G, Zhang J, Lu Y, Jiang X. Patient delay and associated factors among Chinese women with breast cancer: A cross-sectional study. Medicine (Baltimore). 2019;98(40):e17454.
29. Rajaram N, Jaganathan M, Muniandy K, Rajoo Y, Zainal H, Rahim N, et al. Barriers to help-seeking for Malaysian women with symptoms of breast cancer: a mixed-methods, two-step cluster analysis. BMC Health Serv Res. 2023;23(1):206.
30. Simon AE, Waller J, Robb K, Wardle J. Patient delay in presentation of possible cancer symptoms: the contribution of knowledge and attitudes in a population sample from the United Kingdom. Cancer Epidemiol Biomarkers Prev. 2010;19(9):2272-7.
31. Agarwal G, Ramakant P, Forgach ER, Rendón JC, Chaparro JM, Basurto CS, et al. Breast cancer care in developing countries. World J Surg. 2009;33(10):2069-76.
32. Schmid M, Wolf RC, Freudenmann RW, Schönfeldt-Lecuona C. Tomophobia, the phobic fear caused by an invasive medical procedure - an emerging anxiety disorder: a case report. J Med Case Rep. 2009;3:131.
33. Yadav RJ, Pandey A, Singh P. A study on acceptability of Indian system of medicine and homeopathy in India: results from the State of West Bengal. Indian J Public Health. 2007;51(1):47-9.
| Files | ||
| Issue | Vol 18, No 4 (December 2024) | |
| Section | Original Articles | |
| DOI | https://doi.org/10.18502/jfrh.v18i4.17422 | |
| Keywords | ||
| Breast Cancer Delayed Presentation Hospital | ||
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How to Cite
1.
Nehra K, T J, Bhardwaj G, Pasricha R. Factors Affecting Presentation Delay to the Hospital Among Breast Cancer Patients: A Retrospective Analysis. J Family Reprod Health. 2024;18(4):226-234.
