Diagnosis Delay and Predicated Factors in Libyan Women with Breast Cancer

Abstract

Aims. To investigate the diagnosis-related delay time and its predicating factors as well as impacts of this delay on stages of disease. Methods. A total of 400 women, aged 19 to 80 years with breast cancer diagnosed during 2020-2021 were interviewed about the period from the first discovering of symptoms to final histology diagnosis of breast cancer. This timed (diagnosis related time) was divided into three arms: 1) less than 3 months, 2) 3-6 months, and 3) more than 6 months. If diagnosis related time took longer than three months, considered delayed. Patient related time was the calculated time from the date of the discovering of symptoms to the date of the first medical advice. If this time took longer than two months, considered delayed. Systemic related time, the calculated time from the date of first medical advice to the date of final histology diagnosis. Systemic related time considered delayed if took longer than 1 month, Retrospective preclinical and clinical data were collected on a form (questionnaire) during an interview with each patient and from patient's records. Results. The median of diagnosis related time was 6 months, 25 months as the maximum. 40.5% of patients were diagnosed within a period less than 3 months after symptoms and 10.3% of patients from 3 to 6 month, while 49.2% of patients within a period longer than 6 months. A several factors predicted patient-related delay time: Symptoms were not considered serious enough in 18% of patients. Alternative therapy was applied in 17.7% of the patients, while fear and shame prevented the visit to the doctor in 7.7% and 4.3% of patients, respectively. Patient-related delay time was also associated with old age (p<0.0001), with rural residence (p<0.0001), with illiteracy (p<0.0001), with comorbidity (p<0.0001), with women who had used oral contraceptive pills longer than 5 years (p<0.0001), with unawareness of breast cancer (p<0.0001), with women who did not report monthly self-examination (p<0.0001), with initial breast symptom(s) that did not include a lump (p<0.0001), and with past history of benign fibrocystic disease (p=0.049). Failure of medical practitioners to act on presenting findings with inappropriate reassurance that the lump was benign was an important reason for prolongation the systemic related time. At the time of diagnosis, the stage distribution was as follows: 13% stage I, 27.5% stage II, 47.2% stage III and 12.3% stage IV. Diagnosis-related delay time was associated to larger tumour size (p <0.0001), to positive lymph nodes (p< 0.0001), and to a higher rate of advanced stages (p<0.0001). Conclusion. The present study shows a significant relationship between late diagnosis and advanced stage of breast cancer. In Libya, late diagnosis of breast cancer is still a large serious health problem. It was related to a complex interaction between patient and systemic predicating factors, which resulting in a high risk of advanced stage of breast cancer with lower survival rate. Therefore, public awareness programs and training of general practitioners are highly recommended to reduce breast cancer mortality by promoting early detection.