Patient- and system-related diagnostic delay in breast cancer

Background: Breast cancer patients in developing countries usuallyseek treatment at a more advanced-stage of disease. This workwas aimed at evaluating the avoidable risk factors related todiagnostic delay of breast cancer (patient- and system-related)in Alexandria, Egypt. Methods: Data were collected from 565incidents, histologically confirmed cases of breast cancer,recruited from nine hospitals in Alexandria, reflecting differentpatterns of health care delivery during the period July 1997–June1998. Results: Patient-related delay (interval between firstsymptom and first medical consultation > three months) wasfound in 38.1%, while system-related delay (interval betweenfirst medical consultation and final diagnosis > four weeks)was found in 12.9% of cases. A significant association betweendelay in seeking medical advice and late stage at diagnosiswas detected; in fact, while 26.3% of women with less than threemonths delay were at stage III and IV, the corresponding proportionamong women with more than three months delay was 72.1% (²1=109.6,p<0.0001). Regarding patient-related delay, age >40 years,lower educational level and not conducting breast self examinationwere independent risk factors associated with diagnostic delay.As for the system-related factors, place of first visit (generalpractitioner), absence of a palpable lump and lack of healthinsurance were significant predictors for delay. Conclusion:The patient's role in diagnostic delay of breast cancer is veryimportant in Egypt. Also, Interactive training directed to generalpractitioners to rationalise their approach to cases with breastlumps should be promoted to reduce system-related delay.