Why are You Late? A Descriptive Study of Delay in Treatment Seeking among Patients of Carcinoma Breast Presenting to a Tertiary Care Hospital in South India

Abstract

Objectives: The objectives of this study were as follows: Primary: To estimate the proportion of breast cancer patients with delay in presentation. Secondary: To assess the reasons for delay in presentation among patients with breast cancer. To identify the sociodemographic and clinical characteristics associated with delayed presentation among patients with breast cancer. Materials and Methods: We conducted a hospital-based descriptive study at a tertiary care hospital- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), from a period of January 2016 to June 2016. The participants were interviewed at the time of their hospital visit with a standardised questionnaire after obtaining informed consent. The patients were asked to recall the time interval between the first recognition of symptoms and the first medical consultation. A duration of >3 months was considered a patient delay. The patient reported the first symptom, and the symptoms at presentation were noted. Through clinical examination of the breasts, axilla and other systems was performed, and the positive clinical features were recorded. Results: A total of 126 women were included in the study. Out of 126 patients, 37 patients (29.4%) presented to healthcare personnel within 3 months of identifying their symptoms, and 89 patients (70.6%) presented later than 3 months. The mean duration of delay is 171.5 days, with a standard deviation of 229.45 and a median delay being 120 days. The most common cause for delay was due to the patient’s perception that the lump was harmless or temporary. The average time taken by the patients to present to JIPMER for definitive management of breast cancer after visiting a local physician was a median of 25 days and a mean of 48.77 days. The time taken for confirmation of diagnosis from the time of presentation to JIPMER was a median duration of 13 days and a mean duration of 16.58 days with a standard deviation of 12.31. About 90% of the patients had their diagnosis confirmed within 1 month. Conclusion: In our study, the proportion of delayed presentation among breast cancer patients was found to be 70.6%. Patients from rural areas and with lower educational status were found to have a higher incidence of delayed presentation. Lack of awareness of breast cancer symptoms and their misinterpretation as harmless, temporary and benign are the main reasons for delayed presentation. Patients who practised breast self-examination presented earlier. Further studies with a larger sample will help in identifying the other sociodemographic and clinical characteristics responsible for delayed presentation.