Faisal Bilal Lodhi, Bashir Ahmad, Syed Ijaz Hussain Shah, Muhammad Naeem, Riaz Hussain Dab, Nida Ali.
Determinants of delayed presentation in breast cancer.
Annals Punjab Med Coll Jan ;4(1):9-16.

Objective: To find out the factors which influence delayed presentation of breast cancer. Study design: A prospective study. Place and duration of study: The study was conducted in the department of surgery at Allied Hospital Faisalabad for a period of one year from 01- 11- 2008 to 30-11-2009. Patients and methods: With an informed consent, study was conducted on 75 patients of breast cancer who presented late in Allied Hospital Faisalabad for their treatment. Diagnosis of breast cancer in all the patients was established by tissue biopsy. Every patient was interviewed on a structured questionnaire to find out the determinants of delayed presentation from the date of first symptom recognition to the  start of treatment. Results: Extent of delayed presentation in our study ranged from 3 to 18 months with mean duration of 8 months. Patient delay showed a major influence on delayed presentation and its determinants were painless lump breast, negative family history of breast cancer, negative history of benign breast disease, increasing age above 40 years, lack of awareness about breast cancer, poor economic class, psychosocial and cultural beliefs, rural background,  number of siblings 4 or above, lack of female doctors and illiteracy. Pre-hospital system delay showed a minor attribution to delayed presentation and it was associated with delayed or non-referral to consultants, mal-treatment by health care providers other than breast surgeons, false negative/misinterpretation of mammograms and false negative results of fine needle aspiration cytology. Locally advanced breast cancer (LABC/Stage III) was found in 62.7% patients, while, 12% patients had metastatic breast cancer (MBC/Stage IV). Rest of the 25.33% patients had early breast cancer (EBC/stage I&II). Delay of more than 6 months was found in 48 (64%) patients and out of them 60% had advance stage, while only 4% patients were observed in stage II (EBC). Delay of 3 to 6 months was noted in 27 (36%) patients and among them 3 (4%), 13 (17.3%) and 11(14.7%) patients had stages I, II and III respectively. Conclusion: Delayed presentation of breast cancer is mainly attributed to patient delay rather than the system delay and longer delays in presentation adversely influence the stage of breast cancer.

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