Barriers to Early Presentation of Symptomatic Breast Cancer in Local Population

A Qualitative Study

Authors

  • Maira Dastgir Nousherwani Shalamar Medical and Dental College
  • Hira Tariq Shalamar Medical and Dental College
  • Talat Waseem Shalamar Medical and Dental College

DOI:

https://doi.org/10.48111/2021.03.02

Keywords:

Breast cancer, Early Identification, Prognosis, Barriers

Abstract

BACKGROUND: Breast cancer is the most common type of cancer in women and the second most common after lung cancer in the world. Statistics consistent with GLOBOCAN 2012 state that 1.67 million cases of breast cancer were diagnosed in 2012 alone and resulted in 522,000 deaths that year making it the most frequent cause of cancer death in women in less developed regions. Pakistan itself has the highest prevalence of breast cancer amongst all countries in Asia where every one-in-nine women are likely to suffer from it at any point in their lives. In addition to the high disease burden, a major fraction of these cases is diagnosed at advanced stages. This advanced stage diagnosis results in more aggressive treatment, poorer outcomes, poorer quality of life and higher mortality rate. Public awareness of this disease may help in early detection of breast cancer, decreasing mortality rates and, ultimately, increasing probability of survival. Identification of these delaying factors is crucial for removal of barriers to early detection and treatment of breast cancer patients.

 

METHODS: This is a qualitative study based on interviews and includes breast cancer patients as study participants. 24 Subjects fulfilling the inclusion criteria were selected from Shalamar Hospital’s one stop Breast Clinic data by purposeful criterion I sampling and their consent was taken for an in-depth interview according to a preformed interview-guide, taking 20-30 mins each, which were then transcribed. Transcribed interviews were further managed using QSR NVivo (V. 9). Iterative analysis following tenets of grounded theory identified themes and their inter-relationships. Thematic analysis was undertaken, and final results explained in tables and percentages.

 

RESULTS: Twenty-four women were included in this study, four women had passed away due to severity of their disease, four women did not agree to become a part of our study and there were sixteen women who consented for it. All sixteen women were aged >40 years and were married. Several barriers to early presentation and diagnosis of Breast Cancer were reported and identified.

 

CONCLUSION: A significant percentage of women with breast cancer in Pakistan delay presentation primarily because of lack of awareness about the disease and its management. Along with the need to be examined by female doctors only, failure to understand breast cancer symptoms, ignoring them, and reliance on spiritual healers for cure were all identified as significant risk factors for delayed presentation. Coordinated efforts are, therefore, needed from public health departments regarding awareness about breast cancer and its therapeutic outcomes, to educate women and remove the barriers identified.

Keywords: Breast Cancer, Early Identification, Barriers, Prognosis

References

Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136(5):E359-E386. doi:10.1002/ijc.29210

Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65(2):87-108. doi:10.3322/caac.21262

Sasco AJ. Epidemiology of breast cancer: An environmental disease? APMIS. 2001;109(5):321-332. doi:10.1034/j.1600-0463.2001.090501.x

Sohail S AS. Breast cancer in pakistan - awareness and early detection - PubMed. J coll physicians surg pak.

Menhas R, Umer S. Breast cancer among Pakistani women. Iran J Public Health. 2015;44(4):586-587.

Daily Times - Latest Pakistan News, World, Business, Sports, Lifestyle.

Zaheer S, Shah N, Maqbool SA, Soomro NM. Estimates of past and future time trends in age-specific breast cancer incidence among women in Karachi, Pakistan: 2004-2025. BMC Public Health. 2019;19(1):1001. doi:10.1186/s12889-019-7330-z

Gilani GM, Kamal S, Akhter AS. A Differential Study of Breast Cancer Patients in Punjab, Pakistan.

Neal RD, Tharmanathan P, France B, et al. Is increased time to diagnosis and treatment in symptomatic cancer associated with poorer outcomes? Systematic review. Br J Cancer. 2015;112(Suppl 1):S92-S107. doi:10.1038/bjc.2015.48

Breast Cancer: Statistics | Cancer.Net.

Khan N, Ahmad R, Nadeem M, Hussain I. Influence of Education and Socio-Economic Factors on Stage of Cancer Diagnosis: A Study in Pakistani Population.

Malak AT, Dicle A. Assessing the efficacy of a peer education model in teaching breast self-examination to university students. Asian Pacific J Cancer Prev. 2007;8(4):481-484.

Jones CEL, Maben J, Lucas G, Davies EA, Jack RH, Ream E. Barriers to early diagnosis of symptomatic breast cancer: A qualitative study of Black African, Black Caribbean and White British women living in the UK. BMJ Open. 2015;5(3). doi:10.1136/bmjopen-2014-006944

Orsini M, Tretarre B, Daurès JP, Bessaoud F. Individual socioeconomic status and breast cancer diagnostic stages: A French case-control study. Eur J Public Health. 2016;26(3):445-450. doi:10.1093/eurpub/ckv233

Khan MA, Shafique S, Khan MT, Shahzad MF, Iqbal S. Presentation delay in breast cancer patients, identifying the barriers in North Pakistan. Asian Pacific J Cancer Prev. 2015;16(1):377-380. doi:10.7314/APJCP.2015.16.1.377

Unger-Saldaña K. Challenges to the early diagnosis and treatment of breast cancer in developing countries. World J Clin Oncol. 2014;5(3):465-477. doi:10.5306/wjco.v5.i3.465

Cancer Statistics Review, 1975-2012 - Previous Version - SEER Cancer Statistics Review.

Jones S, Gregory CGP, Nehill C, et al. Australian women’s awareness of breast cancer symptoms and responses to potential symptoms. Cancer Causes Control. 2010;21:945-958. doi:10.1007/s10552-010-9522-9

Getachew S, Tesfaw A, Kaba M, et al. Perceived barriers to early diagnosis of breast Cancer in south and southwestern Ethiopia: a qualitative study. BMC Womens Health. 2020;20(1). doi:10.1186/s12905-020-00909-7

Crow M.K, Soo E HF. Metastatic breast cancer. Med Oncol a Compr Rev. 1995;(2nd Edition. Pazdur R (ed)):311.

Rehman H, Moazzam A, Ansari N. Role of Microfinance Institutions in Women Empowerment: A Case Study of Akhuwat, Pakistan. South Asian Stud. 2015;30(1):107.

Maree JE, Wright SCD. How would early detection be possible? An enquiry into cancer related knowledge, understanding and health seeking behaviour of urban black women in Tshwane, South Africa. Eur J Oncol Nurs. 2010;14(3):190-196. doi:10.1016/j.ejon.2009.10.009

Khan MA. treatment navigation pathway and barriers to treatment for cancer patients in khyber pakhtunkhwa, pakistan. vol 25.; 2017.

Arroyo JMG, López MLD. Psychological Problems Derived from Mastectomy: A Qualitative Study. Int J Surg Oncol. 2011;2011:1-8. doi:10.1155/2011/132461

Martei YM, Vanderpuye V, Jones BA. Fear of Mastectomy Associated with Delayed Breast Cancer Presentation Among Ghanaian Women. Oncologist. 2018;23(12):1446-1452. doi:10.1634/theoncologist.2017-0409

Cooke M, Ronalds C. Women doctors in urban general practice: The patients. Br Med J (Clin Res Ed). 1985;290(6470):753-755. doi:10.1136/bmj.290.6470.753

Mitchell J, Lannin DR, Mathews HF, Swanson MS. Religious Beliefs and Breast Cancer Screening. J Women’s Heal. 2002;11(10):907-915. doi:10.1089/154099902762203740

Padela AI, Gunter K, Killawi A, Heisler M. Religious values and healthcare accommodations: Voices from the american muslim community. J Gen Intern Med. 2012;27(6):708-715. doi:10.1007/s11606-011-1965-5

Kishore Jugal, Ahmad Irfan, Ravneet Kaur MP. Beliefs and Perceptions about Cancers among Patients Attending Radiotherapy OPD in Delhi, India. Asian Pacific J Cancer Prev. 2008;9(1):155-158.

Zaid H, Silbermann M, Ben-Arye E, Saad B. Greco-Arab and Islamic herbal-derived anticancer modalities: From tradition to molecular mechanisms. Evidence-based Complement Altern Med. 2012;2012. doi:10.1155/2012/349040

Austoker J. Breast self examination. Br Med J. 2003;326(7379):1-2. doi:10.1136/bmj.326.7379.1

Taha H, Al-Qutob R, Nyström L, Wahlström R, Berggren V. “ Voices of Fear and Safety” Women’s ambivalence towards breast cancer and breast health: A qualitative study from Jordan. BMC Womens Health. 2012;12(1):21. doi:10.1186/1472-6874-12-21

Smith RA, Caleffi M, Albert US, et al. Breast cancer in limited-resource countries: Early detection and access to care. Breast J. 2006;12(SUPPL. 1):S16-S26. doi:10.1111/j.1075-122X.2006.00200.x

Krieger N, Chen JT, Kosheleva A, Waterman PD. Shrinking, widening, reversing, and stagnating trends in US socioeconomic inequities in cancer mortality for the total, black, and white populations: 1960-2006. Cancer Causes Control. 2012;23(2):297-319. doi:10.1007/s10552-011-9879-4

Akhigbe AO, Omuemu VO. Knowledge, attitudes and practice of breast cancer screening among female health workers in a Nigerian urban city. BMC Cancer. 2009;9. doi:10.1186/1471-2407-9-203

Birnbaum JK, Duggan C, Anderson BO, Etzioni R. Early detection and treatment strategies for breast cancer in low-income and upper middle-income countries: a modelling study. Lancet Glob Heal. 2018;6(8):e885-e893. doi:10.1016/S2214-109X(18)30257-2

Rodriguez-Rincon D, Leach B, d’Angelo C, Harshfield A, Manville C. Factors Affecting Access to Treatment of Early Breast Cancer: Case Studies from Brazil, Canada, Italy, Spain and UK: Implications for Future Research, Policy and Practice. RAND Corporation; 2019. doi:10.7249/rr3010.4

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Published

2021-09-29

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Section

Original Research Communication

How to Cite

Barriers to Early Presentation of Symptomatic Breast Cancer in Local Population: A Qualitative Study. (2021). Archives of Surgical Research, 2(3), 4-15. https://doi.org/10.48111/2021.03.02