Barriers to Early Presentation of Symptomatic Breast Cancer in Local Population

A Qualitative Study

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