Factors Influencing Delayed Presentation of Breast Cancer: A Systematic Literature Review.

Abstract

INTRODUCTION: Breast cancer is the most common cancer in women worldwide. It is amongst the leading cause of cancer-related death in women. Its incidence is higher in developed countries owing to early detection and diagnosis through screening. However, an alarming rise in its incidence and mortality rates are seen in developing countries. Early detection and treatment initiation is crucial for its management. Delayed presentation of the patients is seen to be associated with advanced-stage diagnosis, more aggressive treatment, poorer outcomes, poorer quality of life, and higher mortality rate. Delay in effective oncological treatment could be due to patient presentation delay or provider delay. Identification of these delaying factors is crucial for the removal of the barriers to early detection and treatment of breast cancer patients.

OBJECTIVE: The objective of this literature review is to identify the factors that delay the presentation of breast cancer patients in developed and developing countries.

METHODS: This systematic literature review is written according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. A comprehensive literature search of PubMed/MEDLINE and ERIC was performed using search terms “delayed presentation” OR “late presentation” AND “breast cancer” OR “breast carcinoma”. 143 papers were identified through a literature search. Following the removal of 4 duplicates, titles and abstracts of 139 papers were reviewed. After thorough analysis, 12 papers were included in this literature review.

RESULTS: Factors that are seen to delay presentation are overlapping and can be broadly characterized as personal, socio-cultural, and economic. The role of these factors in delaying presentation is seen to vary in developed and developing countries. Hence, the role of these barriers cannot be extrapolated from one region to another as different studies have demonstrated contradicting results. Cancer control programs in developed countries have significantly reduced the influence of sociocultural barriers in delaying patient presentation. However, economic factors play a crucial role in the delay. While in developing countries fear-related barriers, lack of awareness, and poverty are the most prevalent factors.

CONCLUSION: The incidence of breast cancer is rising worldwide. Early presentation in breast cancer is crucial for its management. Several personal, socio-cultural, and economic factors influence the presentation of patients. The role and distribution of these barriers are diverse. Social, cultural, and economic differences make it difficult to extrapolate the influence of these barriers from one region to another.