Time intervals experienced between first symptom recognition and pathologic diagnosis of breast cancer in Addis Ababa, Ethiopia: a cross-sectional study.
OBJECTIVES
This study aimed to estimate the magnitude of patient and diagnostic delays and associated factors among women with breast cancer in Addis Ababa.


DESIGN
This is a cross-sectional study.


SETTINGS AND PARTICIPANTS
All women newly diagnosed with breast cancer in seven major healthcare facilities in Addis Ababa (n=441) were included in the study.


MAIN OUTCOMES AND MEASURES
Patient interval (time from recognition of first symptom to medical consultation) and diagnostic interval (time from first consultation to diagnosis). Patient intervals >90 days and diagnostic intervals >30 days were considered delays, and associated factors were determined using multivariable Poisson regressions with robust variance.


RESULTS
Thirty-six percent (95% CI [31.1%, 40.3%]) of the patients had patient intervals of >90 days, and 69% (95% CI [64.6%, 73.3%]) of the patients had diagnostic intervals of >30 days. Diagnostic interval exceeded 1 year for 18% of patients. Ninety-five percent of the patients detected the first symptoms of breast cancer by themselves, with breast lump (78.0%) as the most common first symptom. Only 8.0% were concerned about cancer initially, with most attributing their symptoms to other factors. In the multivariable analysis, using traditional medicine before consultation was significantly associated with increased prevalence of patient delay (adjusted prevalence ratio (PR) = 2.13, 95% CI [1.68, 2.71]). First consultation at health centres (adjusted PR = 1.19, 95% CI [1.02, 1.39]) and visiting ≥4 facilities (adjusted PR = 1.24, 95% CI [1.10, 1.40]) were associated with higher prevalence of diagnostic delay. However, progression of symptoms before consultation (adjusted PR = 0.73, 95% CI [0.60, 0.90]) was associated with decreased prevalence of diagnostic delay.


CONCLUSIONS
Patients with breast cancer in Addis Ababa have prolonged patient and diagnostic intervals. These underscore the need for public health programme to increase knowledge about breast cancer symptoms and the importance of early presentation and early diagnosis among the general public and healthcare providers.
['Gebremariam|Alem|A|0000-0003-2173-6685', 'Addissie|Adamu|A|', 'Worku|Alemayehu|A|', 'Assefa|Mathewos|M|', 'Pace|Lydia E|LE|', 'Kantelhardt|Eva Johanna|EJ|0000-0001-7935-719X', 'Jemal|Ahmedin|A|']
D000328:Adult D000367:Age Factors D000368:Aged D001940:Breast D001943:Breast Neoplasms D003430:Cross-Sectional Studies D057210:Delayed Diagnosis D004522:Educational Status D005002:Ethiopia D005260:Female D006801:Humans D008875:Middle Aged D016012:Poisson Distribution D012307:Risk Factors D011795:Surveys and Questionnaires D013997:Time Factors
time intervals symptom recognition patient interval diagnostic interval breast neoplasms