Abstract PS4-09-19: Factors influencing time to treatment initiation for breast cancer in Ethiopia

Abstract AbstractBackground: Breast cancer is becoming a challenging health condition in Ethiopia with a high rate of morbidity and mortality. Timely care is crucial for improving breast cancer survival. However, women in Ethiopia continue to encounter multiple barriers at various stages of the care pathway from symptom recognition to treatment initiation. This study aimed to assess the factors influencing the interval from symptom detection to treatment initiation among breast cancer patients in Ethiopia. Methods: A cross-sectional study was conducted between July and September 2024 among 458 women with histologically confirmed breast cancer who initiated treatment at three tertiary hospitals in Ethiopia. Data were collected through structured interviews and medical record reviews. Five key intervals from symptom detection to treatment initiation were measured using the Model of Pathways to Treatment. Andersen’s Behavioural Model guided the categorization of explanatory variables into predisposing, enabling, need-related, and contextual factors. Accelerated Failure Time (AFT) models were used to identify predictors of delay, with model selection based on the best-fitting distribution (Weibull, lognormal, or log-logistic). Time ratios (TRs) with 95% confidence intervals (CIs) were reported, and a p-value of 0.05 was considered statistically significant. Result: The study identified multiple factors associated with delays in breast cancer care in Ethiopia. Rural residence (TR = 1.84; 95% CI: 1.20-2.80) and presentation with painless breast mass (TR = 1.94; 95% CI: 1.26-3.00) were linked to longer intervals between symptom detection and first contact with health care providers (HCP). Low breast cancer literacy and use of traditional healing prior to diagnosis were consistently associated with delays across all stages of care. Consulting three or more healthcare providers significantly prolonged both the interval from symptom detection to first healthcare provider contact (TR = 3.13; 95% CI: 1.96-4.98) and the interval from symptom detection to diagnosis (TR = 1.63; 95% CI: 1.02-2.62). Lack of cancer suspicion by the first HCP was linked to longer time from first contact with HCP to diagnosis (TR = 3.07; 95% CI: 2.15-4.39). Similarly, the absence of referral by the first healthcare provider was associated with prolonged intervals from symptom detection to diagnosis (TR = 1.47; 95% CI: 1.06-2.03) and from symptom detection to treatment (TR = 1.47; 95% CI: 1.11-1.95). Being unmarried (TR = 1.46; 95% CI: 1.14-1.87), low-income (TR = 1.48; 95% CI: 1.05-2.08) and using traditional healer after diagnosis (TR = 2.25; 95% CI: 1.33-3.80) were associated with longer diagnosis-to-treatment intervals, while women aged ≥60 years had shorter diagnosis-to-treatment intervals (TR = 0.62; 95% CI: 0.41-0.93). Conclusion: Delays in breast cancer care in Ethiopia are influenced by a combination of predisposing, enabling, need-related, and contextual factors. Key contributors include rural residence, low breast cancer literacy, low household income, use of traditional healing before and after diagnosis, and limited HCP provider capacity for early detection and referral. To improve timely access to breast cancer care, interventions should focus on enhancing community awareness, integrating traditional healers into formal referral pathways, strengthening primary care and referral systems, building the capacity of frontline health workers, and addressing key financial and geographic barriers. Citation Format: A. A. Kibret, H. Jiang, E. Woldetsadik, M. Tafese, B. Deressa, G. Liu. Factors influencing time to treatment initiation for breast cancer in Ethiopia abstract. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS4-09-19.