Patient- and system-related diagnostic delay in breast cancer. Evidence from Alexandria, Egypt

Background: Breast cancer patients in developing countries usually seek treatment at a more advanced-stage of disease. This work was aimed at evaluating the avoidable risk factors related to diagnostic delay of breast cancer (patient- and system-related) in Alexandria, Egypt. Methods: Data were collected from 565 incidents, histologically confirmed cases of breast cancer, recruited from nine hospitals in Alexandria, reflecting different patterns of health care delivery during the period July 1997–June 1998. Results: Patient-related delay (interval between first symptom and first medical consultation > three months) was found in 38.1%, while system-related delay (interval between first medical consultation and final diagnosis > four weeks) was found in 12.9% of cases. A significant association between delay in seeking medical advice and late stage at diagnosis was detected; in fact, while 26.3% of women with less than three months delay were at stage III and IV, the corresponding proportion among women with more than three months delay was 72.1% (χ21=109.6, p<0.0001). Regarding patient-related delay, age >40 years, lower educational level and not conducting breast self examination were independent risk factors associated with diagnostic delay. As for the system-related factors, place of first visit (general practitioner), absence of a palpable lump and lack of health insurance were significant predictors for delay. Conclusion: The patient's role in diagnostic delay of breast cancer is very important in Egypt. Also, Interactive training directed to general practitioners to rationalise their approach to cases with breast lumps should be promoted to reduce system-related delay.