Patient Delay in Accessing Breast Cancer Care in a Sub Saharan African Country: Uganda.

Abstract

AIMS: To assess patient delay differences between early and late stage breast cancer among women in Uganda. STUDY DESIGN: A retrospective analytical study. PLACE AND DURATION OF THE STUDY: A study conducted at a tertiary teaching hospital. Selected patients' data available for the period between 2008 and 2011 were included in this study. METHODOLOGY: We included 201 women with histologically confirmed breast cancer. The variables analysed included age, residence, histological subtype, stage at presentation and time delays. Ethical approval was obtained. RESULTS: The mean age for the early and late presenters was 49 and 46 years respectively (p=0.065). Rural women were more likely to present late. Triple negative breast cancer (TNBC) and HER2+ were the majority cancer subtypes for the late presenters. On average women waited for 29 months before they presented for specialized cancer treatment (median 12 months; range 1-120 months). The duration of symptoms didn't differ between the two groups (p=0.295) and 75% of early stage presenters, reported at least 6 months after noticing symptoms. Only 9% of the TNBC patients presented under 3 months in comparison to 14 % for HER2+, 33% for Luminal B and 36% for luminal A. Overall 23% (39/168) presented with early stage disease. CONCLUSION: Delay in seeking appropriate breast cancer care in Uganda was excessive, a sign of a neglected disease. Tumor biology factors seem to play a role in late stage presentation. Research in factors that lead to prolonged delay in accessing care in a resource poor context are needed urgently.