Delays in presentation and treatment of breast cancer in Nigeria

1527 Background: Programs on breast cancer prevention inresource poor countries often emphasize cost effective interventions to increase the uptake of screening, breast awareness, and the use of breast self examination. The success of such programs depends on the response of women and health professionals to the presence of symptoms of breast cancer. Understanding the factors at play in these responses is a prerequisite for strategies to shorten delays and improve stage at diagnosis. This study was designed to assess the delays and define the causes of delays in getting medical treatment by patients with breast cancer at University of Nigeria Teaching Hospital Enugu, (UNTH-E), Nigeria. Methods: A cross-sectional survey of consecutively presenting patients with breast cancer at the Surgical Oncology unit of the UNTH-E, Nigeria, was carried out between June 1999 and May 2005. A structured questionnaire was used to explore delays and the factors that influence delays in presentation and treatment of breast cancer. Results: One hundred and sixty four patients with breast cancer were interviewed. Most of them were married (71.2%), literate (84.7%), low (58.8%) or middle socioeconomic class (40%), and had access to hospitals within their area of residence. Most (81.6%) reported first for treatment at a modern health facility while 17.5% used alternative practitioners first. Twenty-six percent (42) presented within a month of noticing the symptoms while 45.3% (72) delayed for 3 months or more. In contrast, 17% (18) were seen at the site of definitive treatment within 1 month of seeking help at the initial hospital while 73.4% had a delay of more than 3 months after the initial hospital contact. Institutional or physician related delays were present in 44.5% of the cases while patient-related delays were present in 76.7% of cases. Only use of alternative practitioners as the first treatment point was significantly related to delays of more than 3 months before presentation (p = 0.029). Conclusions: For breast cancer prevention programs in Nigeria to succeed, they must, in addition to breast awareness and screening programs, address the institutional bottlenecks, the dearth of knowledge among primary care physicians, and improved referrals from alternative practitioners. No significant financial relationships to disclose.