Causes of breats cancer diagnosis and treatment delay in southwestern anatolia region

ABSTRACT Aim: The aim of this study is to investigate the factors that are effective on the patient-induced and health system-induced delays in the treatment of breast cancer cases in our region. Materials and Methods: The study included 100 patients with breast cancer who were admitted to Dicle University Medical School General Surgery Clinic between December 2012 and July 2014. The target population consisted of women over 18 years of age who were either diagnosed with, treated, or being treated due to breast cancer within 6 months before the survey. The patients were given a questionnaire after signing the informed consent. The questionnaire comprised 4 sections and 25 items (patient-induced and health system- induced factors, demographic profile, and evaluation of cancer stage). Results: Thirteen percent of the patients were diagnosed during periodical examination, one patient at mammographic check, and the remaining patients were diagnosed via breast symptoms. The symptoms at admission were breast mass (57%) and breast pain (24%). Eighty-four percent of the patients presented to general surgery clinics and 3% applied to family doctors. Family history of breast cancer was present in 14% of the patients. In 82% of the patients, mammography scan was performed in the first week. Breast biopsy was performed in the first week in 78% of the patients and the biopsy analyses were obtained in 2-4 weeks in 87% of the patients. Treatment was started in 4-6 weeks in 94% of the patients. Fifty-nine percent of the patients were under 50 years of age. Seventy-two percent of the patients were uneducated and 82% of the patients were unemployed/housewives. Sixty-three percent of the patients claimed that they had not received any invitation for a mammography scan and the other patients stated that they had no information as to whether they had ever been invited. Sixty-five percent of the patients did not know the size of the diameter of their breast mass, 73% of them did not know whether their lymph nodes were affected, and 58% of them did not know whether the cancer had affected other parts of their body. The clinical profiles of the patients at hospital admission were as follows: 72% had not received any treatment, 15% had a history of breast surgery, 11% had received chemotherapy, 1% had received treatment but did not recall the name of the treatment procedure, and 1% rejected to provide an answer. The treatment procedures included sentinel lymph node biopsy with breast protective surgery (30%), sentinel lymph node biopsy with mastectomy (5%), axillary dissection with breast protective surgery (7%), and modified radical mastectomy (23%). A large proportion of our patients did not know the stage of their breast cancer. Conclusion: Delayed diagnosis of breast cancer leads to important changes in the post-diagnostic period. The delays in the diagnosis and treatment of breast cancer can result from the patient's age, level of education, emotional state, and the national health system. We conclude that the total delay time can be minimized by raising awareness of breast cancer among women and health care professionals and by a number of effective measures to be taken particularly by the first-step health centers in our region to raise awareness about the fact that the patients who present to the polyclinics do not worry about their complaints and they are not aware of and do not care about their lesions, and also to invite women over 40 years of age to mammography scanning. In addition, diagnostic assessment programs for breast cancer should be performed both in our region and our country.