title: Use of CAM results in delay in seeking medical advice for breast cancer.
abstract: Cancer patients in developing countries often delay seeking medical advice. It can adversely influence the clinicopathological behavior and out-come of the disease process. This study was undertaken to obtain information about initial perceptions of patients presenting with breast lump, subsequent efforts to seek medical advice, frequency and reasons for delay in seeking medical advice and its possible impact on clinicopathological characteristics. We prospectively gathered data from 138 recently diagnosed (< or = 3 months) breast cancer patients who had initially presented with a breast lump and were referred to the medical oncology service for further treatment. Delay in seeking medical advice was defined as time period of > or = 1 month between initial perception of lump and first physician visit. The study was conducted at the National Cancer Institute, Karachi, Pakistan. Most (85%) patients discovered the lump accidentally. In other cases, lump was discovered by the family physician or by the patient as part of regular self-examination. Etiologic perceptions included malignancy (17%), benign growth (26%), milk clot (19%), trauma (23%) and infection (10%). On average, patients took 8.7 weeks to inform the family and 17.2 weeks to first physician visit. Fifty three percent delayed seeking medical advice. Common reasons were; antecedent use of complimentary/alternative therapies (34%), lack of significance attached to the lump (23%), fear of surgery (22%), conflicting personal commitments (7%), fear of cancer (5%), and others (8%). Twenty nine percent practiced CAM before visiting any physician. Common methods used were homeopathy (70%), spiritual therapy (15%) and Ayurvedic medicine (13%). CAM use was associated with delay in seeking medical advice (OR: 5.6; 95% CI: 2.3, 13.3) and presentation at an advanced stage of disease (OR: 2.2; 95% CI: 1.01, 4.6). Patients who delayed seeking medical advice more often had positive axillary nodes and stage III/IV disease. Breast cancer patients in Pakistan frequently (53%) delay seeking medical advice. Antecedent practice of CAM is widespread and a common underlying reason. The delay results in significant worsening of the disease process.
authors.affiliation: National Cancer Institute, Karachi, Pakistan. imalik@ahs.llumc.edu
authors.forename: Imtiaz A
authors.initials: IA
authors.lastname: Malik
authors.forename: Sethuraman
authors.initials: S
authors.lastname: Gopalan
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000523:psychology* / Q000628:therapy; D000529:Complementary Therapies / Q000706:statistics & numerical data*; D003906:Developing Countries; D005260:Female; D006801:Humans; D008875:Middle Aged; D010154:Pakistan; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D010817:Physician-Patient Relations; D011795:Surveys and Questionnaires; D013997:Time Factors