title: Patient delay in women presenting with advanced breast cancer: an Iranian study.
abstract: BACKGROUND
  Due to the lack of systematic screening programmes for early detection of breast cancer in Iran and the predominance of advanced cases, we aimed to study the extent and determinants of patient delay in women with advanced breast cancer.
  
  
  METHODS
  In this 1-year cross-sectional study, all consecutive women with advanced breast cancer (stages IIb, III or IV) who initially presented to a university hospital were studied.
  
  
  RESULTS
  Sixty-eight percent (136/200) of cases had delayed their first visit by >1 month and 42.5% by >3 months. The median patient delay was 12 weeks. Delay was associated with: older age, being married, lower income, less education, place of residence (small cities), negative family history of breast cancer, belief in the fatality of breast cancer, lack of access to health care services, lack of knowledge of breast cancer symptoms, and denying the importance of breast self-examination. The main reasons given for the delay were: lack of knowledge regarding the necessity of such a visit, fear, negligence, lack of access to physicians, and poverty.
  
  
  CONCLUSIONS
  In contrast to some other studies, this study found that married women and those with a negative family history of breast cancer waited longer than others before seeking care. Public education initiatives focused on encouraging women (especially high-risk groups such as older women, married women, and those living in small cities or villages) to see a doctor promptly for evaluation of breast symptoms can decrease delay and improve patient outcome.
authors.affiliation: Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran. harirchi@sina.tums.ac.ir
authors.forename: I
authors.initials: I
authors.lastname: Harirchi
authors.forename: F
authors.initials: F
authors.lastname: Ghaemmaghami
authors.forename: M
authors.initials: M
authors.lastname: Karbakhsh
authors.forename: R
authors.initials: R
authors.lastname: Moghimi
authors.forename: H
authors.initials: H
authors.lastname: Mazaherie
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007492:Iran; D008875:Middle Aged; D009367:Neoplasm Staging; D010342:Patient Acceptance of Health Care