Diagnosis delay in Libyan female breast cancer.
OBJECTIVE
To study the diagnosis delay and its impact on stage of disease among women with breast cancer on Libya.


METHODS
200 women, aged 22 to 75 years with breast cancer diagnosed during 2008-2009 were interviewed about the period from the first symptoms to the final histological diagnosis of breast cancer. This period (diagnosis time) was categorized into 3 periods: <3 months, 3-6 months, and >6 months. If diagnosis time was longer than 3 months, the diagnosis was considered delayed (diagnosis delay). Consultation time was the time taken to visit the general practitioner after the first symptoms. Retrospective preclinical and clinical data were collected on a form (questionnaire) during an interview with each patient and from medical records.


RESULTS
The median of diagnosis time was 7.5 months. Only 30.0% of patients were diagnosed within 3 months after symptoms. 14% of patients were diagnosed within 3-6 months and 56% within a period longer than 6 months. A number of factors predicted diagnosis delay: Symptoms were not considered serious in 27% of patients. Alternative therapy (therapy not associated with cancer) was applied in 13.0% of the patients. Fear and shame prevented the visit to the doctor in 10% and 4.5% of patients, respectively. Inappropriate reassurance that the lump was benign was an important reason for prolongation of the diagnosis time. Diagnosis delay was associated with initial breast symptom(s) that did not include a lump (p < 0.0001), with women who did not report monthly self examination (p < 0.0001), with old age (p = 0.004), with illiteracy (p = 0.009), with history of benign fibrocystic disease (p = 0.029) and with women who had used oral contraceptive pills longer than 5 years (p = 0.043). At the time of diagnosis, the clinical stage distribution was as follows: 9.0% stage I, 25.5% stage II, 54.0% stage III and 11.5% stage IV.Diagnosis delay was associated with bigger tumour size (p <0.0001), with positive lymph nodes (N2, N3; p < 0.0001), with high incidence of late clinical stages (p < 0.0001), and with metastatic disease (p < 0.0001).


CONCLUSIONS
Diagnosis delay is very serious problem in Libya. Diagnosis delay was associated with complex interactions between several factors and with advanced stages. There is a need for improving breast cancer awareness and training of general practitioners to reduce breast cancer mortality by promoting early detection. The treatment guidelines should pay more attention to the early phases of breast cancer. Especially, guidelines for good practices in managing detectable of tumors are necessary.
Department of Oncology, University of Turku, Turku, Finland. eelramah@yahoo.com
Eramah
E
Ermiah
Fathi
F
Abdalla
Abdelbaset
A
Buhmeida
Entesar
E
Larbesh
Seppo
S
Pyrhönen
Yrjö
Y
Collan
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000208:ethnology / Q000473:pathology / Q000523:psychology; D016009:Chi-Square Distribution; D002983:Clinical Competence; D003466:Cultural Characteristics; D057210:Delayed Diagnosis; D055088:Early Detection of Cancer; D005239:Fear; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology; D006801:Humans; D008002:Libya / Q000453:epidemiology; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D010342:Patient Acceptance of Health Care / Q000208:ethnology; D011237:Predictive Value of Tests; D011379:Prognosis; D012017:Referral and Consultation; D012189:Retrospective Studies; D012307:Risk Factors; D012752:Shame; D013997:Time Factors; D047368:Tumor Burden; D055815:Young Adult