title: The Haiti Breast Cancer Initiative: Initial Findings and Analysis of Barriers-to-Care Delaying Patient Presentation.
abstract: Background. In Haiti, breast cancer patients present at such advanced stages that even modern therapies offer modest survival benefit. Identifying the personal, sociocultural, and economic barriers-to-care delaying patient presentation is crucial to controlling disease. Methods. Patients presenting to the Hôpital Bon Sauveur in Cange were prospectively accrued. Delay was defined as 12 weeks or longer from initial sign/symptom discovery to presentation, as durations greater than this cutoff correlate with reduced survival. A matched case-control analysis with multivariate logistic regression was used to identify factors predicting delay. Results. Of N = 123 patients accrued, 90 (73%) reported symptom-presentation duration and formed the basis of this study: 52 patients presented within 12 weeks of symptoms, while 38 patients waited longer than 12 weeks. On logistic regression, lower education status (OR = 5.6, P = 0.03), failure to initially recognize mass as important (OR = 13.0, P < 0.01), and fear of treatment cost (OR = 8.3, P = 0.03) were shown to independently predict delayed patient presentation. Conclusion. To reduce stage at presentation, future interventions must educate patients on the recognition of initial breast cancer signs and symptoms and address cost concerns by providing care free of charge and/or advertising that existing care is already free.
authors.affiliation: Program in Global Surgery and Social Change, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA ; Department of Plastic and Oral Surgery, Children's Hospital Boston, 300 Longwood Avenue, Enders 1, Boston, MA 02115, USA ; Duke University School of Medicine, 201 Trent Drive, Durham, NC 27715, USA.
authors.forename: Ketan
authors.initials: K
authors.lastname: Sharma
authors.forename: Ainhoa
authors.initials: A
authors.lastname: Costas
authors.forename: Ruth
authors.initials: R
authors.lastname: Damuse
authors.forename: Jean
authors.initials: J
authors.lastname: Hamiltong-Pierre
authors.forename: Jordan
authors.initials: J
authors.lastname: Pyda
authors.forename: Cecilia T
authors.initials: CT
authors.lastname: Ong
authors.forename: Lawrence N
authors.initials: LN
authors.lastname: Shulman
authors.forename: John G
authors.initials: JG
authors.lastname: Meara