title: "Injustice! That is the cause": a qualitative study of the social, economic, and structural determinants of late diagnosis and treatment of breast cancer in Egypt.
abstract: BACKGROUND
  In developing countries, breast cancer is generally diagnosed late. Two companion quantitative studies found that health system shortages were a major cause of delayed diagnosis together with poor health literacy. Yet, patients' perceptions regarding the delays were missing.
  
  
  OBJECTIVE
  We conducted a qualitative study to deepen our understanding of women's experiences with diagnosis and treatment delays and highlight nuances not identifiable in the quantitative studies.
  
  
  METHODS
  Fifteen women recruited from the quantitative study were interviewed. Information on diagnosis/treatment delays collected in the quantitative study constituted the basis for the selection of participants, the aim being to ensure a maximum of variability in the types of delays.
  
  
  RESULTS
  In addition to women's health literacy challenges, which likely resulted from the interactions of individual, interpersonal, and systemic factors, barriers attributable to healthcare system weaknesses and financial constraints were revealed to be key factors.
  
  
  CONCLUSIONS
  To reduce late-stage diagnosis, tackling women's "lack of breast cancer awareness" is far from sufficient. Although the majority of health professionals are not in a position to address structural and policy barriers, it is nonetheless important for them to be cognizant of these barriers so that they can better advise and guide their patients.
  
  
  CONCLUSIONS
  Our study aimed to provide a deeper understanding of the social, cultural, and structural barriers patients face in Egypt. Such knowledge should help nurses and other health professionals develop a nonjudgmental, compassionate, and perceptive approach to care.
authors.affiliation: Author Affiliations: Breast Cancer Foundation of Egypt, Cairo, and Oxford Health NHS Foundation Trust, Oxford, United Kingdom (Ms McEwan); Department of Health, Behavior & Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland (Dr Underwood), and Center for Communication Programs, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, and Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium (Dr Corbex).
authors.forename: Joanne
authors.initials: J
authors.lastname: McEwan
authors.forename: Carol
authors.initials: C
authors.lastname: Underwood
authors.forename: Marilys
authors.initials: M
authors.lastname: Corbex
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D057210:Delayed Diagnosis; D004534:Egypt / Q000453:epidemiology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D054625:Healthcare Disparities; D006801:Humans; D008875:Middle Aged; D036301:Qualitative Research; D012959:Socioeconomic Factors; D061665:Time-to-Treatment; D016387:Women's Health