title: Delayed presentation of self-discovered breast cancer symptoms in Iranian women: a qualitative study.
abstract: BACKGROUND
  Delayed presentation of symptomatic breast cancer is a public health issue in Iran, making a major contribution to low survival. Despite the importance of this problem, current knowledge is insufficient to inform interventions to shorten patient delay. The aim of this study was to explore factors influencing patient delay in Iranian women with self-discovered breast cancer symptom.
  
  
  METHODS
  This qualitative study was conducted during 2012-2013. Purposeful sampling was used to recruit 20 Iranian women with self-discovered symptoms of breast cancer who attended the Cancer Institute of Tehran University of Medical Sciences, Tehran, Iran. Data were collected through semi-structured in-depth audiotaped interviews, which were transcribed and analyzed using conventional content analysis with MAXqda software version 10.
  
  
  RESULTS
  Content analysis of the data revealed four main themes related to the delay in seeking medical help including: 1) attributing symptoms to the benign conditions; 2) conditional health behavior; 3) inhibiting emotional expression; and 4) barriers to access to health care systems.
  
  
  CONCLUSIONS
  These results suggest that patient delay is influenced by complex and multiple factors. Effective intervention to reduce patient delay for breast cancer should be developed by focusing on improvement of women's medical knowledge, managing patients' emotional expression and reform of the referral system.
authors.affiliation: Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran E-mail : LatifnejadR@mums.ac.ir;rlatifnejad@yahoo.com.
authors.forename: Zohreh
authors.initials: Z
authors.lastname: Khakbazan
authors.forename: Ali
authors.initials: A
authors.lastname: Taghipour
authors.forename: Robab Latifnejad
authors.initials: RL
authors.lastname: Roudsari
authors.forename: Eesa
authors.initials: E
authors.lastname: Mohammadi
authors.forename: Ramesh
authors.initials: R
authors.lastname: Omranipour
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001294:Attitude to Health; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D016504:Breast Self-Examination / Q000523:psychology / Q000706:statistics & numerical data*; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D003906:Developing Countries; D004522:Educational Status; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007492:Iran; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D036301:Qualitative Research; D012017:Referral and Consultation / Q000706:statistics & numerical data; D018570:Risk Assessment; D012923:Social Class; D012959:Socioeconomic Factors; D061665:Time-to-Treatment / Q000706:statistics & numerical data*