title: Presentation delay in breast cancer patients, identifying the barriers in North Pakistan.
abstract: BACKGROUND
  There is strong evidence that delayed diagnosis of breast cancer is associated with poor survival. Our objectives were to determine the frequency of breast cancer patients with delayed presentation, the reasons of delay and its association with different socio-demographic variables in our North Pakistan setting.
  
  
  METHODS
  We interviewed 315 histologically confirmed breast cancer patients. Delay was defined as more than 3 months from appearance of symptoms to consultation with a doctor. Questions were asked from each patient which could reflect their understanding about the disease and which could be the likely reasons for their delayed presentation.
  
  
  RESULTS
  39.0 % (n=123) of patients presented late and out of those, 40.7% wasted time using alternative medicines; 25.2 % did not having enough resources; 17.1 % presented late due to painless lump; 10.6% felt shyness and 6.5% presented late due to other reasons. Higher age, negative family history, < 8 school years of education and low to middle socio-economic status were significantly associated with delayed presentation (p< 0.05). Education and socioeconomic status were two independent variables related to the delayed presentation after adjustment for others (OR of 2.26, 2.29 and 95%CI was 1.25-4.10, 1.06-4.94 respectively).
  
  
  CONCLUSIONS
  Significant numbers of women with breast cancer in North Pakistan experience presentation delay due to their misconceptions about the disease. Coordinated efforts with public health departments are needed to educate the focused groups and removing the barriers identified in the study. Long term impact will be reduced overall burden of the disease in the region.
authors: Department of Nuclear Medicine Nuclear Medicine, Oncology and Radiotherapy Institute, Islamabad, Pakistan E-mail : draleemkhan@yahoo.com.
authors: Muhammad Aleem
authors: MA
authors: Khan
authors: Sehrish
authors: S
authors: Shafique
authors: Muhammad Taha
authors: MT
authors: Khan
authors: Muhammad Faheem
authors: MF
authors: Shahzad
authors: Sundas
authors: S
authors: Iqbal
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000401:mortality; D000529:Complementary Therapies / Q000706:statistics & numerical data; D003625:Data Collection; D057210:Delayed Diagnosis / Q000523:psychology*; D004522:Educational Status; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D010154:Pakistan; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D012923:Social Class; D055990:Therapeutic Misconception / Q000523:psychology*; D013997:Time Factors