title: Presentation delay in breast cancer patients and its association with sociodemographic factors in North Pakistan.
abstract: BACKGROUND
  There is strong evidence that delayed diagnosis of breast cancer is associated with poor survival. The 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 settings.
  
  
  METHODS
  We interviewed 315 histologically confirmed breast cancer patients. Delay was defined as more than 3 months from appearance of symptoms to the consultation from 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
  A total of 39.01% (n=123) of patients presented late and out of those, 40.7% wasted time using alternative medicines; 25.2% were 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 [odds ratios (OR) of 2.26, 2.29 and 95% confidence intervals (CI) was 1.25-4.10, 1.06-4.94 respectively].
  
  
  CONCLUSIONS
  Significant percentage of women with breast cancer in North Pakistan is experiencing presentation delay due to their misconceptions about the disease. Coordinated efforts with public health department are needed to educate the focused groups and mitigating the barriers identified in the study. Long term impact will be reduced overall burden of the disease in the region.
authors.affiliation: 1 Department of Nuclear Medicine, Nuclear Medicine, Oncology and Radiotherapy Institute, Islamabad, Pakistan ; 2 Department of Medicine, Ziauddin Medical University, Kemari Campus, Karachi, Pakistan ; 3 Armed Forces Institute of Cardiology, Rawalpindi, Pakistan ; 4 Department of Physiology, Rawal Institute of Health Sciences, Islamabad, Pakistan ; 5 Nuffield Brentwood Hospital, Brentwood, Essex, UK.
authors.forename: Muhammad Aleem
authors.initials: MA
authors.lastname: Khan
authors.affiliation: 1 Department of Nuclear Medicine, Nuclear Medicine, Oncology and Radiotherapy Institute, Islamabad, Pakistan ; 2 Department of Medicine, Ziauddin Medical University, Kemari Campus, Karachi, Pakistan ; 3 Armed Forces Institute of Cardiology, Rawalpindi, Pakistan ; 4 Department of Physiology, Rawal Institute of Health Sciences, Islamabad, Pakistan ; 5 Nuffield Brentwood Hospital, Brentwood, Essex, UK.
authors.forename: Sheharyar
authors.initials: S
authors.lastname: Hanif
authors.affiliation: 1 Department of Nuclear Medicine, Nuclear Medicine, Oncology and Radiotherapy Institute, Islamabad, Pakistan ; 2 Department of Medicine, Ziauddin Medical University, Kemari Campus, Karachi, Pakistan ; 3 Armed Forces Institute of Cardiology, Rawalpindi, Pakistan ; 4 Department of Physiology, Rawal Institute of Health Sciences, Islamabad, Pakistan ; 5 Nuffield Brentwood Hospital, Brentwood, Essex, UK.
authors.forename: Sundas
authors.initials: S
authors.lastname: Iqbal
authors.affiliation: 1 Department of Nuclear Medicine, Nuclear Medicine, Oncology and Radiotherapy Institute, Islamabad, Pakistan ; 2 Department of Medicine, Ziauddin Medical University, Kemari Campus, Karachi, Pakistan ; 3 Armed Forces Institute of Cardiology, Rawalpindi, Pakistan ; 4 Department of Physiology, Rawal Institute of Health Sciences, Islamabad, Pakistan ; 5 Nuffield Brentwood Hospital, Brentwood, Essex, UK.
authors.forename: Muhammad Faheem
authors.initials: MF
authors.lastname: Shahzad
authors.affiliation: 1 Department of Nuclear Medicine, Nuclear Medicine, Oncology and Radiotherapy Institute, Islamabad, Pakistan ; 2 Department of Medicine, Ziauddin Medical University, Kemari Campus, Karachi, Pakistan ; 3 Armed Forces Institute of Cardiology, Rawalpindi, Pakistan ; 4 Department of Physiology, Rawal Institute of Health Sciences, Islamabad, Pakistan ; 5 Nuffield Brentwood Hospital, Brentwood, Essex, UK.
authors.forename: Sehrish
authors.initials: S
authors.lastname: Shafique
authors.affiliation: 1 Department of Nuclear Medicine, Nuclear Medicine, Oncology and Radiotherapy Institute, Islamabad, Pakistan ; 2 Department of Medicine, Ziauddin Medical University, Kemari Campus, Karachi, Pakistan ; 3 Armed Forces Institute of Cardiology, Rawalpindi, Pakistan ; 4 Department of Physiology, Rawal Institute of Health Sciences, Islamabad, Pakistan ; 5 Nuffield Brentwood Hospital, Brentwood, Essex, UK.
authors.forename: Muhammad Taha
authors.initials: MT
authors.lastname: Khan
keywords: Breast cancer; delayed diagnosis; survival