title: Understanding pathways to breast cancer diagnosis among women in the Western Cape Province, South Africa: a qualitative study.
abstract: OBJECTIVE
  The aim of this study was to explore and understand women's pathways to breast cancer diagnosis and factors influencing this journey.
  
  
  METHODS
  Indepth interviews were conducted with clients at a tertiary level breast cancer clinic in Cape Town, South Africa. A thematic analysis was performed underpinned by the theoretical concepts of the Model of Pathways to Treatment framework.
  
  
  METHODS
  20 women were interviewed within 1 week of being diagnosed with breast cancer.
  
  
  RESULTS
  The average time between discovery of bodily changes to breast cancer diagnosis was 8.5 months. Deficits in breast self-awareness and knowledge of breast cancer symptoms delayed women's interpretation of bodily changes as being abnormal. All women first noticed breast lumps; however, many did not perceive it as abnormal until additional symptoms were present. General good health, attribution of symptoms to ageing, and past benign breast disease resulted in women being complacent about bodily changes. Disclosure to family members served as a trigger to seek healthcare. The initial type of primary level care services women accessed was influenced by perceptions of care each service provided, finances, structural factors, and personal safety related to the physical location of services.
  
  
  CONCLUSIONS
  Symptom appraisal and interpretation contributed significantly to delayed presentation. To improve timely diagnosis of breast cancer, interventions that increase women's confidence in detecting breast changes, improve knowledge of breast cancer symptoms, address myths, and encourage prompt help-seeking behaviour are required.
authors.affiliation: Cancer Research Initiative, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa Women's Health Research Unit, Faculty of Health Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Moodley
authors.affiliation: Department of Surgery, University of Cape Town, Cape Town, South Africa.
authors.forename: Lydia
authors.initials: L
authors.lastname: Cairncross
authors.affiliation: Department of Radiation Oncology, University of Cape Town, Cape Town, South Africa.
authors.forename: Thurandrie
authors.initials: T
authors.lastname: Naiker
authors.affiliation: Women's Health Research Unit, Faculty of Health Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Mariette
authors.initials: M
authors.lastname: Momberg
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000523:psychology*; D057210:Delayed Diagnosis; D005190:Family / Q000523:psychology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D036301:Qualitative Research; D012944:Social Support; D013019:South Africa; D013997:Time Factors
keywords: PUBLIC HEALTH; QUALITATIVE RESEARCH