Factors influencing diagnosis delay of advanced breast cancer in Moroccan women.
Delay in the diagnosis of breast cancer in symptomatic women of 3 months or more is associated with advanced stage and low survival. We conducted this study to learn more about the extent and reasons behind diagnosis delay of advanced breast cancer in Moroccan women.



A group of patients with advanced breast cancer were interviewed at the National Institute of Oncology in Rabat during the period from February to December 2014. Diagnosis delay was devised into patient delay and system delay. Patient delay was defined as time from first symptoms until first medical consultation. System delay was defined as time from first presentation to a health care provider until definite diagnosis or treatment. Prospective information and clinical data were collected on a form during an interview with each patient and from medical records.



In all, 137 patients were interviewed. The mean age of women was 48.3 ± 10.4 years. The median of consultation time was 6[4,12] months and the median of diagnosis time was 1[1,3] months. Diagnosis delay was associated to a personal reason in 96 (70.1 %) patients and to a medical reason in 19 (13.9 %) patients. A number of factors predicted diagnosis delay: symptoms were not considered serious in 66 (55.9 %) patients; traditional therapy was applied in 15 (12.7 %) patients and fear of cancer diagnosis and/or treatment in 14 (11.9 %) patients. A use of traditional methods was significantly associated with rural residence and far away from basic health center (p = 0.000). Paradoxically, a family history of breast cancer was significantly higher in who report a fear of cancer diagnosis and/or treatment to diagnosis delay (p < 0.001). Also, a significantly higher risk of more than 6 months delay was found among rural women (P = 0.035) and women who live far away from specialized care center (P = 0.001).



Diagnosis delay is very serious problem in Morocco. Diagnosis delay was associated with complex interactions between several factors and with advanced stages. There is a need for improving breast cancer information in our populations and training of general practitioners to reduce advanced breast cancer by promoting early detection.
Department of radiotherapy, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco. magabdelhak@gmail.com.
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Maghous
Department of radiotherapy, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco.
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Rais
Laboratory of epidemiology and clinical research, School of medicine and pharmacy of Rabat, Mohammed V University in Rabat, Rabat, Morocco.
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Ahid
Department of radiotherapy, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco.
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Benhmidou
Department of Medical Oncology, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco.
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Bellahamou
Department of radiotherapy, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco.
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Loughlimi
Department of radiotherapy, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco.
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Marnouche
Department of radiotherapy, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco.
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Elmajjaoui
Department of radiotherapy, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco.
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Elkacemi
Department of radiotherapy, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco.
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Kebdani
Department of radiotherapy, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco.
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Benjaafar
D000328:Adult; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000523:psychology; D057210:Delayed Diagnosis / Q000145:classification* / Q000523:psychology; D005260:Female; D006801:Humans; D008875:Middle Aged; D009018:Morocco; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D013997:Time Factors; D061665:Time-to-Treatment
Breast cancer; Diagnosis delay; Patient delay; System delay