title: Factors contributing to delays in diagnosis of breast cancers in Ghana, West Africa.
abstract: Late diagnoses and poor prognoses of breast cancer are common throughout Africa.
  
  
  
  To identify responsible factors, we utilized data from a population-based case-control study involving 1184 women with breast malignancies conducted in three hospitals in Accra and Kumasi, Ghana. Interviews focused on potential breast cancer risk factors as well as factors that might contribute to presentation delays. We calculated odds ratios (OR) and 95% confidence intervals (CI) comparing malignances with biopsy masses larger than 5 cm. (62.4% of the 1027 cases with measurable lesions) to smaller lesions.
  
  
  
  In multivariate analyses, strong predictors of larger masses were limited education (OR 1.96, 95% CI 1.32-2.90 <primary vs. ≥senior secondary school), being separated/divorced or widowed (1.75, 1.18-2.60 and 2.25, 1.43-3.55, respectively, vs. currently married), delay in care seeking after onset of symptoms (2.64, 1.77-3.95 for ≥12 vs. ≤2 months), care having initially been sought from someone other than a doctor/nurse (1.86, 0.85-4.09), and frequent use of herbal medications/treatment (1.51, 0.95-2.43 for ≥3x/day usage vs. none). Particularly high risks associated with these factors were found among less educated women; for example, women with less than junior secondary schooling who delayed seeking care for breast symptoms for 6 months or longer were at nearly 4-times the risk of more educated women who promptly sought assistance.
  
  
  
  Our findings suggest that additional communication, particularly among less educated women, could promote earlier breast cancer diagnoses. Involvement of individuals other than medical practitioners, including traditional healers, may be helpful in this process.
authors.affiliation: National Cancer Institute, 9609 Medical Center Drive, Room 7E-442, MSC 9776, Bethesda, MD, 20892-9776, USA. brintonl@mail.nih.gov.
authors.forename: Louise
authors.initials: L
authors.lastname: Brinton
authors.affiliation: National Cancer Institute, 9609 Medical Center Drive, Room 7E-442, MSC 9776, Bethesda, MD, 20892-9776, USA.|University of Edinburgh, Edinburgh, Scotland, UK.
authors.forename: Jonine
authors.initials: J
authors.lastname: Figueroa
authors.affiliation: Komfo Anoyke Teaching Hospital, Kumasi, Ghana.
authors.forename: Ernest
authors.initials: E
authors.lastname: Adjei
authors.affiliation: Komfo Anoyke Teaching Hospital, Kumasi, Ghana.
authors.forename: Daniel
authors.initials: D
authors.lastname: Ansong
authors.affiliation: University of Ghana, Accra, Ghana.
authors.forename: Richard
authors.initials: R
authors.lastname: Biritwum
authors.affiliation: Korle Bu Teaching Hospital, Accra, Ghana.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Edusei
authors.affiliation: University of Ghana, Accra, Ghana.
authors.forename: Kofi M
authors.initials: KM
authors.lastname: Nyarko
authors.affiliation: Peace and Love Hospital, Kumasi, Ghana.
authors.forename: Seth
authors.initials: S
authors.lastname: Wiafe
authors.affiliation: Korle Bu Teaching Hospital, Accra, Ghana.
authors.forename: Joel
authors.initials: J
authors.lastname: Yarney
authors.affiliation: Peace and Love Hospital, Kumasi, Ghana.
authors.forename: Beatrice Wiafe
authors.initials: BW
authors.lastname: Addai
authors.affiliation: Komfo Anoyke Teaching Hospital, Kumasi, Ghana.
authors.forename: Baffour
authors.initials: B
authors.lastname: Awuah
authors.affiliation: University of Ghana, Accra, Ghana.|Korle Bu Teaching Hospital, Accra, Ghana.
authors.forename: Joe Nat
authors.initials: JN
authors.lastname: Clegg-Lamptey
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D016022:Case-Control Studies; D057210:Delayed Diagnosis; D005260:Female; D005869:Ghana / Q000453:epidemiology; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D016017:Odds Ratio; D011159:Population Surveillance; D012307:Risk Factors; D061665:Time-to-Treatment; D047368:Tumor Burden; D055815:Young Adult
keywords: Africa; Breast cancer; Diagnosis delays; Epidemiology