Delays in presentation and treatment of breast cancer in Enugu, Nigeria

Abstract

Objective: To assess the delays and define the causes of delay in presentation and treatment of breast cancer patients in Enugu, Nigeria.

Design: A cross-sectional survey of breast cancer patients using a semi structured questionnaire.

Setting: Surgical Oncology unit, University of Nigeria Teaching Hospital Enugu, (UNTH-E), Nigeria.

Subjects: 164 consecutively presenting breast cancer patients seen between June 1999 and May 2005.

Results: Most of the patients (82.3%) reported for initial evaluation at a modern health facility while 17.5% reported first to alternative practitioners. Forty six patients (26.4%) presented within a month of noticing the symptoms while 72 (45.3%) delayed more than 3 months. In contrast, 18 (17%) were seen at the site of definitive treatment within one month of seeking help at the initial hospital while 73.4% had a delay of more than 3 months after the initial hospital contact. Institutional or physician induced delays were present in 46.2% of the cases while patient related delays were present in 79.2% of cases. Only use of alternative practitioners for initial treatment was significantly related to delays of more than three months before presentation (p = 0.017).

Conclusion: For breast cancer prevention programs in Nigeria to succeed, they must in addition to breast awareness and screening programs, address the institutional bottlenecks, the dearth of knowledge among primary care physicians and improve referrals from alternative practitioners and prayer houses.