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Review
. 2018 Mar 21;18(1):312.
doi: 10.1186/s12885-018-4219-7.

From symptom discovery to treatment - women's pathways to breast cancer care: a cross-sectional study

Jennifer Moodley  1   2   3 , Lydia Cairncross  4 , Thurandrie Naiker  5 , Deborah Constant  6
Affiliations
Review

From symptom discovery to treatment - women's pathways to breast cancer care: a cross-sectional study

Jennifer Moodley et al. BMC Cancer. .

Abstract

Background: Typically, women in South Africa (SA) are diagnosed with breast cancer when they self-present with symptoms to health facilities. The aim of this study was to determine the pathway that women follow to breast cancer care and factors associated with this journey.

Methods: A cross-sectional study was conducted at a tertiary hospital in the Western Cape Province, SA, between May 2015 and May 2016. Newly diagnosed breast cancer patients were interviewed to determine their socio-demographic profile; knowledge of risk factors, signs and symptoms; appraisal of breast changes; clinical profile and; key time events in the journey to care. The Model of Pathways to Treatment Framework underpinned the analysis. The total time (TT) between a woman noticing the first breast change and the date of scheduled treatment was divided into 3 intervals: the patient interval (PI); the diagnostic interval (DI) and the pre-treatment interval (PTI). For the PI, DI and PTI a bivariate comparison of median time intervals by various characteristics was conducted using Wilcoxon rank-sum and Kruskal-Wallis tests. Cox Proportional-Hazards models were used to identify factors independently associated with the PI, DI and PTI.

Results: The median age of the 201 participants was 54 years, and 22% presented with late stage disease. The median TT was 110 days, with median patient, diagnostic and pre-treatment intervals of 23, 28 and 37 days respectively. Factors associated with the PI were: older age (Hazard ratio (HR) 0.59, 95% CI 0.40-0.86), initial symptom denial (HR 0.43, 95% CI 0.19-0.97) and waiting for a lump to increase in size before seeking care (HR 0.51, 95% CI 0.33-0.77). Women with co-morbidities had a significantly longer DI (HR 0.67, 95% CI 0.47-0.96) as did women who mentioned denial of initial breast symptoms (HR 4.61, 95% CI 1.80-11.78). The PTI was associated with late stage disease at presentation (HR 1.78, 95% CI 1.15-2.76).

Conclusion: The Model of Pathways to Treatment provides a useful framework to explore patient's journeys to care and identified opportunities for targeted interventions.

Keywords: Breast cancer; Breast cancer knowledge; Cancer symptoms; Delay in diagnosis; South Africa; Timely diagnosis.

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Conflict of interest statement

Competing interest

The authors declare that they have no competing interests.

Ethics approval and consent to participate

Ethical approval to conduct the study was obtained from the Human Research Ethics Committee, University of Cape Town (Reference number 313/2013). Written informed consent was obtained from all participants.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Unprompted and prompted knowledge of breast cancer risk factors
Fig. 2
Fig. 2
Unprompted and prompted knowledge of breast cancer signs
See this image and copyright information in PMC

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