Prevalence of Themes Linked to Delayed Presentation of Breast Cancer in Africa: A Meta-Analysis of Patient-Reported Studies

Abstract

Purpose: The prevalence of themes linked to delay in presentation of breast cancer (BC) and their underlying factors vary considerably throughout Africa. Regional differences and trends are largely unreported. The purpose of this research was to provide summary estimates of the prevalence and distribution of the themes and underlying factors linked to delay in the presentation of BC, regional variation, and trends in an effort to identify targets for intervention.

Design: We screened articles found through PubMed/Medline, African Journal OnLine, Science Direct, Google/Google Scholar, and ResearchGate. We included patient-reported surveys on the reasons linked to delayed presentation under 6 previously identified themes: symptom misinterpretation, fear, preference for alternative care, social influence, hospital-related factors, and access factors. The meta-analytical procedure in MetaXL used the quality-effect model.

Results: Twelve of the 236 identified articles were eligible for this review. The overall summary estimate of late presentation (> 90 days) was 54% (95% CI, 23 to 85) and was worst in the eastern and central regions. Symptom misinterpretation was the most common theme (50%; 95% CI, 21 to 56), followed by fear (17%; 95% CI, 3 to 27), hospital-related theme (11%; 95% CI, 1 to 21), preference for alternative care (10%; 95% CI, 0 to 21), social influence (7%; 95% CI, 0 to 14), and access-related theme (6%; 95% CI, 0 to 13). The most common factor underlying symptom misinterpretation was mischaracterizing the breast lesion as benign (60%; 95% CI, 4 to 100) which surpassed lack of awareness in the last decade. Misdiagnosis and failure to refer were the dominant hospital-related factors.

Conclusion: Modifiable factors such as mischaracterizing malignant masses as benign, fear, misdiagnosis, and failure to refer were the prevalent factors contributing to delays throughout Africa. These factors are promising targets for intervention.

FIG 1

Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram showing article selection process. AJOL, African Journal OnLine.

FIG 2

(A) Trend of themes contributing to delay before and after 2010. (B) Trend of the factors underlying symptom misinterpretation before and after 2010 (see parent forest plot in the Data Supplement). Access, access-related issues; Alternative, prefers alternative therapy such as native, spiritual, or herbs; Fear, fear of cancer or fear of treatment; Hospital, hospital-related issues; Misinterpretation, symptom misinterpretation; Not aware, not aware of breast cancer; No pain, delay due to experiencing no pain; Social, delay due social influence; Think benign, mistaking breast cancer for benign lump; Think hormone, attributing breast changes to hormonal changes.