Factors associated with Delayed Diagnosis of women Breast Cancer

Introduction

 ‘Breast cancer’ is a malignant tumor that has developed from cells of the breast which affects mostly women , in 2020, approximately one new case diagnosed with breast cancer every 18 seconds; counting for 2.1 million women; whereas the estimated deaths were 626,679 (WHO, 2020)

Breast cancer is the most common type of cancer in Egyptian women and although incidence rates are not as high as in the west yet, breast cancer mortality is considerably worse (Fitzmaurice.,et al,2019). Breast cancer in Egypt constitutes 33% of female cancer cases and more than 22,000 new cases diagnosed each year (Ahmed.,et al,2020).

Delayed diagnosis of the breast cancer lead to advanced stage presentation and poor clinical outcomes and have low survival rates and has been classified in two types: (1) patient delay, the interval between the discovery of symptoms and the first medical consultation; and (2) system delay, the interval between first consultation and definite diagnosis or treatment. Prolonged delays are usually defined as intervals greater than 12 week ( McCutchan,et al,2015).

According to recent studies, factors related to patient delay include( not attributed the symptoms to cancer, patients’ distrust, fear of cancer, educational level, supports from family members and friends, financial constraints, …) . Factors associated with system delay include( factors associated with physician’s experience (i.e. medical negligence), mammography misinterpreted, non-specific medical treatment without control, a negative fine-needle aspiration biopsy, surgical excision without pathological examination, not oriented to specialized service, lack of information and appointment delay …)( Kantelhardt,et al.2015) .

Nurses play vital role in prevention of breast cancer by using their teaching and counseling skills to encourage participation in breast cancer prevention programs and informing patients about recommended screening tests for early detection of breast cancer (Salwa,et al,2015).

Significance of the Study

Delayed diagnosis of breast cancer is more responsible rather than the disease itself in causing high incidence and mortality rates,leaving a large low of survival (Fitzmaurice.,et al,2019). One of these studies is that conductedat Cairo University Hospital by (Gehan M.et al,2013) and found that the most common factors for  delayed diagnosis of breast cancer were lack of awareness about breast cancer and screening test and fear of cancer. In addition, this study is considered the first one in this geographical location to investigate causes and factors associated with Delayed Diagnosis of women Breast Cancer.

Aims of the Study

The aim of the study is to assess factors associated with delayed diagnosis of woman breast cancer.

Research question

1. What are factor associated with delayed diagnosis of woman breast cancer?
2. What are relation between socio-demographic characteristics and factors that delay diagnosis of woman breast cancer?

Subjects and Methods

Research Design:                                                                                                     

A descriptive exploratory research design is used in this study.

Subjects (Sample):

Purposive sample of 100 women admitted at Aswan oncology cancer institute with diagnosis of late stage of breast cancer.

This calculator utilizes the following formula for the sample size n:

n = N*X / (X + N – 1),

Where,

X = Z_α/2² ­*p*(1-p) / MOE²,

and Z_α/2 is “the critical value of the Normal distribution at α/2 (e.g. for a confidence level of 95%, α is 0.05 and the critical value is 1.96)”, MOE is the margin of error, p is the sample proportion, and N is the population size.  Note that “a Finite Population Correction has been applied to the sample size formula” (n=100).

Inclusion Criteria:

• All adult female aged between 18 - 65 years.
• Participants were recruited after a definite diagnosis for late stage breast cancer.

Exclusion Criteria:

• Women who were refused to participate in the study.
• Women who was diagnosed with early stage of breast cancer.

Setting:                                                                   

This study was conducted in the surgical inpatient ward and outpatient clinic, chemotherapy and radiation inpatient therapy wards at Aswan oncology cancer institute.

Study duration:

This study was conducted at Aswan oncology cancer institute during the period of four months from the beginning of February 2018 to end of Mai 2018.

Study Tools:

Two tools were being constructed and used for collecting data , These tools were formulated by the researcher after extensive review literature(Caplan L,2014 : Maghous,et al,2016: Gehan,et al,2013).

First tool: Bio Socio demographic questionnaire sheet include two parts:

• 1^st part: - socio-demographic data for patients: It consists of (6) item as age, marital status, level of education, occupation, income and residence.
• 2^nd part: - medical data includes family history of breast cancer, presented symptoms, classification of disease and delayed time of diagnosis.

The second tool: which include two parts: Part one: It has two components:

A) Women’s knowledge about the screening method of breast cancer and consists of (9) question (4 question about breast self-examination, 3 question about mammogram, 2 question about clinical breast examination).

Scoring system: The total score is 45 grad, score of (5) given for correct answer and score of (0) for incorrect answer.

B) Women’s knowledge about the risk factor of breast cancer and consist of (14) item such as their knowledge about (Therapeutic radiation to the chest, A previous benign tumor in the breast, oral contraceptive pills, Hormone replacement therapy ,…………..).

Scoring system: The total score is 75 grade, score of (5) given for correct answer and score of (0) for incorrect answer.

Part 2: It is include two component, factors related to patients delay of breast cancer and consists of (10) item and factor related to health system delay of breast cancer and consists of (8) item.

Tools Validity and reliability

The tools were tested for content validity by assent of five experts from the faculty of nursing (a jury of five expert's opinion).Tools reliability was done to identify the extent of tools items were measurable with the study concept and its correlation with each other. The reliability of self-care compliance scale was Cronbach's ⍺= .79, the content validity coefficient (CVI) of all the items was 0.9.

Pilot study:

A pilot study was conducted on 10% (10) of patients to examine the feasibility of the study.

Ethical consideration

The study was approved by the Research Ethics Committee of the Faculty of Nursing, Minia University. An oral permission was be obtained from patients, the nature and purpose of the study was be explained, patients had right to withdraw from the study at any point .They also informed that the information obtained would be confidential and would be used only for the purpose of the study and their names would be coded for data entry so that their names could not be identified.

Study Procedure

All participants were recruited after definite diagnosed with late- stage breast cancer at Aswan Oncology Institute, collecting data was done through three days per week from 10 am to 1 pm, interviews the sample was taken 45 to 50 minutes to each. The researcher read and explained every item to females and was used an interview questionnaire sheet to collect data through (First tool) and (Second tool).

Limitation of the study:

Lack awareness and poor understanding of women lead to increase session time.

Statistical analysis:

Date entry and data analysis were done using SPSS version 24(Statistical Package for Social Science). Data were presented as number, percentage, mean, standard deviation. Chi-square test and Fisher Exact test was used to compare qualitative variables. An independent sample t-test was used to compare quantitative variables between groups. P-value considered statistically significant when P < 0.05.

Results and data analysis

Table (1): Percentage distribution of study sample according to their socio- demographic characteristics (n =100).

Table (1) showed that more than one-third of women (37.0%) are ranged from 18 <40 years old, with mean age, 46.23±7.89 years, about residence it was found that (67.0%) of patients from Rural, regarding occupation there was (68.0%) housewife .on other hands more than half of the study (56.0%) was married, also there was (70.0%) of patients illiterate. According to income, it was found that more than half of patients with low income and highest percentage were (57.0%).

Table (2): Mean distribution of study sample according to the delayed time (n=100).

Table (2) showed the mean distribution of the study sample according to the delayed time, the total time delay was 15.43 months.

Table (3): Percentage distribution of study sample according to factors that delay women in diagnosis of breast cancer (n=100).

Table (3) showed that the majority of a patient (96%) had Lack awareness of breast cancer and signs &symptoms, about (53%) had fear of disease & treatment adverse effects.

Table (4): Percentage distribution of study sample according to relation between socio- demographic characteristics & delay diagnosis.

Table (4) explained that there was a high significance difference (P<0.000) between the level of education with delay diagnosis, also there was a high significance difference (P<0.000) between time delayed to diagnosed with occupation .

Table (5): Percentage distribution of study sample according to Correlation between delay time of diagnosis and grading of tumors.

R(p) : r : correlation coefficient    P: p-value  

Table (5) explicated that there was a positive correlation increasing between each of size of the tumor, N lymph node and metastases with increase delayed time of diagnosis.