Patient- and system-related diagnostic delay in breast cancer - Evidence from Alexandria, Egypt

Background: Breast cancer patients in developing countries usually seek tre atment at a more advanced-stage of disease. This work was aimed at evaluati ng the avoidable risk factors related to diagnostic delay of breast cancer (patient- and system-related) in Alexandria, Egypt. Methods: Data were coll ected from 565 incidents, histologically confirmed cases of breast cancer, recruited from nine hospitals in Alexandria, reflecting different patterns of health care delivery during the period July 1997-June 1998, Results: Pat ient-related delay (interval between first symptom and first medical consul tation > three months) was found in 38.1%, while system-related delay (inte rval between first medical consultation and final diagnosis > four weeks) w as found in 12.9% of cases. A significant association between delay in seek ing medical advice and late stage at diagnosis was detected; in fact, while 26.3% of women with less than three months delay were at stage III and IV, the corresponding proportion among women with more than three months delay was 72.1%(chi(2)1=109.6, p<0,0001), Regarding patient-related delay, age > 40 years, lower educational level and not conducting breast self examinatio n were independent risk factors associated with diagnostic delay. As for th e system-related factors, place of first visit (general practitioner), abse nce of a palpable lump and lack of health insurance were significant predic tors for delay. Conclusion: The patient's role in diagnostic delay of breas t cancer is very important in Egypt. Also, interactive training directed to general practitioners to rationalise their approach to cases with breast l umps should be promoted to reduce system-related delay.