Delayed presentation of breast cancer patients

Abstract

Objective: To determine the extent and nature of delayed presentation of patients treated for breast cancer at Kenyatta National Hospital (KNH). Design : Prospective cross sectional study. Setting: Kenyatta National Hospital (KNH) which is a Tertiary, Teaching and Referral hospital in Nairobi, Kenya Patients and methods: All patients attending the KNH breast clinic or admitted to the 3 surgical wards for the first time with a cytologically or histologically proven diagnosis of late stage breast cancer (Manchester Classification 1940 stage III and IV) were entered into the study. The study covered a two and a half year period starting the 1st of October 2003. Results: A total of 166 patients were recruited into the study. The mean age was 47 years with a range between 17 and 88 years. Females constituted 98.8%. The female study population had an average of 4.5 children per subject with a median of 4 and a range of 0-11. A lump as the first noticed symptom was seen in 87.3% and 52.1% were pre-menopausal. Only 11 (6.62%) patients presented within 30 days of discovering their breast symptom, 34 (20.4%) presented between thirty and ninety days and the remaining 115 (73.1%) presented three months after noticing their symptom. Three reasons accounted for 67.5% of the delay. 33 (19.9%) kept away fearing that they would be told they had cancer while 39 (23.5%) presented late because their breast symptom was painless. Another 40 (24.1%) said they had earlier visited medical personnel who had reassured them that their symptoms were benign. Conclusion: Majority of patients treated for advanced breast disease presented to the health care providers at KNH more than three months after noticing their breast symptom and a sizeable number of patients are being reassured falsely that they have benign disease without the benefit of biopsy. East African Medical Journal Vol. 87 No. 4 April 2010