Pathways to breast cancer presentation – Associate Professor Jennifer Moodley
Associate Professor Jennifer Moodley
Dept Faculty of Health Sciences, University of Cape Town
Pathways to breast cancer presentation.
Breast cancer is a major public health burden and remains the commonest cancer among women worldwide. In South Africa, it is the most common cancer in women, and accounts for 15.6% of female cancer deaths. Similar to other developing countries, the majority of patients in South Africa present with late stage disease, which is associated with a poorer prognosis. In addition patients often delay in presenting for assessment and treatment. Delay in breast cancer presentation adversely affects survival. Research on factors associated with delayed breast cancer presentation from developing countries is limited. There have been no studies focusing on the magnitude of and factors associated with delayed breast cancer presentation in South Africa. Understanding and addressing delayed breast cancer presentation is critical to reducing the unacceptably high breast cancer burden in South Africa.
The overall aim of the project is to determine magnitude of and factors associated with delayed presentation of breast cancer. Specific objectives are to: (1) describe the socio-demographic, risk factor and clinical profile of newly diagnosed breast cancer client; (2) describe pathways to presentation at a tertiary breast cancer clinic and determine (a) the average time between the discovery of initial symptoms and presentation to an initial provider and the proportion of patients presenting at greater than 12 weeks since symptom onset (i.e. patient related delay interval) and (b) the average interval between presentation to an initial provider and effective oncology treatment (i.e. provider related delay interval); (3) determine factors associated with delayed presentation and; (4) explore client interpretation and understanding of the signs and symptoms of breast cancer, and personal and socio-cultural factors that contribute to delayed presentation of breast cancer
The study will be conducted at the Breast Clinic at Groote Schuur Hospital (GSH), Cape Town.
Mixed methods will be used to meet the study objectives. A cross-sectional study of 425 newly diagnosed breast cancer clients will be conducted to determine the client profile, the pathways to care and factors associated with delayed presentation. In addition to a structured interview, client records will be reviewed to obtain information on the histo-pathological diagnosis, stage at presentation, date and results of diagnostic tests and date of commencement of treatment. Qualitative research using in-depth interviews (20 newly diagnosed clients) will be conducted to explore client interpretation and understanding of the signs and symptoms of breast cancer and factors that contribute to delayed presentation of breast cancer. Quantitative data will be analyzed using STATA -univariate, bivariate and multiple logistic regression will be conducted. Qualitative data will be entered into Atlas Ti and analyzed using a thematic approach.
Results of the study could have public benefit by providing insight into factors influencing delayed presentation of breast cancer. If addressed this could result in earlier presentation and down staging of breast cancer.