Factors contributing to late breast cancer diagnosis : a qualitative study on the patient’s perspective in Tanzania

Abstract

Background

Breast cancer remains a significant public health issue worldwide, with late diagnosis leading to poorer outcomes. In Tanzania, many women are diagnosed with advanced stages of breast cancer. The aim of this study was to identify reasons for late presentations from the patient’s perspective. Methods

Employing a qualitative study design, in-depth interviews were conducted with breast cancer patients. Purposeful sampling was used to recruit patients from inpatient and outpatient settings in the Cancer Care Center of the Kilimanjaro Christian Medical Centre. Eligible patients who were at least 18 years old, and with diagnosed breast cancer were invited for the interview immediately after their medical follow-up visit. Interview transcripts were analysed thematically. Results

Twenty patients (ten rural and ten urban) participated in the study. The average age was 54.05 years (SD = 9.46). Three women had stage 2, three had stage 3, and 14 had stage 4 breast cancer. Factors that were mentioned for late diagnosis of breast cancer were thematically grouped on three levels: the patient, community, and healthcare system. On the patient level, common reasons reported were a misunderstanding of breast cancer (n = 19, 95%), including lack of knowledge and awareness of breast cancer signs and symptoms, as well as the costs for transportation to the healthcare centre (10, 50%). On the community level, the reasons mentioned were experiencing stigma (n = 19, 95%) initially seeking care from traditional healers (n = 18, 90%), a burdensome spousal relationship (n = 15, 75%) and having faith in God (n = 19). On the health system level, patients (n = 13, 65%) expressed concerns regarding the high costs of cancer treatment, which limited their access to health care. Conclusion

Our findings show that, from the patient’s perspective, the main reasons for delayed diagnosis of breast cancer can be grouped at the patient, the community, and the healthcare levels. Themes at the patient level are a lack of knowledge of breast cancer signs and symptoms and lack of awareness of having those symptoms. Community level themes were stigma, seeking initial care from traditional healers, and interacting with religious leaders, and themes related to healthcare included costs of cancer treatment, and negative attitudes of healthcare providers.