383 - Why do women with breast cancer in Sarawak, Malaysia present late?
|Date||28 September 2012|
|Event||ESMO Congress 2012|
|Topics|| Breast Cancer
Cancer Aetiology, Epidemiology, Prevention
Breast cancer (BC) is the most common cancer in Sarawak. We explore the reasons of late stage presentation in this study.Methods
Based on a 175 questions questionnaire, information on barriers to late presentation were collected as a prospective study on 626 cases (2009 to 2011). Descriptive statistics and statistical tests were performed using the SPSS ver 17.0.Results
The stage at diagnosis differed significantly with 71% of the Chinese being diagnosed at early stage compared to only 50% in Malay and 45% in Natives (p < 0.0004).
The delay between first symptom and first medical consultation (DELAY 1) was more than one month in 57% of the patients and it differed significantly among ethnic groups (50% for Chinese, 64% for Malay and 65% for Natives, p < 0.002). The highest delay were: women aged <30 years (75%) vs >50 years (53%, p < 0.037); from rural area (65%) vs urban areas (55%, p < 0.04).The main variables affecting this delay were knowledge about BC (p < 0.004), lack of interest in one's health ( p < 0.0005) and choice of first professional consulted (doctor/nurse vs traditional healer, p < 0.03).
The delay between first medical consultation and effective diagnosis (DELAY 2) for > 1 month was 14% of the patients and it differed significantly among ethnic groups (14% for Chinese, 23% for Malay and 13% for Natives, p < 0.0008). The main reasons: the number of doctors consulted before diagnosis (less the better, p < 0.0003); Malays (66.4%) and natives (64.4%) consulted more than two doctors when compared to Chinese (42.6%, p < 0.0001) and were less likely to follow the recommendations given by the doctors (p < 0.06).
The impact of teaching Breast self-examination (BSE) on DELAY 1 and 2: Seventy-eight percent of patients were taught BSE and by 80% of government nurses. The age group (30-40 years) had been taught BSE more than other age groups. For DELAY 1, 72% were not taught BSE, p < 0.0001. There was no difference for those with DELAY 2. However for both DELAY 1 and 2, 42% were not taught BSE, p < 0.0001.Conclusions
More than 50% of the patients had DELAY 1 and 14% for DELAY 2. Learning BSE had an impact on DELAY 1 but not for DELAY2. Those in age groups (>40 to 60 years) had less BSE taught and this finding is crucial for public health education as most BC occur after 45 years.Disclosure
All authors have declared no conflicts of interest.