383 - Why do women with breast cancer in Sarawak, Malaysia present late?

Date 28 September 2012
Event ESMO Congress 2012
Session Publication Only
Topics Breast Cancer
Aetiology, Epidemiology, Screening and Prevention
Basic Scientific Principles
Presenter Beena Devi
Authors B.C. Devi
  • Radiotherapy, Oncology & Palliative Care, Sarawak General Hospital, 93596/MY



Breast cancer (BC) is the most common cancer in Sarawak. We explore the reasons of late stage presentation in this study.


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.


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.


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.


All authors have declared no conflicts of interest.