1569P - Secondary delay in breast cancer diagnosis and role of rural medical practitioners: A cause and cure finding study

Background

Today Breast cancer is the most commonly diagnosed cancer in women in India. Not only India has seen increasing incidence of breast cancer but also there is increase in mortality rate. While majority of patients in western nations are diagnosed in stage I or stage II, almost half of the patients in India present at a advanced stage. Though government authorities are doing their best to address this issue and community workers like Accredited Social health Activists and Auxillary Nurse Midwife have made significant impact, a large proportion of patients remain out of reach. Other methods need to be explored to be able to diagnose larger number of patients at an early stage.

Methods

A cross sectional study was conducted in south 24 paraganas, a rural district of West Bengal in India. 150 medical practioners practicing alternative medicine were enrolled in the study. Paper based case report forms were used and data was later entered into Excel sheets. Questionnaire recorded reasons for late presentation of patients, social, cultural and spiritual beliefs about the disease, economic impact, possible solution and what issues these practioners face in addressing these issues. Also these practioners were assessed as to how they examine and manage patients at their clinic.

Results

92% of practioners did not know how to examine breast lump and identify signs of malignancy 17% believed cancer is an incurable disease 26% were unaware of an oncologist and refer patients to general medical practioner 38% stated loss of daily wages and huge expenses in treatment were main reasons why patients delay treatment 11% stated stigma associated with surgery of breast and chemotherapy results in treatment avoidance.

Conclusions

Reasons for secondary delay in breast cancer diagnosis is multifactorial. Issues both among patients and practioners needs to be addressed. These practitioners are 1st line of contact for many of these patients and trusted by many. A network of these practioners can be built and they can be trained to examine and triage patients. Creation of referreal pathways to nearest oncology center, web or app based training and support programs, awareness about the disease and its management along with provision for financial assistance is needed.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Netaji Subhash Chandra Bose Cancer Research Institute.

Disclosure

All authors have declared no conflicts of interest.