Large lag between breast cancer symptom onset and clinical consultation in LMICs

In low- and middle-income countries (LMICs), there appears to be a long interval between the first onset of breast cancer symptoms and presentation to a healthcare provider, reports a recent study.

The present meta-analysis included 50 studies, yielding a cumulative sample of 18,014 breast cancer patients. Most of the included studies had medium risk of bias (78 percent), while 18 percent had high risk; only two studies were of low bias risk.

Papers were retrieved from the databases of Medline, Embase, and Web of Science. Grey literature studies were searched for on Google Scholar, OpenGrey, EThOS, and ProQuest Dissertations & Theses.

Meta-analysis found a large variation in the median duration of time interval between symptom onset and clinical presentation, ranging from 6 to 390 days. Pooled median interval was 50 days, which dropped to 44 days after removing papers with high risk of bias.

Stratifying results according to geographic region showed that delays in presentation were longest in the Middle East, where patients waited 3–4 months before seeing a healthcare professional. This was followed by Southeast Asia (2 months), Africa (1–2 months), Latin America (1 month), and Eastern Europe (1 month).

Other notable risk factors for such delay included older age, low socioeconomic status, illiteracy, low knowledge of cancer, fear, poor social support, and negative beliefs about cancer.

Of note, in Southeast Asia, Africa, and the Middle East, the use of alternative medicine and distrust in the healthcare system also contributed to these delays in presentation.