A multivariate model to predict delay in diagnosis and treatment of breast cancer in Pakistan: A retrospective cohort study.

Abstract

e13175 Background: The mortality of breast cancer (BC) is significantly increased by delays in diagnosis and treatment. This study aimed to investigate the factors contributing to delayed presentation among BC patients in low- and middle-income country Pakistan. Methods: We did a retrospective cohort study to include BC patients who presented at three hospitals in Rawalpindi, Pakistan, from January to November 2024. Patient delay (PD), diagnostic delay (DD) and treatment delay (TD) were defined as the time from the onset of first symptom to first doctor visit, the time from first doctor visit to definitive diagnosis, and the time from diagnosis to start of the treatment, respectively. A multivariate linear regression model was constructed in SPSS (Table 1). Results: Data from 311 patients were included, with mean age of 49 ± 11.2 years. Among them, 94 (30.2%) reported a family history of breast cancer. Most patients had no prior symptoms of breast cancer (89.1%) and were unaware of self-examination techniques (80.7%). The mean PD, DD and TD were 132.2, 66.4 and 43.9 days, respectively. PD was significantly greater in patients who used alternative medicine (258 days vs 105 days, p < 0.001). Patients who experienced breast cancer symptoms in the past had greater PD (156 days vs 127 days, p = 0.032) and DD (168 days vs 54 days, p = 0.004). Patients who only had breast lumps had greater PD (146 days vs 68 days, p = 0.019) and DD (170 days vs 56 days, p = 0.004) compared to those with nipple changes. TD was significantly higher in smokers compared to non-smokers (86 days vs 43 days, p = 0.001). Conclusions: Delays in BC diagnosis and treatment in Pakistan are mainly influenced by factors such as lack of symptom awareness or usage of alternative medicine. Addressing these delays requires targeted education and countrywide implementation of screening mammography to improve patient outcomes. Variable Patient delay Diagnosis delay Treatment delay B Lower CI Upper CI p-value B Lower CI Upper CI p-value B Lower CI Upper CI p-value Age -0.341 -1.906 2.588 0.765 -1.182 -2.676 0.312 0.121 -0.135 -0.524 0.255 0.497 Marital Status 54.199 -3.097 111.495 0.064 9.327 -28.775 47.429 0.630 0.590 -9.302 10.481 0.907 Self-examination -35.358 -101.060 30.344 0.290 5.530 -38.162 49.222 0.803 -7.828 -19.219 3.564 0.177 Family History -19.529 -58.052 18.994 0.319 18.837 -6.781 44.454 0.149 -3.756 -10.421 2.908 0.268 Distance from nearest healthcare facility -29.890 -81.248 21.468 0.253 12.028 -22.125 46.181 0.489 0.479 -8.427 9.386 0.916 Past Breast Cancer Symptoms 81.857 7.146 156.568 0.032 74.192 24.509 123.874 0.004 -1.110 -14.042 11.823 0.866 Smoking 24.542 -117.358 166.443 0.734 30.692 -63.672 125.056 0.523 46.084 20.461 71.707 <0.001 Skin changes -28.387 -52.026 -4.748 0.019 22.900 7.180 38.620 0.004 -2.763 -6.900 1.374 0.190 Alternative medicine 138.958 73.938 203.979 <0.001 25.498 -17.741 68.737 0.247 -7.023 -18.347 4.300 0.223