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Factors contributing to delays in diagnosis of breast cancers in Ghana, West Africa

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Background

Late diagnoses and poor prognoses of breast cancer are common throughout Africa.

Methods

To identify responsible factors, we utilized data from a population-based case–control study involving 1184 women with breast malignancies conducted in three hospitals in Accra and Kumasi, Ghana. Interviews focused on potential breast cancer risk factors as well as factors that might contribute to presentation delays. We calculated odds ratios (OR) and 95% confidence intervals (CI) comparing malignances with biopsy masses larger than 5 cm. (62.4% of the 1027 cases with measurable lesions) to smaller lesions.

Results

In multivariate analyses, strong predictors of larger masses were limited education (OR 1.96, 95% CI 1.32–2.90 <primary vs. ≥senior secondary school), being separated/divorced or widowed (1.75, 1.18–2.60 and 2.25, 1.43–3.55, respectively, vs. currently married), delay in care seeking after onset of symptoms (2.64, 1.77–3.95 for ≥12 vs. ≤2 months), care having initially been sought from someone other than a doctor/nurse (1.86, 0.85–4.09), and frequent use of herbal medications/treatment (1.51, 0.95–2.43 for ≥3x/day usage vs. none). Particularly high risks associated with these factors were found among less educated women; for example, women with less than junior secondary schooling who delayed seeking care for breast symptoms for 6 months or longer were at nearly 4-times the risk of more educated women who promptly sought assistance.

Conclusions

Our findings suggest that additional communication, particularly among less educated women, could promote earlier breast cancer diagnoses. Involvement of individuals other than medical practitioners, including traditional healers, may be helpful in this process.

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Acknowledgements

This study was supported by the intramural research program of the National Cancer Institute (NCI).

Ghana Breast Health Study Team

Korle Bu Teaching Hospital: Dr. Anthony Adjei, Dr. Florence Dedey, Dr. Verna Vanderpuye, Victoria Okyne, Naomi Ohene Oti, Evelyn Tay, Dr. Adu-Aryee, Angela Kenu, Obed Ekpedzor. Komfo Anoyke Teaching Hospital: Dr. Francis Aitpillah, Dr. Joseph Oppong, Dr. Ernest Osei-Bonsu, Dr. Nicholas Titiloye, Isaac Boakye, Bernard Arhin, Emmanuel Assimah, Samuel Ka-chungu. Peace and Love Hospital, Kumasi, Ghana: Prof. Margaret Frempong, Emma Brew Abaidoo, Bridget Nortey Mensah, Samuel Amanama, Prince Agyuapong, Debora Boateng-Ansong, Thomas Agyei, Richard Opoku, Kofi Owusu Gyimah. National Cancer Institute, Bethesda, MD: Dr. Stephen Hewitt, Maya Palakal, Jake Thistle. University of Michigan, Ann Arbor, MI: Dr. Lisa Newman. Westat, Inc.: Michelle Brotzman, Shelley Niwa, Usha Singh.

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Authors and Affiliations

  1. National Cancer Institute, 9609 Medical Center Drive, Room 7E-442, MSC 9776, Bethesda, MD, 20892-9776, USA

    Louise Brinton & Jonine Figueroa

  2. University of Edinburgh, Edinburgh, Scotland, UK

    Jonine Figueroa

  3. Komfo Anoyke Teaching Hospital, Kumasi, Ghana

    Ernest Adjei, Daniel Ansong & Baffour Awuah

  4. University of Ghana, Accra, Ghana

    Richard Biritwum, Kofi M. Nyarko & Joe Nat Clegg-Lamptey

  5. Korle Bu Teaching Hospital, Accra, Ghana

    Lawrence Edusei, Joel Yarney & Joe Nat Clegg-Lamptey

  6. Peace and Love Hospital, Kumasi, Ghana

    Seth Wiafe & Beatrice Wiafe Addai

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  1. Louise Brinton
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  8. Seth Wiafe
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  11. Baffour Awuah
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Consortia

On behalf of the Ghana Breast Health Study team

  • Anthony Adjei
  • , Florence Dedey
  • , Verna Vanderpuye
  • , Victoria Okyne
  • , Naomi Ohene Oti
  • , Evelyn Tay
  • ,  Adu-Aryee
  • , Angela Kenu
  • , Obed Ekpedzor
  • , Francis Aitpillah
  • , Joseph Oppong
  • , Ernest Osei-Bonsu
  • , Nicholas Titiloye
  • , Isaac Boakye
  • , Bernard Arhin
  • , Emmanuel Assimah
  • , Samuel Ka-chungu
  • , Margaret Frempong
  • , Emma Brew Abaidoo
  • , Bridget Nortey Mensah
  • , Samuel Amanama
  • , Prince Agyuapong
  • , Debora Boateng-Ansong
  • , Thomas Agyei
  • , Richard Opoku
  • , Kofi Owusu Gyimah
  • , Stephen Hewitt
  • , Maya Palakal
  • , Jake Thistle
  • , Lisa Newman
  • , Michelle Brotzman
  • , Shelley Niwa
  •  & Usha Singh

Corresponding author

Correspondence to Louise Brinton.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study does not contain any animal participants.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Brinton, L., Figueroa, J., Adjei, E. et al. Factors contributing to delays in diagnosis of breast cancers in Ghana, West Africa. Breast Cancer Res Treat 162, 105–114 (2017). https://doi.org/10.1007/s10549-016-4088-1

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  • DOI: https://doi.org/10.1007/s10549-016-4088-1

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