Clinical and Translational Oncology

, Volume 19, Issue 10, pp 1276–1282 | Cite as

Breast self-exam and patient interval associate with advanced breast cancer and treatment delay in Mexican women

  • E. Leon-RodriguezEmail author
  • C. Molina-Calzada
  • M. M. Rivera-Franco
  • A. Campos-Castro
Research Article



The objective of this study was to compare treatment intervals in breast cancer patients according to the detection method (breast self-exam vs screening).

Patients and methods

We conducted a retrospective analysis including 291 breast cancer patients at a Mexican tertiary referral hospital.


Breast cancer detection method was mostly breast self-exam (60%). The median patient interval was 60.5 days, and was associated with marital status and socioeconomic level. Differences between the two groups were statistically significant for global interval, p = 0.002; however, health system interval was not statistically different.


In our country, breast cancer screening is opportunistic, with several weaknesses within its management and quality systems. Our study showed that even in specialized health care centers, breast cancer is detected by self-exam in up to 2/3 of patients, which can explain the advanced stages at diagnosis in our country. In developing countries, the immediate health care access for breast cancer patients should be prioritized as an initial step to reduce the global treatment initiation interval in order to reduce mortality.


Breast cancer Breast self-exam Mammogram Mexico 


Compliance with ethical standards

Conflict of interest

None of the authors have any conflict of interests to disclose.

Research involving human participants and/or animals

This retrospective protocol was approved by the Institutional Review Board (Ethics and Human Research Committees) of Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico, with the reference number 2120.

Informed consent

Informed consent was obtained from all the patients before undergoing treatment. But our Institutional Review Board (Ethics and Human Research Committees) agreed that patients were not requested to fill out an additional informed consent to participate in this retrospective study since all their information was protected and codified with numbers in our database and the manuscript, and no intervention was given.


  1. 1.
    Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; 2013. Available from: Accessed 01 Oct 2016.
  2. 2.
    Porter P. Westernizing women´s risk? Breast cancer in lower-income countries. N Engl J Med. 2008;358:213–6.CrossRefPubMedGoogle Scholar
  3. 3.
    Weir HK, Thun MJ, Hankey BF, Ries LA, Howe HL, Wingo PA, et al. Annual report to the nation on the status of cancer, 1975–2000, featuring the uses of surveillance data for cancer prevention and control. J Natl Cancer Inst. 2003;95:1276–99.CrossRefPubMedGoogle Scholar
  4. 4.
    Sankaranarayanan R, Swaminathan R, Brenner H, Chen K, Chia KS, Chen JG, et al. Cancer survival in Africa, Asia, and Central America: a population-based study. Lancet Oncol. 2010;11:165–73.CrossRefPubMedGoogle Scholar
  5. 5.
    Knaul FM, Nigenda G, Lozano R, Arreola-Ornelas H, Langer A, Frenk J. Cancer de mama en México: una prioridad apremiante. Salud Publica Mex 2009;51(suppl 2):S335–S344.Google Scholar
  6. 6.
    Unger-Saldaña K. Challenges to the early diagnosis and treatment of breast cancer in developing countries. World J Clin Oncol. 2014;5(3):465–77.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Caplan L. Delay in breast cancer: implications for stage at diagnosis and survival. Front Public Health. 2014;2:87.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Thomas DB, Gao DL, Ray RM, Wang WW, Allison CJ, Chen FL, et al. Randomized trial of breast self-examination in Shanghai: final results. J Natl Cancer Inst 2002;94(19):1445e57.Google Scholar
  9. 9.
    Perry N, Broeders M, de Wolf C, Törnberg S, Holland R, von Karsa L. European guidelines for quality assurance in breast cancer screening and diagnosis. Fourth edition–summary document. Ann Oncol. 2008; 19(4):614–22.Google Scholar
  10. 10.
    Pack G, Gallo J. The culpability for delay in the treatment of cancer. Am J Cancer. 1938;33:443–62.Google Scholar
  11. 11.
    Dobson CM, Russell AJ, Rubin GP. Patient delay in cancer diagnosis: what do we really mean and can we be more specific? BMC Health Services Res. 2014;14:387.CrossRefGoogle Scholar
  12. 12.
    Ramirez AJ, Westcombe AM, Burgess CC, Sutton S, Littlejohns P, Richards MA. Factors predicting delayed presentation of symptomatic breast cancer: a systematic review. Lancet. 1999;353(9159):1127–31.CrossRefPubMedGoogle Scholar
  13. 13.
    Richards MA, Smith P, Ramirez AJ, Fentiman IS, Rubens RD. The influence on survival of delay in the presentation and treatment of symptomatic breast cancer. Br J Cancer. 1999;79:858–64.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Bright K, Barghash M, Donach M, de la Barrera MG, Schneider RJ, Formenti SC. The role of health system factors in delaying final diagnosis and treatment of breast cancer in Mexico City, Mexico. Breast. 2011;20(suppl 2):s54–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Unger-Saldaña, Miranda A, Zarco-Espinosa G, Mainero-Ratchelous F, Bargalló-Rocha E, Miguel Lázaro-León J. Health system delay and its effect on clinical stage of breast cancer: Multicenter study. Cancer. 2015;121(13):2198–206.Google Scholar
  16. 16.
    Piñeros M, Sánchez R, Cendales R, Perry F, Ocampo R. Patient delay among Colombian women with breast cancer. Salud Publica Mex. 2009;51(5):372–80.CrossRefPubMedGoogle Scholar
  17. 17.
    Odongo J, Makumbi T, Kalungid S, Galukande M. Patient delay factors in women presenting with breast cancer in a low income country. BMC Res Notes. 2015;8:467.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Galukande M, Mirembe F, Wabinga H. Patient delay in accessing breast cancer care in a sub Saharan African Country: Uganda. Br J Med Med Res. 2014;4(13):2599–610.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Arndt V, Sturmer T, Stegmaier C, Ziegler H, Dhom G, Brenner H. Patient delay and stage of diagnosis among breast cancer patients in Germany—a population based study. Br J Cancer. 2002;86(7):1034–40.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Allgar VL, Neal RD. Delays in the diagnosis of 6 cancers: analysis of data from the National Survey of NHS Patients: cancer. Br J Cancer. 2005;92:1959–70.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Mousa SM, Seifeldin IA, Hablas A, Elbana ES, Soliman AS. Patterns of seeking medical care among Egyptian breast cancer patients: relationship to late-stage presentation. Breast. 2011;20:555–61.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Norsa’adah B, Rampal KG, Rahmah MA, Naing NN, Biswal BM. Diagnosis delay of breast cancer and its associated factors in Malaysian women [serial online]. BMC Cancer. 2011;11:141.Google Scholar
  23. 23.
    Maghous A, Rais F, Ahid S, Benhmidou N, Bellahamou K, Loughlimi H, et al. Factors influencing diagnosis delay of advanced breast cancer in Moroccan women. BMC Cancer. 2016;16:356.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    López-Carrillo L, Torres-Sánchez L, López-Cervantes M, Rueda-Neria C. Identification of breast lesions in Mexico. Salud Publica Mex. 2001;43(3):199–202.CrossRefPubMedGoogle Scholar
  25. 25.
    Uscanga-Sánchez S, Torres-Mejía G, Ángeles-Llerenas A, Domínguez-Malpica R, Lazcano-Ponce E. Breast cancer screening process indicators in Mexico: a case study. Salud Publica Mex. 2014;56(5):528–37.CrossRefPubMedGoogle Scholar
  26. 26.
    Ma I, Dueck A, Gray R, Wasif N, Giurescu M, Lorans R, et al. Clinical and self breast examination remain important in the era of modern screening. Ann Surg Oncol. 2012;19(5):1484–90.CrossRefPubMedGoogle Scholar
  27. 27.
    Kösters JP, Gøtzsche PC. Regular self-examination or clinical examination for early detection of breast cancer. Cochrane Database Syst Rev. 2003;2. Art. No. CD003373.Google Scholar
  28. 28.
    Inegi. Overall population by age group according to gender, 1950–2010 [Internet]. Mexico, Inegi 2010. Accessed 25 Sep 2016.
  29. 29.
    Martínez-Montañez OG, Uribe-Zúñiga P, Hernández-Avila M. Public policies for breast cancer detection in Mexico. Salud Publica Mex. 2009; 51(Supl 2):s350–s360.Google Scholar
  30. 30.
    Unger-Saldaña K, Infante-Castañeda CB. Breast cancer delay: a grounded model of help-seeking behaviour. Soc Sci Med. 2011;72(7):1096–104.CrossRefPubMedGoogle Scholar

Copyright information

© Federación de Sociedades Españolas de Oncología (FESEO) 2017

Authors and Affiliations

  • E. Leon-Rodriguez
    • 1
    Email author
  • C. Molina-Calzada
    • 1
  • M. M. Rivera-Franco
    • 1
  • A. Campos-Castro
    • 1
  1. 1.Hematology and Oncology DepartmentInstituto Nacional de Ciencias Medicas y Nutricion Salvador ZubiranMexico CityMexico

Personalised recommendations