Abstract
Purpose
Breast cancer is the first most common type of cancer among women worldwide. Delay in diagnosis and treatment may lead to late-stage and poor prognosis. Measuring waiting times is a good indicator of the quality and performance of cancer care. This study aims at investigating the factors associated with delayed diagnosis and treatment of breast cancer in Casablanca.
Methods
This is a cross-sectional study with consecutive recruitment from January to June 2018 of patients with breast cancer in the University hospital center Ibn Rochd of Casablanca and the private center Ryad of Casablanca. The target population consisted of women newly diagnosed with breast cancer. Women who had secondary breast cancer or refused to answer the questionnaire were excluded. The information was collected by trained Ph.D. student via a structured questionnaire based on the patients’ medical records. Ordinal logistic regressions, stratified on medical care type (public and private), were used to identify factors associated with a longer delay: Patient Delay (PD), Diagnosis Delay (DD), and Health System Delay (HSD). The p-values < 0.05 were considered statistically significant. Statistical analyses were performed using R statistical analysis software version 4.0.5. We used quartiles to define long delays. A longer PD was defined as a delay ≥ 35 days, a longer DD as a delay ≥ 16 days and a longer HSD as a delay ≥ 48 days.
Results
The total study population included 300 women with an average age of 52 ± 11 years. Fifty-one percent (51.7%) are diagnosed at a late stage. For women who received public care, the factors associated with diagnostic delay were marriage (aOR = 1.66 [0.92–3.01]) and consulting once or twice before diagnosis (aOR = 2.86 [1.31–6.24]). For women who received private care, delay in treatment was higher for women who were housewives (aOR = 3.94 [1.05–14.75]).
Conclusion
Our study showed that factors associated with diagnosis delay were marriage and consulting once or twice before diagnosis in public care, and with treatment delay was higher for women who were housewives in private care which leads us to conclude that population-wide awareness and education programs are needed
to improve the recognition of symptoms and promote prompt healthcare seeking to improve early diagnosis and survival. The ideas highlighted in this study can be used to provide recommendations for areas of improved cancer education as well as potential prevention and screening programs. Additional studies are needed to determine if similar differential delays exist in other regions of Morocco.
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Data Availability
The datasets analyzed during the current study are available from the corresponding author on reasonable request.
References
Breast Globocan. 2020. https://gco.iarc.fr/today/data/factsheets/cancers/20-Breast-fact-sheet.pdf. Accessed 09 Nov 2022.
Khalis M, Chajès V, Moskal A, Biessy C, Huybrechts I, Rinaldi S, et al. Healthy life style and breast cancer risk: a case-control study in Morocco. Cancer Epidemiol. 2019;58:160–6.
Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136:E359-386.
Bouchbika Z, Serhier Z, Sahraoui S, Bennani-Othmani M, Benider A. Stade du cancer du sein lors du diagnostic: impact des campagnes de sensibilisation. Prat Organ Soins CNAMTS. 2012;43:269–75.
Mimouni M, Chaouki W, Errihani H, Benjaafar N. An analysis of breast cancer treatment waiting times: experience of a tertiary referral center in Morocco. Bull Cancer (Paris). 2018;105:755–62.
Unger-Saldaña K. Challenges to the early diagnosis and treatment of breast cancer in developing countries. World J Clin Oncol. 2014;5:465–77.
Ozmen V, Boylu S, Ok E, Canturk NZ, Celik V, Kapkac M, et al. Factors affecting breast cancer treatment delay in Turkey: a study from Turkish federation of breast diseases societies. Eur J Public Health. 2015;25:9–14.
Poum A, Promthet S, Duffy SW, Parkin DM. factors associated with delayed diagnosis of breast cancer in Northeast Thailand. J Epidemiol. 2014;24:102–8.
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.
Benbakhta B, Tazi M, Benjaafar N, Khattabi A, Maaroufi A. Determinants of patient and health system delays for women with breast cancer in Morocco, 2013. Rev Epidemiol Sante Publique. 2015;63:191–201.
Moodley J, Cairncross L, Naiker T, Momberg M. Understanding pathways to breast cancer diagnosis among women in the Western Cape Province, South Africa: a qualitative study. BMJ Open. 2016;6:e009905.
Mouhdi H. Revue de la stratégie de financement de la couverture médicale de base au Maroc. J maroc Sci Méd. 2016. https://doi.org/10.48401/IMIST.PRSM/jmsm-v20i4.7947
Amin MB, Edge S, Greene F, Byrd DR, Brookland RK, Washington MK, et al., éditeurs. American Joint Committee on Cancer. AJCC cancer staging manual. 8th ed. New York, NY: Springer, 2017; 589–636. 8e éd. Springer International Publishing; 2017 https://www.springer.com/gp/book/9783319406176. Accessed 14 May 2021
Jassem J, Ozmen V, Bacanu F, Drobniene M, Eglitis J, Lakshmaiah KC, et al. Delays in diagnosis and treatment of breast cancer: a multinational analysis. Eur J Public Health. 2014;24:761–7.
Ben Fatma L, Belaid I, Said N, Gahbiche S, Hochlef M, Chabchoub I, et al. What could be the reasons of late diagnosis of breast cancer in Tunisia? Tunis Med. 2018;96:665–71.
Ghazali SM, Othman Z, Cheong KC, Hock LK, Wan Mahiyuddin WR, Kamaluddin MA, et al. Non-practice of breast self examination and marital status are associated with delayed presentation with breast cancer. Asian Pac J Cancer Prev APJCP. 2013;14:1141–5.
Frie KG, Kamaté B, Traoré CB, Ly M, Mallé B, Coulibaly B, Wienke A, Kantelhardt EJ. Factors associated with time to first healthcare visit, diagnosis and treatment, and their impact on survival among breast cancer patients in Mali. PLoS One. 2018;13(11):e0207928. https://doi.org/10.1371/journal.pone.0207928.
Brahmi SA, et al. Complementary medicine use among Moroccan patients with cancer: a descriptive study. Pan Afr Med J. 2011;10:36.
Soliman Ann A, Elisha M, Renne P. SocioculturalBarriersRelated to late-stage presentation of breast cancer in Morocco. J Canc Educ. 2018;34:735–42.
Akuoko CP, Armah E, Sarpong T, Quansah DY, Amankwaa I, BoatengD. Barriers to earlypresentation and diagnosis of breast cancer amongAfricanwomen living in sub-SaharanAfrica. PLoS One. 2017;12:e0171024.
Clegg-Lamptey J, Dakubo J, Attobra YN. Why do breast cancer patients report late or abscond duringtreatment in Ghana? A pilot study. Ghana Med J. 2009;43(Suppl 3):127–31.
Okobia MN, Bunker CH, Okonofua FE, Osime U. Knowledge, attitude and practice of Nigerianwomentowardsbreastcancer: a cross-sectional study. World J Surg Oncol. 2006;4:11. https://doi.org/10.1186/1477-7819-4-11.
Pace LE, Dusengimana JV, Hategekimana V, Habineza H, Bigirimana JB, Tapela N, et al. Benign and malignant breast disease at Rwanda’s First Public Cancer Referral Center. Oncologist. 2015;20(Suppl 7):780–8.
Cipora E, Konieczny M, Czerw A, Mikos M, Budzik MP, Deptała A, et al. Causes of delays in breast cancer diagnosis in Poland. Pol Merkur Lek Organ Pol Tow Lek. 2019;47:85–90.
Ibrahim NA, Oludara MA. Socio-demographic factors and reasons associated with delay in breast cancer presentation: a study in Nigerian women. Breast. 2012;21(3):416–8. https://doi.org/10.1016/j.breast.2012.02.006.
Sharma K, Costas A, Shulman LN, Meara JG. A systematic review of barriers to breast cancer care in developing countries resulting in delayed patient presentation. J Oncol. 2012;2012:121873.
Montella M, Crispo A, Botti G, De Marco M, De Bellis G, Fabbrocini G, et al. Assessment of delay in obtaining definitive breast cancer treatment in southern Italy. Breast Cancer Res Treat. 2001;66:209–15.
Jassem J, Ozmen V, Bacanu F, Drobniene M, Eglitis J, Lakshmaiah KC, Kahan Z, Mardiak J, Pieńkowski T, Semiglazova T, Stamatovic L, Timcheva C, Vasovic S, Vrbanec D, Zaborek P. Delays in diagnosis and treatment of breast cancer: a multinational analysis. Eur J Public Health. 2013;12:1–7.
El Fakir S, et al. Health-related quality of life among breast cancer patients and influencing factors in Morocco. Asian Pac J Cancer Prev. 2016;17(Suppl 12):5063–9.
Moustatraf A, Taoufik J. Pour un financement pérenne du Régime d’assistance médicale au Maroc. Sante Publ. 2018;30(6):859–68.
Mateo AM, Mazor AM, Obeid E, Daly JM, Sigurdson ER, Handorf EA, et al. Time to surgery and the impact of delay in the non-neoadjuvant setting on triple-negative breast cancers and other phenotypes. Ann SurgOncol. 2020;27:1679–92.
Facione NC, Miaskowski C, Dodd MJ, Paul SM. The self-reported likelihood of patient delay in breast cancer: new thoughts for early detection. Prev Med. 2002;34:397–407.
PlanNational de Prévention et de Contrôle du Cancer 2020 - 2029. https://www.contrelecancer.ma/fr/media/2020/11/16/plan-national-de-prevention-et-de-controle-du-cancer-2020-2029/. Accessed 7 Oct 2021.
Wang F, McLafferty S, Escamilla V, Luo L. Late-stage breast cancer diagnosis and health care access in Illinois. Prof Geogr. 2008;60(Suppl 1):54–69.
Acknowledgements
We would like to acknowledge all patients who participated in this study. The authors would like to thank the staff of the university hospital center IBN ROCHD and the private center of oncology RYAD.
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The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.
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HZ, SN were responsible for study conception, design. SN and SZ for supervision. HZ collected the data, and HZ and SZ extracted and analyzed the data. HZ wrote the manuscript. All authors reviewed the manuscript. All authors read and approved the final manuscript.
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The study was approved by the Medical Ethics Committee in the Faculty of medicine and pharmacy in Casablanca with the number order N° 11/17.
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Zahfir, H., Zoukal, S., Hassoune, S. et al. Factors Related to Delayed Diagnosis and Treatment of Breast Cancer Among Moroccan Women in Casablanca. Indian J Gynecol Oncolog 20, 68 (2022). https://doi.org/10.1007/s40944-022-00668-3
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DOI: https://doi.org/10.1007/s40944-022-00668-3