Identifying the reasons for delayed presentation of Pakistani breast cancer patients at a tertiary care hospital

Figures & data

Figure 1 Flow diagram of the patients included in this study.

Abbreviations: N_o, Patients included at the start of the study; N₁, data on the patients analyzed and presented in this study.

Table 1 Sociodemographic data of selected patients and studied variables

Variable	Category	Patients (n)	Patients (%)
Age at diagnosis	<40 years	43	34.4
	≥40 years	82	65.6
Education	<8 years	76	60.8
	≥8 years	49	39.2
Marital status	Married	124	99.2
	Single	1	0.8
Socioeconomic status	<PKR 5,000/month	84	67.2
	≥PKR 5,000/month	41	32.8
Residence	Rural	62	49.6
	Urban	63	50.4
Menopausal status	Pre-menopausal	70	56
	Post-menopausal	55	44
Tumor location	Left breast	63	50.4
	Right breast	62	49.6
Disease stage	II	51	40.8
	III	73	58.4
	IV	1	0.8
Family history of any cancer	No one	81	64.8
	At least one person	44	35.2
Family history of breast cancer	No one	88	70.4
	At least one person	37	29.6

Abbreviation: PKR, Pakistani rupee.

Table 2 Frequency of patients with presenting symptoms and duration of presentation delay

Symptom	Patients, n (%)	Delay <3 months	Delay ≥3 months
Painless lump in breast	116 (92.8%)	12 (85.7%)	104 (93.7%)
Lump in armpit	6 (4.8%)	1 (7.1%)	5 (4.5%)
Change in breast shape	4 (3.2%)	2 (14.2.1%)	2 (1.8%)
Nipple discharge	4 (3.2%)	1 (7.1%)	3 (2.7%)
Painful lump in breast	4 (3.2%)	0 (0%)	4 (3.6%)
Redness/swelling over breast	3 (2.4%)	1 (7.1%)	2 (1.8%)
Pain in arm or back	2 (1.6%)	1 (7.1%)	1 (0.9%)
Bone pain	2 (1.6%)	0 (0%)	2 (1.8%)
Ulcer over breast	1 (0.8%)	0 (0%)	1 (0.9%)
Weakness	1 (0.8%)	0 (0%)	1 (0.9%)
Total	N=125	n=14	n=111

Note: Patients often presented with more than one symptom, so column totals do not add up to 100%.

Figure 2 Distribution of patients according to the duration of delay before consulting a physician.

Table 3 Assessment of patients’ knowledge about breast cancer risk factors

Risk factor variable	Patients (N=125), n (%)
	Yes	No	I do not know
Age	31 (24.8)	41 (32.8)	53 (42.4)
Gender	34 (27.2)	29 (23.2)	62 (49.6)
Early menarche	9 (7.2)	24 (19.2)	92 (73.6)
Late menopause	12 (9.6)	29 (23.2)	84 (67.2)
Parity age	11 (8.8)	14 (11.2)	100 (80)
Trauma	41 (32.8)	35 (28)	49 (39.2)
Stress	21 (16.8)	78 (62.4)	26 (20.8)
Oral contraceptives	38 (30.4)	16 (12.8)	71 (56.8)
Obesity	19 (15.2)	29 (23.2)	77 (61.6)
Family history	71 (56.8)	21 (16.8)	33 (26.4)
Overweight	33 (26.4)	31 (24.8)	61 (48.8)
Breastfeeding	76 (60.8)	32 (25.6)	17 (13.6)
Smoking	41 (32.8)	20 (16)	64 (51.2)
Drinking	42 (33.6)	21 (16.8)	62 (49.6)
Pollution	44 (35.2)	31 (24.8)	50 (40)
Previous breast cancer	13 (10.4)	17 (13.6)	95 (76)
Radiation	30 (24)	22 (17.6)	73 (58.4)

Figure 3 Percentage of patients with reasons for delayed presentation.

Note: Patients highlighted more than one barrier to presentation, so the totals do not add up to 100%.

Table 4 Sociodemographic factors and their association with presentation delay

Variable	Category	Time of presentation, n (%)		P-valuea
		<3 months	≥3 months
Age at diagnosis	<40 years	4 (9.3%)	39 (90.7%)	0.078
	≥40 years	18 (22.0%)	64 (78.0%)
Education	<8 years	3 (3.9%)	73 (96.1%)	<0.001**
	≥8 years	19 (38.8%)	30 (61.2%)
Marital status	Married	21 (16.9%)	103 (83.1%)	0.03*
	Single	1 (100%)	0 (0%)
Socioeconomic status	<PKR 5,000/month	19 (22.6%)	65 (77.4%)	0.035*
	≥PKR 5,000/month	3 (7.3%)	38 (92.7%)
Residence	Rural	5 (8.1%)	57 (91.9%)	0.005**
	Urban	17 (27.0%)	46 (73.0%)
Menopausal status	Pre-menopausal	13 (18.6%)	57 (81.4%)	0.748
	Post-menopausal	9 (16.4%)	46 (83.6%)
Tumor location	Left breast	8 (12.7%)	55 (87.3%)	0.147
	Right breast	14 (22.6%)	48 (77.4%)
Family history of any cancer	No one	13 (16.0%)	68 (84.0%)	0.537
	At least one person	9 (20.5%)	35 (79.5%)
Family history of breast cancer	No one	16 (18.2%)	72 (81.8%)	0.792
	At least one person	6 (16.2%)	31 (83.8%)

Note:

a Chi-squared test:

* P≤0.05 and

** P≤0.001 indicate statistical significance.

Abbreviation: PKR, Pakistani rupee.

Table 5 Logistic regression analysis showing odds ratios and confidence intervals for the studied variables

Variable	Category	Delay in diagnosis, n (%)		Binary analysis
		<3 months	≥3 months	OR	95% CI	P-value
Age at diagnosis	<40 years	4 (9.3%)	39 (90.7%)	0.043	0.912–0.043	0.038
	≥40 years	18 (22.0%)	64 (78.0%)
Education	<8 years	3 (3.9%)	73 (96.1%)	4.682	–	<0.001
	≥8 years	19 (38.8%)	30 (61.2%)
Marital status	Married	21 (16.9%)	103 (83.1%)	0.000	0.000	1.000
	Single	1 (100%)	0 (0%)
Socioeconomic status	<PKR 5,000/month	19 (22.6%)	65 (77.4%)	1.875	59.006–1.875	0.007
	≥PKR 5,000/month	3 (7.3%)	38 (92.7%)
Residence	Rural	5 (8.1%)	57 (91.9%)	0.062	0.701–0.062	0.011
	Urban	17 (27.0%)	46 (73.0%)
Menopausal status	Pre-menopausal	13 (18.6%)	57 (81.4%)	0.371	4.909–0.371	0.649
	Post-menopausal	9 (16.4%)	46 (83.6%)
Tumor location	Left breast	8 (12.7%)	55 (87.3%)	0.117	1.224–0.117	0.105
	Right breast	14 (22.6%)	48 (77.4%)
Family history of any cancer	No one	13 (16.0%)	68 (84.0%)	0.028	1.461–0.028	0.113
	At least one person	9 (20.5%)	35 (79.5%)
Family history of breast cancer	No one	16 (18.2%)	72 (81.8%)	0.529	28.095–0.529	0.183
	At least one person	6 (16.2%)	31 (83.8%)

Note: The “–” symbol in the table indicates data not shown due to the low number of patients within <3 month range for delay in diagnosis.

Abbreviation: PKR, Pakistani rupee.