Time intervals experienced between first symptom recognition and pathologic diagnosis of breast cancer in Addis Ababa, Ethiopia: a cross-sectional study
Time intervals experienced between first symptom recognition and pathologic diagnosis of breast cancer in Addis Ababa, Ethiopia: a cross-sectional study
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DOI：
10.1136/bmjopen-2019-032228
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发表时间：
2019-11-01
期刊：
影响因子：
2.9
通讯作者：
Jemal, Ahmedin
中科院分区：
文献类型：
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作者：
Gebremariam, Alem;Addissie, Adamu;Jemal, Ahmedin
目的本研究旨在评估阿迪斯妇女乳腺癌患者和诊断延迟的程度及其相关因素。设计这是一项横断面研究。设置和参与者在阿迪斯的七个主要医疗机构中新诊断为乳腺癌的所有妇女（n=441）都包括在研究中。主要结果和测量患者间隔（从发现第一症状到就诊的时间）和诊断间隔（从第一次就诊到诊断的时间）。患者间隔>90天和诊断间隔>30天被认为是延迟，相关因素使用具有稳健方差的多变量泊松回归来确定。（95% CI [31.1%，40.3%]）患者的患者间隔>90天，69%（95% CI [64.6%，73.3%]）患者的诊断间隔>30天。18%的患者的诊断间隔超过1年。95%的患者可自行发现乳腺癌的首发症状，其中以乳房肿块（78.0%）为最常见的首发症状。只有8.0%的人最初担心癌症，大多数人将他们的症状归因于其他因素。在多变量分析中，咨询前使用传统药物与患者延迟患病率增加显著相关（校正患病率比（PR）= 2.13，95% CI [1.68，2.71]）。在卫生中心的首次咨询（调整后的PR = 1.19，95%CI [1.02，1.39]）和访问≥ 4个设施（调整后的PR = 1.24，95%CI [1.10，1.40]）与诊断延迟的患病率较高相关。然而，咨询前症状的进展（调整后的PR = 0.73，95%CI [0.60，0.90]）与诊断延迟发生率的降低相关。结论阿迪斯的乳腺癌患者延长了患者和诊断间隔。这些都强调了公共卫生计划的必要性，以增加对乳腺癌症状的认识，以及公众和医疗保健提供者早期表现和早期诊断的重要性。
Objectives This study aimed to estimate the magnitude of patient and diagnostic delays and associated factors among women with breast cancer in Addis Ababa.Design This is a cross-sectional study.Settings and participants All women newly diagnosed with breast cancer in seven major healthcare facilities in Addis Ababa (n=441) were included in the study.Main outcomes and measures Patient interval (time from recognition of first symptom to medical consultation) and diagnostic interval (time from first consultation to diagnosis). Patient intervals >90 days and diagnostic intervals >30 days were considered delays, and associated factors were determined using multivariable Poisson regressions with robust variance.Results Thirty-six percent (95% CI [31.1%, 40.3%]) of the patients had patient intervals of >90 days, and 69% (95% CI [64.6%, 73.3%]) of the patients had diagnostic intervals of >30 days. Diagnostic interval exceeded 1 year for 18% of patients. Ninety-five percent of the patients detected the first symptoms of breast cancer by themselves, with breast lump (78.0%) as the most common first symptom. Only 8.0% were concerned about cancer initially, with most attributing their symptoms to other factors. In the multivariable analysis, using traditional medicine before consultation was significantly associated with increased prevalence of patient delay (adjusted prevalence ratio (PR) = 2.13, 95% CI [1.68, 2.71]). First consultation at health centres (adjusted PR = 1.19, 95% CI [1.02, 1.39]) and visiting >= 4 facilities (adjusted PR = 1.24, 95% CI [1.10, 1.40]) were associated with higher prevalence of diagnostic delay. However, progression of symptoms before consultation (adjusted PR = 0.73, 95% CI [0.60, 0.90]) was associated with decreased prevalence of diagnostic delay.Conclusions Patients with breast cancer in Addis Ababa have prolonged patient and diagnostic intervals. These underscore the need for public health programme to increase knowledge about breast cancer symptoms and the importance of early presentation and early diagnosis among the general public and healthcare providers.