Prevalence of Themes Linked to Delayed Presentation of Breast Cancer in Africa: A Meta-Analysis of Patient-Reported Studies

Author:

Agodirin Olayide S.1,Aremu Isiaka2,Rahman Ganiyu A.3,Olatoke Samuel A.1,Akande Halimat J.4,Oguntola Adetunji S.5,Olasehinde Olalekan6,Ojulari Sheriff7,Etonyeaku Amarachukwu6,Olaogun Julius8,Romanoff Anya910

Affiliation:

1. Department of Surgery, University of Ilorin and University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria

2. Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria

3. Department of Surgery, University of Cape Coast and Cape Coast Teaching Hospital, Cape Coast, Ghana

4. Department of Radiology, University of Ilorin and University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria

5. Department of Surgery, Lautech Teaching Hospital, Ogbomoso, Oyo State, Nigeria

6. Department of Surgery, Obafemi Awolowo Teaching Hospital, Ile-Ife, Osun State, Nigeria

7. Department of Physiology, University of Ilorin, Ilorin, Kwara State, Nigeria

8. Department of Surgery, Ekiti State Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria

9. Breast Surgery, Dubin Breast Center, Icahn School of Medicine, The Mount Sinai Hospital, New York, NY

10. Department of Health System Design and Global Health, Icahn School of Medicine, The Mount Sinai Hospital, New York, NY

Abstract

PURPOSE The prevalence of themes linked to delay in presentation of breast cancer (BC) and their underlying factors vary considerably throughout Africa. Regional differences and trends are largely unreported. The purpose of this research was to provide summary estimates of the prevalence and distribution of the themes and underlying factors linked to delay in the presentation of BC, regional variation, and trends in an effort to identify targets for intervention. DESIGN We screened articles found through PubMed/Medline, African Journal OnLine, Science Direct, Google/Google Scholar, and ResearchGate. We included patient-reported surveys on the reasons linked to delayed presentation under 6 previously identified themes: symptom misinterpretation, fear, preference for alternative care, social influence, hospital-related factors, and access factors. The meta-analytical procedure in MetaXL used the quality-effect model. RESULTS Twelve of the 236 identified articles were eligible for this review. The overall summary estimate of late presentation (> 90 days) was 54% (95% CI, 23 to 85) and was worst in the eastern and central regions. Symptom misinterpretation was the most common theme (50%; 95% CI, 21 to 56), followed by fear (17%; 95% CI, 3 to 27), hospital-related theme (11%; 95% CI, 1 to 21), preference for alternative care (10%; 95% CI, 0 to 21), social influence (7%; 95% CI, 0 to 14), and access-related theme (6%; 95% CI, 0 to 13). The most common factor underlying symptom misinterpretation was mischaracterizing the breast lesion as benign (60%; 95% CI, 4 to 100) which surpassed lack of awareness in the last decade. Misdiagnosis and failure to refer were the dominant hospital-related factors. CONCLUSION Modifiable factors such as mischaracterizing malignant masses as benign, fear, misdiagnosis, and failure to refer were the prevalent factors contributing to delays throughout Africa. These factors are promising targets for intervention.

Publisher

American Society of Clinical Oncology (ASCO)

Subject

Cancer Research,Oncology

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