Factors contributing to delays in diagnosis of breast cancers in Ghana, West Africa

Late diagnoses and poor prognoses of breast cancer are common throughout Africa. To identify responsible factors, we utilized data from a population-based case-control study involving 1184 women with breast malignancies conducted in three hospitals in Accra and Kumasi, Ghana. Interviews focused on potential breast cancer risk factors as well as factors that might contribute to presentation delays. We calculated odds ratios (OR) and 95% confidence intervals (CI) comparing malignances with biopsy masses larger than 5 cm. (62.4% of the 1027 cases with measurable lesions) to smaller lesions. In multivariate analyses, strong predictors of larger masses were limited education (OR 1.96, 95% CI 1.32-2.90 < primary vs. >= senior secondary school), being separated/divorced or widowed (1.75, 1.18-2.60 and 2.25, 1.43-3.55, respectively, vs. currently married), delay in care seeking after onset of symptoms (2.64, 1.77-3.95 for >= 12 vs. <= 2 months), care having initially been sought from someone other than a doctor/nurse (1.86, 0.85-4.09), and frequent use of herbal medications/treatment (1.51, 0.95-2.43 for >= 3x/day usage vs. none). Particularly high risks associated with these factors were found among less educated women; for example, women with less than junior secondary schooling who delayed seeking care for breast symptoms for 6 months or longer were at nearly 4-times the risk of more educated women who promptly sought assistance. Our findings suggest that additional communication, particularly among less educated women, could promote earlier breast cancer diagnoses. Involvement of individuals other than medical practitioners, including traditional healers, may be helpful in this process.