Determinants of early breast cancer presentation: a qualitative exploration among female survivors in Indonesia

Objective Early presentation with breast cancer symptoms is crucial to the effectiveness of treatment and the affected women's long-term survival. However, in Indonesia, 60-70% of breast cancer patients first present themselves to the hospital in an advanced stage. Knowledge about the determinants of breast cancer early presentation could inform efforts to promote healthcare seeking at earlier symptomatic stages. In the current study, we explored the psychosocial determinants of early presentation among female breast cancer survivors. Methods Face-to-face semi-structured interviews were conducted with 23 female breast cancer survivors in Surabaya, Indonesia (mean age = 49.8 years). Directed content analysis approach was used to analyse the data. Results Half of the respondents underwent breast cancer screening prior to onset of symptoms. Nine determinants of breast cancer early presentation were reflected in the women's responses: (lack of) knowledge, perceived behavioural control, previous health related experiences and risk perceptions, attitudes and beliefs, norms, competing priorities, financial issues, instrumental factors, and health provider factors. Conclusion Health promotion efforts should focus on both internal and external psychosocial determinants related to the breast cancer early presentation, and on involving women's social environment as target for education. Additionally, providing accessible and affordable healthcare is important for early presentation.