Factors Contributing to Delays in Diagnosis of Breast Cancers in Ghana, West Africa

Louise BRINTON, National Cancer Institute, National Institutes of Health, United States
FIGUEROA J. 6 , ADJEI E. 2 , AITPILLAH F. 2 , ANSONG D. 2 , BIRITWUM R. 5 , EDUSEI L. 3 , NYARKO K. 5 , OPPONG J. 2 , OSEI-BONSU E. 2 , VANDERPUYE V. 3 , WIAFE S. 4 , JOEL Y. 3 , WIAFE-ADDAI B. 4 , AWUAH B. 2 , JOE C. 3

1 Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
2 Komfo Anoyke Teaching Hospital, Kumasi, Ghana
3 Korle Bu Teaching Hospital, Accra, Ghana
4 Peace and Love Hospital, Kumasi, Ghana
5 University of Ghana, Accra, Ghana
6 Usher Institute of Population Health Sciences and Informatics, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, Scotland

Late diagnoses of breast cancer are common throughout sub-Saharan Africa, resulting in many poor prognoses.  To identify associated causes, we utilized data from a population-based case-control study conducted in three hospitals in Accra and Kumasi, Ghana in which cases comprised women presenting with suspicious breast lesions.  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) for various factors comparing invasive breast cancers with masses larger than 5 cm. (61.7% of the 827 cases with measurable lesions) to smaller lesions.  In contrast to at least one other study, distance from residence to a medical facility was only marginally associated with larger tumors, likely reflecting the restricted catchment area of study subjects.  In analyses adjusted only for age and study site, factors significantly associated with larger masses were low levels of education, being widowed/separated/ divorced, lack of ownership of such items as a car or computer, practicing no or a traditional religion, not regularly seeing a doctor or nurse, financial problems in paying for medical care, frequent use of herbal medications/treatment, and delays in seeking care once symptoms arose.  In multivariate analyses, independent predictors of larger masses were low levels of education (OR=2.17, 95% CI 1.42-3.31 no formal vs. >senior secondary education), being widowed/separated/ divorced (OR=1.71, 1.19-2.44 vs. currently married), frequent use of herbal medications/treatment (OR=1.73, 0.99-3.03 for >3x/day usage vs. none), and delays in seeking care (OR=1.50, 1.04-2.17 for >2 vs. <1 month).  These findings suggest that additional communication, particularly among poorly educated women, should stress the importance of prompt medical attention for unusual breast symptoms.  Given higher risks of larger tumors among women availing themselves of traditional medicine, the involvement of traditional healers in outreach programs would appear advantageous.