Factors Associated with Delayed Diagnosis of Breast Cancer in Northeast Thailand

Background: We identified factors associated with delayed first consultation for breast symptoms (patient delay), delayed diagnosis after first consultation (doctor delay), and advanced pathologic stage at presentation among 180 women with breast cancer in Thailand.

Methods: In this cross-sectional study 180 patients with invasive breast cancer were interviewed about potential risk factors and markers of delayed presentation. Patient delay was defined as time from onset of symptoms to first consultation with a health care provider, and doctor delay was defined as time from first consultation with a health care provider to diagnosis of breast cancer. Linear regression and logistic regression were used for the data analyses.

Results: Among the 180 patients, 17% delayed seeking consultation for longer than 3 months, and 42% reported a doctor delay of longer than 3 months. In multivariate linear analysis, a significant increase in patient delay was associated with higher family income and smoking; factors associated with increased doctor delay were previous breast symptoms, self-treatment, and travel time to the hospital. In multiple logistic regression, doctor delay was related to age at first birth (P = 0.003), previous breast symptoms (P = 0.01), and number of consultations with a surgeon before diagnosis (P = 0.007). Regarding stage of breast cancer, there were significant associations with age at diagnosis (P for trend = 0.04), education (P for trend = 0.01), family income (P for trend = 0.02), time to referral (P = 0.01), and number of consultations with a surgeon before diagnosis (P < 0.01).

Conclusions: Hospital referral from a health care provider was a major contributor to delayed diagnosis. Breast cancer awareness campaigns in Thailand should target individuals in low- and high-income groups, as well as practitioners.