|Year : 2015 | Volume
| Issue : 1 | Page : 102-105
Delay in presentation to the hospital and factors affecting it in breast cancer patients attending tertiary care center in Central India
NA Thakur1, AY Humne2, LB Godale1
1 Departments of Preventive and Social Medicine, Government Medical College, Latur, India
2 Government Medical College, Nagpur, Maharashtra, India
|Date of Web Publication||3-Feb-2016|
N A Thakur
Departments of Preventive and Social Medicine, Government Medical College, Latur
Source of Support: None, Conflict of Interest: None
Introduction: Despite lower incidence of breast cancer in India, the total number of cases and the net mortality is high. To reduce this increasing load of mortality due to breast cancer we need to lay emphasis on early detection and increased use of systemic therapy. Early detection itself depends on early presentation to a health facility; thus, it is important to identify factors affecting delay in a presentation to hospital.Aim And Objectives: To study the clinico-social profile of breast carcinoma patients attending a tertiary care hospital and to study the time lag since detection of lump by women and presentation to the hospital and factors affecting them. Materials And Methods: A total of 120 primary breast cancer patients visiting a tertiary care hospital over a period of 7 months (August 2010 to February 2011) were taken up for study. A detailed retrospective analysis of patients was done according to planned proforma.
Observations: Maximum study subjects were in the age group of 41-50 years. Right and left breasts were equally affected. The most common histo-pathological type of breast carcinoma observed was invasive ductal carcinoma (NOS) in 105 (87.50%) cases. Majority of the cases were in stage III or stage II. The median time lag self-detection of lump in the breast by women and presentation to the hospital was 6 months. Women living in a rural area, those with lower socio-economic status and those with older age tend to assess health-care late. Conclusions: Carcinoma of the breast is a common cancer affecting young to middle age group with invasive ductal carcinoma being the most common histological type. Delay in presentation and late stage presentation is a major concern. Hence, proper awareness and screening programmers are needed to identify, inform and educate these categories of women.
Keywords: Breast, cancer, India, late presentation
|How to cite this article:|
Thakur N A, Humne A Y, Godale L B. Delay in presentation to the hospital and factors affecting it in breast cancer patients attending tertiary care center in Central India. Indian J Cancer 2015;52:102-5
|How to cite this URL:|
Thakur N A, Humne A Y, Godale L B. Delay in presentation to the hospital and factors affecting it in breast cancer patients attending tertiary care center in Central India. Indian J Cancer [serial online] 2015 [cited 2019 Aug 19];52:102-5. Available from: http://www.indianjcancer.com/text.asp?2015/52/1/102/175602
| » Introduction|| |
The upward trend in breast cancer globally and in India has become a matter of great concern. Breast cancer is the most common site-specific cancer and is the leading cause of death from cancer in women., Despite the lower incidence in India (crude rate 20.2/lakh), the total number of cases (115,251), and net mortality (53,592) is high because of the large population, inadequate screening programs and lack of education. The numerous myths and ignorance that prevail in the Indian society result in an unrealistic fear of the disease. Breast cancer awareness programs are more concentrated in the cities and have not reached the remote and rural parts of the country., Women often do not present for medical care early enough due to various reasons such as illiteracy, lack of awareness, and financial constraints. It is hardly surprising that the majority of breast cancer patients in India are still treated at locally advanced and metastatic stages. To reduce this increasing load of mortality due to breast cancer, we need to lay emphasis on early detection and increased use of systemic therapy and that can happen if we have a better understanding of the trend, age group involved and other risk factors. The purpose of this study was to describe the clinico-pathological features of breast cancer in the current local scenario, which would make a difference in the management of breast carcinoma in future. Further, the results of the study can provide data for epidemiological interests and help compare the local data with other parts of the country and elsewhere.
| » Aim and Objectives|| |
To study the clinico-social profile of breast carcinoma patients attending a tertiary care hospital and to study the time lag since detection of lump by women and presentation to the hospital and factors affecting them.
| » Materials and Methods|| |
A total of 120 primary breast cancer patients visiting a tertiary care hospital over a period of 7 months (August 2010 to February 2011) were taken up for study. A detailed retrospective analysis of patients was carried out according to planned proforma. Patients were interviewed in person and information was noted regarding identification, socio-demographic variables like residential, marital, socio-economic, educational status, etc. The time lag since self-detection of lump in breast and presentation to any health facility was noted. Data were analyzed using statistical software STATA 10.1, 2009. Qualitative data were analyzed with percentage, c 2 test although quantitative data were summarized with mean and SD.
Age of patients ranged from 27 years to 75 years with a mean of 45.99 years and SD 9.61 years. Majority of the study subjects were in the age group 41-50 years followed by 31-40 years [Table 1]. Right breast was affected in 65 cases (54%) and left in 52 (43%). Although in remaining 3 cases, the carcinoma was bilateral. Right and left breasts were equally affected (χ=0.6176, df = 1, P = 0.432). The most common histo-pathological type of breast carcinoma observed was invasive ductal carcinoma not otherwise specified (NOS) in 105 (87.50%) cases followed by medullary carcinoma in 7 (5.83%) cases [Figure 1]. Majority of the cases were in stage III (44 [36.67%]) or stage II (41 (34.175)). Although, very few cases were diagnosed in early stages; 8 (06.66%) in stage I and 2 (01.67%) in stage 0 (Insitu stage) [Figure 2].
|Figure 1: Distribution of cases according to histo-pathological type of breast carcinoma|
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|Figure 2: Distribution of cases according to stage of breast carcinoma (n = 109)|
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The time lag since self-detection of lump in the breast by women and presentation to hospital varied from 2 days to 6 years. The median time lag was 6 months [Table 2]. Thus, 50% of women took >6 months to consult medical opinion for the lump. This finding is important in terms of awareness, inhibitions, presentation in late stage of carcinoma, and prognosis of a case. Women living in a rural area, those with lower socio-economic status and those with older age tend to assess health-care late [Table 3].
|Table 2: Time lag since self-detection of lump in the breast by women and presentation to hospital|
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| » Discussion|| |
Maximum cases were between 46 years and 50 years (20%) followed by 41-45 years (19.16%). Similar findings are noted in other Indian studies.,, Literature suggests that breast cancer occurs at a younger age in Asia. The mean age is around 50 years, and the prevalent age group is 40-49 years old. More than 50% of the patients are under the age of 50 years. Present study gets similar findings with 34.16% of the cases up to 40 years of age indicating early onset of disease.
In the present study, right breast was affected in 65 (54%) cases, left breast in 52 (43%) while in remaining 3 cases, the carcinoma was bilateral. The findings are consistent with those of Sandhu et al., and Meshram et al. Although Laishram et al., found predominant involvement of the left side in 102 cases (71.83%) and of the right side in 38 cases (26.76%). Two cases (1.41%) presented with bilateral breast lumps.
The most common histo-pathological type of breast carcinoma observed in the present study was invasive ductal carcinoma (NOS) in 105 (87.50%) cases followed by edullary carcinoma in 7 (5.83%) cases. Sandhu et al., Meshram et al., Saxena et al., Raina et al., and Laishram et al., also had similar findings. The 30-year survival rate of women with special types of invasive carcinomas (tubular, mucinous, medullary, lobular, and papillary) is greater than 60%, compared with lesser than 20% for women with cancers of no special type. Thus, Invasive ductal carcinoma not otherwise specified (NOS), has a poorer prognosis. Hence, the early detection and treatment is important.
Out of 109 cases, majority of the cases were in stage III (44 [36.67%]) or stage II (41 [34.17%]). Very few cases were diagnosed in early stages: 8 (06.66%) in stage I and 2 (01.67%) in stage 0 (Insitu stage). The 5 year survival rate for patients diagnosed in stage 0 was 99% compared to that of stage I (92%), stage IIA (82%), stage IIB (65%), stage IIIA (47%), stage IIIB (44%), and stage IV (14%). Thus, late stage presentation has a poorer prognosis. Harrison et al., stated that most of the cases were detected in stage III (46%) or stage IV (36.5%) of the disease when treatment options are limited and cure may not be possible. Meshram et al., Raina et al., Laishram et al., also observed that a majority of the patients were in stage III breast carcinoma.
In the present study, it was found that the time lag since self-detection of lump in the breast by women and presentation to hospital varied from 2 days to 6 years. The median time lag was 6 months. Thus, 50% of women took >6 months to consult medical opinion for the lump. As the time advances, the chances of spread of tumor locally and distantly are high. Women with breast cancer present at later stages in Asia compared with western countries., The delay in the presentation is attributed mainly to the various barriers that exist in the Asian region. Such barriers can be structural (e.g., poor health facilities, distance to the health-care facility, inability to take time off work) or organizational (e.g., difficulty in navigating the complex health-care system and interaction with medical staff). Psychological and socio-cultural barriers include poor health motivation, denial of personal risk, fatalism, mistrust of cancer treatments, and the fear of becoming a burden to family members. In some traditional cultures, a woman's decision and actions are controlled by men, and men may be unaware of breast screening. In some cultures in Asia, there is also the strong influence of traditional medicine.
Timely diagnosis of symptomatic disease relies on breast health awareness in the potential patient population and in primary health-care professionals and thus increased breast health awareness in terms of risk factors and recognition of symptoms is a key element of interventions at all resource levels.
| » Conclusions|| |
Carcinoma of the breast is a common cancer affecting young to middle age group with invasive ductal carcinoma being the most common histological type. Delay in presentation and late stage presentation is a major concern. There is a need for health education on self-breast examination and early presentation to a health facility for better management. Hence, proper awareness and screening programs are essential.
| » References|| |
Scwartz SI, Shires GT, Spencer FC, Daly JM, Fischer JE, Galloway AC. Principles of Surgery. 7th ed. New York: Mc Graw Hill, Inc; 1999. p. 554-8.
Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin 2005;55:74-108.
Cancer Fact Sheets, Breast Cancer, Globacan 2008, International Agency for Research on Cancer (IARC), World Health Organization, 2008.
Chauhan A, Subba SH, Menezes RG, Shetty BS, Thakur V, Chabra S, et al
. Younger women are affected by breast cancer in South India – A hospital-based descriptive study. Asian Pac J Cancer Prev 2011;12:709-11.
Dinshaw KA, Rao DN, Ganesh B. Tata memorial hospital cancer registry annual report. Mumbai, India:1999.
Dinshaw KA, Shastri SS, Patil SS. Cancer control programme in India: Challenges for the new millennium. HealthAdministrator 2005;17:10-3.
Verma M. Host susceptibility factors. Cancer Epidemiology. In: Verma M, editor, Vol. 1. New York: Humana Press; 2009.
Meshram II, Hiwarkar PA, Kulkarni PN. Reproductive risk factors for breast cancer: A case control study. Online J Health Allied Sci 2009;8:3-5.
Pakseresht S, Ingle GK, Bahadur AK, Ramteke VK, Singh MM, Garg S, et al
. Risk factors with breast cancer among women in Delhi. Indian J Cancer 2009;46:132-8.
Laishram RS, Jongkey G, Laishram S, Sharma DC. Clinico-morphological patterns of breast cancer in Manipur, India. Int J Pathol 2011;9:40-3.
Sandhu DS, Sandhu S, Karwasra RK, Marwah S. Profile of breast cancer patients at a tertiary care hospital in north India. Indian J Cancer 2010;47:16-22.
Saxena S, Rekhi B, Bansal A, Bagga A, Chintamani, Murthy NS. Clinico-morphological patterns of breast cancer including family history in a New Delhi hospital, India – A cross-sectional study. World J Surg Oncol 2005;3:67.
Raina V, Bhutani M, Bedi R, Sharma A, Deo SV, Shukla NK, et al
. Clinical features and prognostic factors of early breast cancer at a major cancer center in North India. Indian J Cancer 2005;42:40-5.
Kumar V, Abbas AK, Fausto N, Mitchell R. Robbins Basic Pathology. 7th
ed. Philadelphia, USA: Elsevier Publication; 2007. p. 1147.
Fauci AS, Kasper DL, Longo DL, Braunwald E, Hauser SL, Larry Jameson J, et al
. Harrisons Principles of Internal Medicine. 17th
ed. Mc Grow Hill Publishers; 2008. p. 567.
Harrison AP, Srinivasan K, Binu VS, Vidyasagar MS, Nair S. Risk factors for breast cancer among women attending a tertiary care hospital in southern India. Int J Collab Res Intern Med Public Health 2010;2:109-16.
Hisham AN, Yip CH. Spectrum of breast cancer in Malaysian women: Overview. World J Surg 2003;27:921-3.
Agarwal G, Pradeep PV, Aggarwal V, Yip CH, Cheung PS. Spectrum of breast cancer in Asian women. World J Surg 2007;31:1031-40.
Ross RK, Paganini-Hill A, Wan PC, Pike MC. Effect of hormone replacement therapy on breast cancer risk: Estrogen versus estrogen plus progestin. J Natl Cancer Inst 2000;92:328-32.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]