Abstract:
Objectives: To determine the causes of delayed
presentation in breast cancer patients at Korle Bu
Teaching Hospital (KBTH), and reasons for patients
absconding before and during treatment.
Design: Questionnaire survey.
Setting: Out patient departments and surgical wards
of KBTH.
Participants: Women newly diagnosed with breast
cancer and breast cancer patients who previously
absconded and were returning for treatment.
Results: Sixty six newly-diagnosed patients aged
between 20 and 84 (mean 44.8, median 43) years and
35 previous absconders aged 20 to 74 (mean 44.5,
median 44) years were interviewed. The causes of
delayed presentation were: previous medical consultations
26(29.4%), ignorance 19(28.8%), fear of mastectomy
16(24.2%), herbal treatment 13(19.7%),
prayer/prayer camps 13(19.7%) and financial incapability
12(18.2%). Fear of mastectomy 20(57.1%),
herbal treatment 13(37.1%), financial incapability
11(31.4%) and prayers/prayer camps 10(28.6%)
which were prominent causes of late presentation,
were the main reasons for absconding. Newly diagnosed
patients had duration of symptoms one week
to five years (mean 46, median 34 weeks). Those
whose lumps were found by clinical breast examination
in the community presented to hospital between
six weeks to two years (mean 47, median 39 weeks).
Married women were more likely to abscond
(p=0.001).
Conclusions: There are similar reasons for delayed
presentation and absconding among Ghanaian patients.
These must be addressed in outreach programmes,
and patients must be counselled at time of
diagnosis. Dealing with the causes of delayed presentation
appears more important than attempts to screen
for breast cancer, since patients identified through
community screening still present late to hospital.