April 1999, Volume 1, Issue 1, Pages 16 - 19

Paper

Delay in seeking medical advice by breast cancer patients presenting with breast lump Ahmed Elzawawy Professor, Oncology and Nuclear Medicine Center, Suez Canal University & Medical Oncology Unit, Port Said General Hospital, Port Said & Al-Soliman Radiation Oncology Department, Al-Soliman Hospital, Port Said & Nuclear Medicine Unit, Al-Eman Center, Port Said, Egypt     Correspondence to: Prof. Dr. Ahmed Elzawawy , 73, Saad Zagloul St. 42111 Port Said, Egypt. (http://www.icedoc.org)

Keywords

breast;   cancer;   breast lump;   delay in seeking advice

Abstract

Among the most commonly cited causes of delay in seeking medical advice by breast cancer female patients are ignorance, fear and fatalistic attitude. In a previous study performed by us in the region of Suez Canal, Egypt in 1987, we found that psychological factors played the major role in this delay. It was a surprise to see that in a developing country like Egypt most of the delayed patients realized the significance of the presence of breast lump. This initiated us to perform the present updated study in Port Said, Egypt, for 182 breast cancer female patients presenting with breast lump. We applied the previous method that indicates the necessity of doing at least four interviews with each patient within six months. The delay between the discovery of the lump and seeking medical consultation varied between a few hours and 5.3 y with a mean of three months after four interviews while it was only 3 weeks after the first interview. The results revealed that the mean of delay was three months. 136 patients (43.8%) sought medical advice after more than three months of the self-discovery of the lump. These were the patients who delayed (the mean delay was eight months and the percentage of delayed patients was 76% of patients in our previous study, published 11 y ago). Patients who were above 50 y delayed more than younger patients. The presence of a spouse and the work of patients had no effect on the delay. It seems that high education did not prevent the procrastination. Most of the patients, (161, 88.5%) realized the significance of the presence of breast lump. Variations of fear--and not ignorance--were the main causes of delay. The fear of the socio-economic consequences of diagnosis of cancer, particularly the consequences due to financial burden of treatment and travelling away of home to be treated, and the incurability of the disease. The fear of pain and death were more prominent than the fear of disfigurement and mastectomy. The elderly patients had a more fatalistic outlook. The reduction of delay and the percentage of delay in seeking medical advice in comparison to a previous study may be attributed to the progress in availability of cancer treatment modalities in Port Said, particularly the installation of a charity radiotherapy department and the progress of free of charge outpatient chemotherapy regimens. Reduction of financial and social burden, resulting from the availability of nearby treatment facilities should be taken into consideration by policy and health decision-makers and oncologists.

Received December 1998; Accepted 22 December 1998

^© Macmillan Publishers Ltd 1999