Why do breast cancer patients report late or abscond during treatment in ghana? A pilot study.

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.