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Diagnosis delay in Libyan female breast cancer
– Reported, June 14, 2013
In Libya, breast cancer is an important health problem among women. The incidence is 18.8 new cases per 100,000 women per year. Most of the patients present with advanced disease. The patients are often younger than in Europe, in line with the pattern common in Middle East and North Africa (MENA). To improve breast cancer care better understanding of the predicting factors and causes for treatment delay are important issues. Small tumors are more likely to be treated successfully. Delayed presentation of breast cancer is associated with advanced stage and low survival.
In current study, 13.0% of the respondents had taken alternative therapy, compared to 15-73% in Europe. Most patients took alternative treatment as means to avoid surgery. Some patients believed that there were no effective treatments for breast cancer, or that traditional medicines are more effective than modern drugs.
While taking alternative treatments, most patients experienced worsening of symptoms, which eventually led to more advanced stage. The patients want to receive medical therapy but when the response is not favorable, they often use traditional medicine as the last hope.
Negative information, such as side-effects and expected toxicity of chemotherapy led to fear and refusal of therapy. Some patients believed that the effects of chemotherapy were worse than breast cancer itself. Fear of divorce or remarriage of the husband could lead some women to decide not to get their symptoms diagnosed if they suspected breast cancer. Some patients also believed that breast cancer could not be cured, so there was no point of having it diagnosed and treated. Diagnosis delay was also related to a belief that mastectomy causes disfigurement and disability.
There are certain alarm symptoms, important for create cancer diagnosis. However, these are not always known within doctors or nurses. In the present study, we found that the respondents were inappropriately reassured after the first visit to the doctor that a lump can be considered benign without biopsy. This is a false attitude. In this study, this attitude was an important reason to the magnitude of the diagnosis time. Even through the majority of lumps in young patients are benign, histological or cytological diagnosis should be available of every lump.
Mammography is a sensitive means for early detection of breast cancer, but both clinical breast examination (CBE) and breast self-examination (BSE) have the potential to advance the diagnosis of breast cancer without the expense of a mammography facility. Women with regular breast self-examination tended to seek medical care more rapidly and to have earlier stages of disease at diagnosis.
Diagnosis delay is very serious problems in Libya. Diagnosis delay was associated with complex interactions between social, medical and other patient-associated factors leading to advanced stages, potentially resulting in a high mortality. There is a need for improving breast cancer awareness and training of general practitioners to reduce breast cancer mortality by promoting early detection. The treatment guidelines should pay more attention to the early phases of breast cancer. Especially, guidelines for good practices in managing detectable of tumors are necessary.
CREDITS.
http://www.biomedcentral.com/
Eramah Ermiah, Fathi Abdalla, Abdelbaset Buhmeida, Entesar Larbesh, Seppo Pyrhönen and Yrjö Collan
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