Identifying women at risk for delayed presentation of breast cancer: a cross-sectional study in Estonia

BMC Public Health

Mare Tekkel⁴  Jaak Lehtsaar²  Riina Kütner¹  Evelyn Eelma²  Vahur Valvere⁵  Peeter Padrik³  Kaire Innos⁴ 

[1] Clinic of Surgery, North Estonia Medical Centre, Tallinn, Estonia;Clinic of Hematology and Oncology, Tartu University Hospital, Tartu, Estonia;Clinic of Hematology and Oncology, University of Tartu, Tartu, Estonia;Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia;Competence Centre for Cancer Research, Tallinn, Estonia

关键词: Mammography;    Smoking;    Women’s health;    Primary care;    Delayed presentation;    Breast cancer;   

Others  :  1161675
DOI  :  10.1186/1471-2458-13-947

 received in 2013-03-08, accepted in 2013-10-08,  发布年份 2013

【 摘 要 】

Background

Survival from breast cancer remains lower in Estonia than in most other European countries. More advanced stage and larger tumors that have impact on survival may be a result of delay in seeking help for breast cancer symptoms. The aim of this study was to identify determinants of delayed presentation among breast cancer patients in Estonia.

Methods

The study population included women with primary breast cancer diagnosed in Estonia in 2008–2010. All data were collected using structured personal interviews carried out by trained nurses in the hospital setting. Only patients with self-discovered symptoms were included in this analysis. Patient delay was measured as time elapsing from symptom self-discovery to first medical consultation. The effect of different factors on the likelihood of prolonged delay (>90 days) was evaluated using logistic regression.

Results

Among 703 eligible patients, median patient delay was 16 days (interquartile range 5–54 days). Seventeen percent of the patients had their first medical consultation more than three months after self-detection of symptoms. In multivariate analysis, the risk of prolonged delay was significantly associated with age 65 years and over (OR 2.27, 95% CI 1.23–4.20), current smoking (OR 2.09, 95% CI 1.21–3.61), symptoms other than painless breast lump or breast pain (OR 1.84, 95% CI 1.08–3.16), no history of mammograms (OR 1.83, 95% CI 1.13–2.95), having received no information on breast cancer during past year (OR 1.77, 95% CI 1.05–2.99), and previous benign breast problems (OR 1.65, 95% CI 1.01–2.67). Non-significant risk increase was seen with lower education.

Conclusions

This study provides evidence that factors associated with delayed presentation of breast cancer in Eastern Europe are similar to those observed in Western countries. The results suggest that educational messages to general population should aim at increasing awareness of “non-lump” symptoms of breast cancer and encouraging women of all ages to present in a timely manner. Women at risk for delayed presentation such as smokers and women with no history of mammograms could be identified in the primary care setting.

【 授权许可】

   
2013 Innos et al.; licensee BioMed Central Ltd.

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