BackgroundBreast cancer is the most common cancer in females around the world.Annually, more than one million women are diagnosed with breast cancerglobally. In Oman, breast cancer is also the most common cancer in females andits incidence has been rising over the years. Published studies have shown thatmany Omani women have late stage breast cancer at presentation. Possiblereasons for this have not been explored. Although Oman has in place a mortalityregistration database, no population-based mortality data from breast cancer areavailable. Likewise, the only data available about survival rate of people withbreast cancer come from a hospital-based study.AimsThe main aims of the research described in this thesis are:1) To identify the extent of delay in breast cancer diagnosis in Oman.2) To assess the relationship between delay and socio-demographiccharacteristics, medical and obstetric history, nature of presentingsymptoms and women’s knowledge about breast cancer.3) To identify reasons for delay in seeking medical help for self-detectedbreast cancer symptoms in Omani women.4) To calculate the population-based survival rate from breast cancer inOman.MethodsAims 1, 2 and 3 were addressed by a study of 150 patients attending oncologyclinics in both the Royal Hospital and Sultan Qaboos University Hospital, whowere interviewed using structured questionnaires. Patient delay was defined as aperiod of three months or more between an individual;;s first awareness of a signor a symptom of illness and the initial medical consultation.In order to calculate survival rate, the National Cancer Registry records were tobe linked to mortality databases in Oman (Directorate General of Civil Statusand to the Parallel Mortality Database).ResultsThe final analysis of delay included 144 patients with breast cancer. The mediantime taken by women in this sample between discovering the breast symptomsand seeing a doctor was 14 days. 56.9% of the patients had a medicalconsultation in less than a month after detecting symptoms, whereas 20.1 % hada consultation within 1 to 2 months. 22.9 % of the patients delayed consultationby ≥ 3 months. Of the socio-demographic characteristics examined in this study,it was observed that older age, low educational level and employment statuswere associated with patient delay. Practice of breast self-examination andhaving a history of chronic disease were also predictors of delay. 44% ofpatients had early stage disease (stage I/stage II) compared to 56% of patientswith late stage disease (stage III/stage IV). However, patient delay was notassociated with advanced stage cancer in this study.The main reasons given for delay were: failure to recognise the symptoms to bebreast cancer, not seeing oneself at risk for breast cancer, fear andembarrassment, use of alternative therapy and family and work commitments.Due to ethical consideration, I was not able obtain data from Omani NCR andtherefore the linking to mortality databases was not possible.ConclusionThis study is the first in Oman to investigate the extent of patient delay forwomen with self-discovered breast symptoms and the factors that influence thisdelay. The findings of this study indicate the need for public education aimed atraising breast cancer awareness. Further, initiating a screening program inOman should be considered to help women achieve diagnosis of the disease inits early stages.Population-based cancer research should be encouraged in Oman, and effortsshould be taken to improve the quality and completeness of cancer data, whichare important in providing on-going monitoring of cancer.
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