Beliefs and practices associated with late presentation in patients with breast cancer; an observational study of patient presenting in a tertiary care facility in Southwest Nigeria

Background The incidence rate of breast cancer (BC) in the high income countries (HIC) is higher than in low income countries (LIC) and middle income countries (MIC), but the overall mortality rate is much less than in LIC and MIC. Most cases of BC in HIC present early as a result of established screening programs which detects the disease at curable stage. In most LIC and MIC like Nigeria, most cases of BC present late coupled with dearth of personnel, equipment and drugs required with resultant effect of poor survival and high mortality rate associated with BC. Overwhelming studies have identified late presentation as a major cause of poor outcome of BC management in our country; however there are few studies about why the BC patients present late. Methods This is a prospective cross-sectional study of patients who presented with histologically confirmed BC at surgical outpatient clinic and surgical wards of Olabisi Onabanjo University Teaching Hospital from 1 st January 2011 to December 2014. Questionnaire was developed to interview patients at first contact detailing demographic characteristics, symptom duration, place of initial presentation, perception of and BC treatment knowledge. Late presentation is defined as presenting in a health facility (hospital/clinic) after 3months of onset of symptoms. SPSS version 20 was used to analysis the results using descriptive statistics, Chi squared to compare groups and T test /ANOVA to compare means. Results One hundred and thirteen (113) patients who were all females were studied with mean age of 47.8 years (s.d 10.5), out of this figure, 47 (41.6%) patients presented late at hospital of initial presentation, while 83 patients (73.4%) presented late in our facility of which 36 patients (32%) had presented early at the hospital of initial presentation. Factors associated with late presentation includes rural residency (p 0.02), treatment by traditional healers (p 0.001), low biopsy rate (p 0.002), prior BC knowledge (p 0.024), perception of BC treatment as only surgical (p 0.03) mastectomy as procedure (p 0.03), notion that surgery aggravates BC (p 0.003). Mean duration of symptoms at first presentation in a hospital in months was 4 (s.d 3) and at our facility 14 (s.d 10). Mean duration of symptoms at first presentation and at our facilities according to patient perception of BC treatment were as follows: no idea 2.4 (s.d 2), lump removal 1.3 (s.d 0.6), mastectomy4 (s.d 3) (p 0.03), and no idea 8 (s.d 5), lump removal 10 (s.d 7), mastectomy 16 (s.d 10) (p 0.007). Mean duration of symptoms in months at first presentation and in our facility in patient who felt BC is aggravated by surgery and those who did not are as follows: Yes 4.3 (s.d 3.2), No 28 (s.d 2.5) and Yes 17 (s.d 10), No 10 (s.d 9) (p 0.01, p 0.00). Conclusion Negative perception of BC treatment by mastectomy is still very much entrenched in our populace and contributes largely to late presentation of patients with BC. There is need for educating the populace on the need for early detection to facilitate the use of breast conservation techniques, breast reconstruction and avoid mastectomy as much as possible.