Breast cancer barriers in a low and middle income country: evaluation of factors associated with early diagnosis and beginning of treatment

Objective: The aim of this study was to assess the difficulties faced by patients with breast cancer in accessing health services from the detection of the first symptoms to the start of treatment. Methods: A cross-sectional study was conducted between January and December 2020. A structured questionnaire with the inclusion of socioeconomic variables was applied. We sought to understand the possible difficulties faced by patients to gain access to health services, as well as the characteristics of the disease and initial symptoms presented until the beginning of the treatment. Results: In total, 102 women were diagnosed with breast cancer and aged between 25 and 80. In all, 54.9% and 95.1%, respectively, lived in a large city and within 13 km of the health service. Nodule perception was the first symptom in 81 patients (80.4%). After symptom perception, the first consultation was carried out by a general practitioner in 65.7% of the cases, who performed a clinical examination of the breasts and requested a mammogram in 63.7% and 80.4% of the cases, respectively. Considering the mammogram, 50% of patients had never undergone the examination. Regarding the difficulties faced in scheduling the first appointment, fear of diagnosis (83.3%) and negative experiences (31.4%) were the most mentioned. For the difficulties with having a mammogram, the fear of diagnosis (81.4%) and the limitations of transportation/distance (42.2%) stood out. Of the difficulties in scheduling the biopsy, the fear of diagnosis (85.3%) followed by transport/distance (51.0%) were the most frequent reports. At diagnosis, 46.1% of patients were in stages III and IV. Conclusion: The fear of a cancer diagnosis and negative experiences with health services were the difficulties most described by the participants after the occurrence of breast symptoms until the first consultation. Other factors, such as limited transportation and distance to health centers, made it difficult to perform mammography and breast biopsy. Together, the data from this study reinforce the need for comprehensive care for patients with suspected breast cancer.