RESEARCH – March 2012

Delay in presentation and causes of delay among breast cancer patients in Estonia


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Background. Survival from breast cancer (BC), although improving, is still much lower in Estonia than in most other European countries. The purpose of this study was to examine the risk factors for patient delay in BC diagnosis in Estonia.

Methods. Women diagnosed with primary BC from May 2008 to December 2010 and treated at the North Estonia Medical Centre were invited to participate in the study. Data were collected using structured interviews carried out by trained nurses. In addition to sociodemographic, socioeconomic and other potential risk factors, the patients were asked to report the pathway from initial sign/symptom to final diagnosis. Only self-detected symptomatic patients were included in analysis. Associations between potential risk factors and self-reported delayed presentation, defined as not seeking appointment with a doctor within seven days after discovering of symptoms, were assessed using logistic regression.

Results. During the study period, 809 women were interviewed and among these, 571 self-detected symptomatic patients were eligible for this analysis. A total of 36% of the respondents reported to have delayed presenting to a medical professional. Multivariate logistic regression analyses revealed that the risk of delayed presentation was significantly increased among women aged 70 and older compared with younger women, among women of Estonian nationality compared with non-Estonian women, among current smokers compared with nonsmokers and ex-smokers, among women with more than two close persons to confide in compared with women who had no such persons, and among women who had not received information about BC during the past 12 months compared with women who had received information from two or more sources. Also, women diagnosed in 2010 had higher risk of delay than those diagnosed in 2008. Income, self-reported deprivation, unemployment, marital status, household size, and place of residence did not appear to be associated with patient delay. For more than half the patients who had delayed, the main reported reason was regarding symptoms as harmless, unimportant and temporary.

Conclusions. Patient delay in BC diagnosis is an important problem in Estonia. Different information sources should be made available to make sure that information about BC reaches women of all ages, nationalities and social groups but particularly older women. It is important to raise the awareness of other BC symptoms besides breast lump and to stress the importance of early presentation for cancer outcomes.