BACKGROUND AND AIMS: Breast cancer is the second most common malignancy in India, and majority of patients present as a locally advanced breast carcinoma (LABC). Evaluating the prevalence of LABC and assessing the causes of local advancement and delayed presentation is the aim of the present study. SETTINGS AND DESIGN: This was a rural hospital-based prospective cross-sectional study. STATISTICAL ANALYSIS: Descriptive statistics. MATERIALS AND METHODS: Seventy-one cytologically/histopathologically confirmed cases of breast carcinoma were enrolled in the study. Breast sarcomas and lymphoma were excluded and, of them, prevalence of LABC and causes of delay and local advancement, i.e. patient factors, system factors and biological factors, were evaluated. RESULTS: LABC accounted for 50.7% of these patients. On assessing the cause of advancement of LABC, patient factor (69.8%) was the major cause for delayed presentation, followed by system delay (23.6%). Patient factors were lack of awareness of breast cancer (75%) and financial constraints (52.8%). The system factor was nonreferral by general practitioners to specialty centers or trying to treat these patients with other allied modalities of treatment. CONCLUSIONS: LABC in the Indian scenario is an outcome of neglect due to patient and system factors. These factors offer an excellent opportunity to plan a community-oriented preventive strategy for the general population and practitioners to decrease the incidence of LABC.