Ermiah Eramah, Abdalla Fathi, Buhmeida Abdelbaset, Larbesh Entesar, Pyrhönen Seppo, Collan Yrjö
Department of Oncology, University of Turku, Turku, Finland.
BMC Res Notes. 2012 Aug 21;5:452. doi: 10.1186/1756-0500-5-452.
To study the diagnosis delay and its impact on stage of disease among women with breast cancer on Libya.
200 women, aged 22 to 75 years with breast cancer diagnosed during 2008-2009 were interviewed about the period from the first symptoms to the final histological diagnosis of breast cancer. This period (diagnosis time) was categorized into 3 periods: <3 months, 3-6 months, and >6 months. If diagnosis time was longer than 3 months, the diagnosis was considered delayed (diagnosis delay). Consultation time was the time taken to visit the general practitioner after the first symptoms. Retrospective preclinical and clinical data were collected on a form (questionnaire) during an interview with each patient and from medical records.
The median of diagnosis time was 7.5 months. Only 30.0% of patients were diagnosed within 3 months after symptoms. 14% of patients were diagnosed within 3-6 months and 56% within a period longer than 6 months. A number of factors predicted diagnosis delay: Symptoms were not considered serious in 27% of patients. Alternative therapy (therapy not associated with cancer) was applied in 13.0% of the patients. Fear and shame prevented the visit to the doctor in 10% and 4.5% of patients, respectively. Inappropriate reassurance that the lump was benign was an important reason for prolongation of the diagnosis time. Diagnosis delay was associated with initial breast symptom(s) that did not include a lump (p < 0.0001), with women who did not report monthly self examination (p < 0.0001), with old age (p = 0.004), with illiteracy (p = 0.009), with history of benign fibrocystic disease (p = 0.029) and with women who had used oral contraceptive pills longer than 5 years (p = 0.043). At the time of diagnosis, the clinical stage distribution was as follows: 9.0% stage I, 25.5% stage II, 54.0% stage III and 11.5% stage IV.Diagnosis delay was associated with bigger tumour size (p <0.0001), with positive lymph nodes (N2, N3; p < 0.0001), with high incidence of late clinical stages (p < 0.0001), and with metastatic disease (p < 0.0001).
Diagnosis delay is very serious problem in Libya. Diagnosis delay was associated with complex interactions between several factors and with advanced stages. There is a need for improving breast cancer awareness and training of general practitioners to reduce breast cancer mortality by promoting early detection. The treatment guidelines should pay more attention to the early phases of breast cancer. Especially, guidelines for good practices in managing detectable of tumors are necessary.
研究利比亚乳腺癌女性患者的诊断延迟情况及其对疾病分期的影响。
对200名年龄在22至75岁之间、于2008 - 2009年期间确诊为乳腺癌的女性进行访谈，了解从出现首个症状到最终乳腺癌组织学诊断的时间。该时间段（诊断时间）分为3个阶段：<3个月、3 - 6个月和>6个月。若诊断时间超过3个月，则认为诊断延迟。咨询时间是指出现首个症状后就诊于全科医生所花费的时间。在对每位患者进行访谈期间以及从病历中，通过表格（问卷）收集回顾性的临床前和临床数据。
诊断时间的中位数为7.5个月。仅有30.0%的患者在出现症状后的3个月内被诊断。14%的患者在3 - 6个月内被诊断，56%的患者在超过6个月的时间段内被诊断。一些因素可预测诊断延迟：27%的患者认为症状不严重。13.0%的患者采用了替代疗法（与癌症无关的疗法）。分别有10%和4.5%的患者因恐惧和羞耻而未就医。对肿块为良性的不当安抚是诊断时间延长的一个重要原因。诊断延迟与不包括肿块的初始乳房症状相关（p <0.0001），与未报告每月自我检查的女性相关（p <0.0001），与老年相关（p = 0.004），与文盲相关（p = 0.009），与良性纤维囊性疾病史相关（p = 0.029）以及与服用口服避孕药超过5年的女性相关（p = 0.043）。在诊断时，临床分期分布如下：I期9.0%，II期25.5%，III期54.0%，IV期11.5%。诊断延迟与更大的肿瘤大小相关（p <0.0001），与阳性淋巴结（N2、N3；p <0.0001）、晚期临床分期的高发生率相关（p <0.0001）以及与转移性疾病相关（p <0.0001）。
在利比亚，诊断延迟是一个非常严重的问题。诊断延迟与多种因素之间的复杂相互作用以及晚期阶段相关。有必要提高乳腺癌意识并对全科医生进行培训，以通过促进早期发现来降低乳腺癌死亡率。治疗指南应更加关注乳腺癌的早期阶段。特别是，需要制定关于可检测肿瘤管理的良好实践指南。
