撒哈拉以南非洲地区有症状乳腺癌的延迟诊断评估：一项对坦桑尼亚妇女的定性研究。
Delayed diagnostic evaluation of symptomatic breast cancer in sub-Saharan Africa: A qualitative study of Tanzanian women.
机构信息
Department of Radiology, Muhimbili National Hospital, Dar es Salaam, Tanzania.
Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
出版信息
PLoS One. 2022 Oct 6;17(10):e0275639. doi: 10.1371/journal.pone.0275639. eCollection 2022.
BACKGROUND
Women with breast cancer in sub-Saharan Africa are commonly diagnosed at advanced stages. In Tanzania, more than 80% of women are diagnosed with stage III or IV disease, and mortality rates are high. This study explored factors contributing to delayed diagnostic evaluation among women with breast cancer in Tanzania.
METHODS
A qualitative study was performed at Muhimbili National Hospital in Dar es Salaam, Tanzania. Twelve women with symptomatic pathologically proven breast cancer were recruited. In-depth, semi-structured interviews were conducted in Swahili. Interviews explored the women's journey from symptom recognition to diagnosis, including the influence of breast cancer knowledge and pre-conceptions, health seeking behaviors, psychosocial factors, preference for alternative treatments, and the contribution of culture and norms. Audio-recorded interviews were transcribed and translated into English. Thematic analysis was facilitated by a cloud-based qualitative analysis software.
RESULTS
All women reported that their first breast symptom was a self-identified lump or swelling. Major themes for factors contributing to delayed diagnostic presentation of breast cancer included lack of basic knowledge and awareness of breast cancer and misconceptions about the disease. Participants faced barriers with their local primary healthcare providers, including symptom mismanagement and delayed referrals for diagnostic evaluation. Other barriers included financial hardships, fear and stigma of cancer, and use of traditional medicine. The advice and influence of family members and friends played key roles in healthcare-seeking behaviors, serving as both facilitators and barriers.
CONCLUSION
Lack of basic knowledge and awareness of breast cancer, stigma, financial barriers, and local healthcare system barriers were common factors contributing to delayed diagnostic presentation of breast cancer. The influence of friends and family also played key roles as both facilitators and barriers. This information will inform the development of educational intervention strategies to address these barriers and improve earlier diagnosis of symptomatic breast cancer in Tanzania.
背景
撒哈拉以南非洲的乳腺癌女性通常被诊断为晚期。在坦桑尼亚，超过 80%的女性被诊断为 III 期或 IV 期疾病，死亡率很高。本研究探讨了坦桑尼亚乳腺癌女性诊断评估延迟的因素。
方法
在坦桑尼亚达累斯萨拉姆的穆希比利国家医院进行了一项定性研究。招募了 12 名有症状且病理证实的乳腺癌女性。以斯瓦希里语进行深入的半结构化访谈。访谈探讨了女性从症状识别到诊断的历程，包括乳腺癌知识和先入之见、求医行为、心理社会因素、对替代治疗的偏好，以及文化和规范的影响。音频记录的访谈被转录并翻译成英文。基于云的定性分析软件促进了主题分析。
结果
所有女性都报告说，她们的第一个乳房症状是自我识别的肿块或肿胀。导致乳腺癌诊断延迟的主要因素包括缺乏基本的乳腺癌知识和意识以及对该疾病的误解。参与者在当地初级保健提供者方面面临障碍，包括症状管理不善和延迟转介进行诊断评估。其他障碍包括经济困难、对癌症的恐惧和耻辱感以及使用传统医学。家庭成员和朋友的建议和影响在求医行为中起着关键作用，既是促进因素也是障碍。
结论
缺乏基本的乳腺癌知识和意识、耻辱感、经济障碍和当地医疗保健系统障碍是导致乳腺癌诊断延迟的常见因素。朋友和家人的影响也起着关键作用，既是促进因素也是障碍。这些信息将为制定教育干预策略提供信息，以解决这些障碍，提高坦桑尼亚有症状乳腺癌的早期诊断。
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