School of Social Sciences, Faculty of Arts, Monash University, Clayton, Victoria, Australia.
Co-Convener of Health and Biofutures Focus Programme, School of Social Sciences, Faculty of Arts, Monash University, Clayton, Victoria, Australia.
Health Soc Care Community. 2022 Nov;30(6):e6322-e6331. doi: 10.1111/hsc.14074. Epub 2022 Oct 17.
Women in low- and middle-income countries where the prevalence and mortality of breast cancer are growing rapidly are more likely to be diagnosed at advanced stages, which negatively affects their treatment outcomes and chance of survival. The current literature in those settings tends to focus largely on explaining patient delay in seeking medical attention for breast symptoms. Meanwhile, little is known as to what prompts women to attend screening and diagnostic services after discovering symptomatic breasts. Drawn upon the data from in-depth interviews with 33 breast cancer patients in Central Vietnam conducted in 2019, this paper examines the context of women's decisions about breast screening and how the practice of seeking cancer diagnosis occurred. Our findings reveal an absence of a national screening program and that seeking medical advice was conducted on an ad hoc basis after self-detection of breast symptoms. Women's interpretations of symptomatic breasts as suspicious signs of cancer, the co-occurrence of important life events, or encouragement by people in their social network motivated women to seek medical attention at different public and private health facilities. Their encounters with the health sector often involved multiple visits across time and space in which they experienced various forms of diagnosis delay produced by the health system. Our study carries implications for interventions to encourage women's awareness of early cancer symptoms and prompt medical presentation after self-discovery of symptomatic breasts.
在乳腺癌发病率和死亡率迅速上升的中低收入国家,女性更有可能被诊断为晚期,这对她们的治疗效果和生存机会产生负面影响。目前这些地区的文献往往主要集中在解释患者对乳房症状寻求医疗关注的延迟上。与此同时,对于女性在发现乳房有症状后为何会选择参加筛查和诊断服务,知之甚少。本研究利用 2019 年在越南中部对 33 名乳腺癌患者进行的深入访谈数据,考察了女性进行乳房筛查决策的背景,以及寻求癌症诊断的实践过程。研究结果表明,越南没有全国性的筛查项目,女性在自我发现乳房症状后会根据需要寻求医疗建议。女性将乳房症状解释为癌症可疑迹象、重要生活事件的同时发生,或者是社交网络中的人的鼓励,这些因素促使她们在不同的公立和私立医疗机构寻求医疗帮助。她们与卫生部门的接触通常涉及多次往返于不同时间和空间,在此过程中,她们经历了各种形式的由卫生系统导致的诊断延迟。本研究对干预措施具有启示意义,这些措施旨在鼓励女性意识到早期癌症症状,并在自我发现乳房有症状后及时就医。