Faculty of Medicine of Tunis, Department of Epidemiology and Public Health, Street DjabelLakhdar, 1002, Tunis, Tunisia.
Department of Biostatistics and Epidemiology, Cancer Registry North of Tunisia, Salah Azaiz Institute, Tunis, Tunisia.
Asian Pac J Cancer Prev. 2023 Feb 1;24(2):471-477. doi: 10.31557/APJCP.2023.24.2.471.
Breast cancer (BC) remains one of the most common and deadliest cancer among women worldwide and in Tunisia. The lethality of BC is particularly high in developing countries, such as Tunisia, due to late diagnosis in the majority of cases. The objective of this study was to analyze factors associated with delayed presentation among women followed at the Salah Azaiez institute of Tunis during the year 2021.
It was a retrospective cohort study, including patients with primary BC, consulting at the Salah Azaeiz institute of Tunis over a period of six months, from january 1st to june, 30th, 2021. The total diagnostic interval (DI) was divided into patient interval (PI) and healthcare system interval (HSI). Diagnosis delay due to patient (PD) was defined as a delay more than three months between the discovery of symptoms and the first medical consultation. Data were collected using a valid questionnaire "the breast cancer questionnaire delay" and from patients' medical records. The calculation of crude and adjusted Odds Ratios using a stepwise descending binary logistic regression model was performed to measure the association of the studied factors with the delayed presentation.
A total, 146 patients were included. The mean age of the patients was 50.1 ± 10.9 years. More than a half of patients had a primary education (56.8%). Majority of patients were married (86.3%) and unemployed (90.4%). The median of patient interval (PI) and HSI were 31 days [IQR: 12.5-151.5] and 53 days [IQR: 33.0-88.7] respectively. About three quarter of patients (76.4%) presented a healthcare system delay (HSD). After univariate analysis, factors significantly associated with PD were the low level of education (illiterate/primary) (RR: 2.7; 95% CI [1.1-6.4]; p=0.02) and the lack of knowledge about BC symptoms by patients (RR: 15.0; 95% CI [6.0-37.4]; p<10-3). The only variable that remained associated with PD, after multivariate analysis, was lack of initial knowledge of symptoms (OR: 15.0; 95% CI [6.0-37.4]; p<10-3).
Lack of knowledge of symptoms was the main factor associated with delayed presentation among BC women.This study shows the need to inform women about performing breast self-examination as well as clinical signs of BC.
乳腺癌（BC）仍然是全世界和突尼斯女性中最常见和最致命的癌症之一。由于大多数情况下诊断较晚，BC 的致死率在突尼斯等发展中国家特别高。本研究的目的是分析 2021 年在突尼斯萨拉赫·阿扎伊兹研究所就诊的女性中与延迟就诊相关的因素。
这是一项回顾性队列研究，包括在 2021 年 1 月 1 日至 6 月 30 日期间在突尼斯萨拉赫·阿扎伊兹研究所就诊的原发性乳腺癌患者。总诊断间隔（DI）分为患者间隔（PI）和医疗系统间隔（HSI）。由于患者导致的诊断延迟（PD）定义为从发现症状到首次就诊超过三个月的延迟。使用有效的问卷“乳腺癌问卷延迟”和患者病历收集数据。使用逐步降序二元逻辑回归模型计算粗和调整后的优势比（OR），以衡量研究因素与延迟就诊的关联。
共纳入 146 例患者。患者的平均年龄为 50.1 ± 10.9 岁。超过一半的患者接受过小学教育（56.8%）。大多数患者已婚（86.3%）和失业（90.4%）。患者间隔（PI）和医疗系统间隔（HSI）的中位数分别为 31 天[IQR：12.5-151.5]和 53 天[IQR：33.0-88.7]。约四分之三的患者（76.4%）存在医疗系统延迟（HSD）。单因素分析后，与 PD 显著相关的因素是低教育水平（文盲/小学）（RR：2.7；95%CI [1.1-6.4]；p=0.02）和患者对 BC 症状缺乏了解（RR：15.0；95%CI [6.0-37.4]；p<10-3）。多因素分析后，唯一与 PD 相关的变量是缺乏对症状的初步了解（OR：15.0；95%CI [6.0-37.4]；p<10-3）。
对症状缺乏了解是 BC 女性延迟就诊的主要因素。本研究表明，有必要告知女性进行乳房自我检查以及 BC 的临床体征。
