Hoveling Liza A, Heuken Lynn P, Harfst Thachita, Schuurman Melinda S, van Asselt Kristel M, Siesling Sabine, Bode Christina
Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands.
Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands.
Int J Cancer. 2025 Nov 1;157(9):1830-1840. doi: 10.1002/ijc.70008. Epub 2025 Jun 20.
Africa has the highest age-standardized breast cancer (BC) mortality rates, largely due to diagnostic delays. Therefore, this scoping review aims to identify individual-level factors that contribute to diagnostic delay of BC in African women. We conducted a global scoping review on cancer diagnostic delays in women, following PRISMA-ScR guidelines. In this scoping review, diagnostic delay is defined as the time from first symptom recognition to pathological diagnosis. Qualitative and quantitative studies involving cancer patients or healthcare professionals published between 2018 and November 28, 2023, were included. We searched PubMed/MEDLINE and Scopus, excluding non-English studies and those focused solely on screening. Two reviewers independently screened titles, full texts, and extracted data. Disagreements were resolved by discussion. Consultations followed Arksey and O'Malley's framework, with input from a general practitioner, psychologist, and epidemiologist. Factors were classified using Bronfenbrenner's ecological model to analyze BC diagnostic delays in Africa. Of 9699 studies, 128 were relevant; 30 focused on African BC patients. Delays were linked to microsystem factors: lack of awareness, fear, young age, low education, finances, mesosystem factors: family duties, limited access, delayed care, symptom disclosure, exosystem factors: traditional healers, mistrust, referral inefficiencies, and macrosystem factors: religious beliefs, education gaps, cultural norms. Diagnostic delays in women with BC in Africa are mainly due to low awareness, cultural beliefs, and reliance on traditional healers. Expanding current interventions and integrating them into healthcare systems, along with engaging religious leaders, is important. Future research should focus on culturally tailored strategies to improve early detection and outcomes.
非洲的年龄标准化乳腺癌死亡率最高，这主要是由于诊断延迟。因此，本范围综述旨在确定导致非洲女性乳腺癌诊断延迟的个体层面因素。我们遵循PRISMA-ScR指南，对全球女性癌症诊断延迟情况进行了范围综述。在本范围综述中，诊断延迟定义为从首次症状识别到病理诊断的时间。纳入了2018年至2023年11月28日期间发表的涉及癌症患者或医护人员的定性和定量研究。我们检索了PubMed/MEDLINE和Scopus，排除了非英语研究以及仅专注于筛查的研究。两名评审员独立筛选标题、全文并提取数据。分歧通过讨论解决。咨询遵循阿克西和奥马利的框架，并得到了一名全科医生、心理学家和流行病学家的意见。使用布伦芬布伦纳的生态模型对因素进行分类，以分析非洲的乳腺癌诊断延迟情况。在9699项研究中，128项相关；30项聚焦于非洲乳腺癌患者。延迟与微观系统因素有关：意识缺乏、恐惧、年轻、教育程度低、经济状况；中观系统因素：家庭责任、就医机会有限、护理延迟、症状披露；外部系统因素：传统治疗师、不信任、转诊效率低下；以及宏观系统因素：宗教信仰、教育差距、文化规范。非洲乳腺癌女性的诊断延迟主要是由于意识淡薄、文化信仰以及对传统治疗师的依赖。扩大当前的干预措施并将其纳入医疗保健系统，同时让宗教领袖参与进来，这很重要。未来的研究应侧重于制定适合文化背景的策略，以改善早期发现和治疗结果。
