Time to pathologic diagnosis of suspicious breast lesions: An institution‐based study in five Ethiopian hospitals

TL;DR

This study examines how long it takes to diagnose breast cancer in Ethiopia and finds that only 55% of patients meet the WHO's 2-month benchmark.

Contribution

The study provides empirical data on diagnostic delays in Ethiopian hospitals and identifies factors affecting timely breast cancer diagnosis.

Findings

The median time from symptom onset to first healthcare visit was 2.8 months.

55% of patients received a diagnosis within the WHO-recommended 2 months.

Older patients and those referred for pathology at first visit had shorter diagnostic delays.

Abstract

Most breast cancer (BC) patients in sub‐Saharan Africa are diagnosed at advanced stages. The World Health Organization's Global Breast Cancer Initiative Pillar II has a benchmark to diagnose BC within 2 months of the first contact with a health care provider (HCP). In this study, we interviewed 345 women who received a diagnostic workup of a suspicious breast lesion (eventually diagnosed as benign or malignant) at five Ethiopian hospitals in 2022. We assessed the length of the diagnostic journey encompassing the pre‐contact interval between the first experience of symptoms and the first HCP visit, and the post‐contact interval between HCP visit and diagnostic pathology procedures. We used negative binomial regression models to identify factors influencing these time intervals. The median pre‐contact interval was 2.8 months (interquartile range [IQR] 0.5–9.8). The median post‐contact interval was 1.7 months (IQR 0.6–3.9). Regarding the post‐contact interval, 55% of patients received their pathologic diagnosis within the recommended 2 months after the first HCP visit and met the Global Breast Cancer Initiative's benchmark. Increased travel times, limited social support, and consulting multiple HCPs before seeking pathology evaluation prolonged post‐contact intervals. Older patients (>45 years) and those referred for pathology evaluation during the initial HCP visit experienced shorter post‐contact intervals. Of all 345 women, 39% were diagnosed with BC. The relatively low proportion of women diagnosed within the recommended time frame makes it evident that increased awareness for BC, easily accessible diagnostic services, and specific training for HCPs are essential for the timely diagnosis of BC in Ethiopia.

What's new?

The World Health Organization's Global Breast Cancer Initiative set the benchmark to diagnose breast cancer within 2 months of the first contact with a health care provider. This study analyzed the diagnostic journey of women with breast symptoms at five Ethiopian hospitals. Of the 345 women interviewed who received a diagnostic workup of a suspicious breast lesion, 55% received a pathologically confirmed diagnosis within the recommended 2 months, and 39% were diagnosed with breast cancer. Increased awareness among women and frontline healthcare workers, and efficient referral systems are essential to improving breast cancer care and survival in Ethiopia.

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