Patient-mediated factors predicting early- and late-stage presentation of breast cancer in Egypt

Objective: Breast cancer fatality rates are high in low- and middle-income countries because of the late stage at diagnosis. We investigated patient-mediated determinants for late-stage presentation of breast cancer in Egypt. Methods: A case-case comparison was performed for 343 women with breast cancer, comparing those who had been initially diagnosed at Stage I or II with those diagnosed at Stage III or IV. Patients were recruited from the National Cancer Institute of Cairo University and Tanta Cancer Center in the Nile delta. Patients were either newly diagnosed or diagnosed within the year preceding the study. Interviews elicited information on disease history and diagnosis, beliefs and attitudes toward screening practices, distance to treatment facility, education, income, and reproductive history. Results: Forty-six per cent of the patients had presented at late stage. Women seen in Cairo were more likely to present at late stages than patients in Tanta (OR = 5.05; 95% CI = 1.30, 19.70). Women without any pain were more likely to present at later stage (OR = 2.68; 95% CI = 1.18, 6.08). Knowledge of breast self-examination increased the likelihood of women to present in early stages significantly (OR = 0.24; 95% CI = 0.06, 0.94). Conclusions: Despite increasing numbers of cancer centers in Egypt during the past 20 years, additional regional facilities are needed for cancer management. In addition, increasing awareness about breast cancer will have significant long-term impact on breast cancer prevention. Copyright (C) 2010 John Wiley & Sons, Ltd.