Table 2.
Time from recognition of potential symptoms of breast cancer to presentation to the first health care provider, diagnosis and start of treatment, and number of health care providers visited
| Author, year [ref no] | Country (sample size) | Time from |
No. of health care providers visited before visit to the one where diagnosis was made | ||
|---|---|---|---|---|---|
| Symptom recognition to presentation | Presentation to diagnosis | Diagnosis to start of treatment | |||
| North Africa | |||||
| Ahmed, 2014 [11]∗ | Sudan (n = 141) | Md: 12 mo; Ra: 2–108 mo | n/a | n/a | |
| Aloulou, 2015 [12] | Morocco (n = 130) | Me: 8.47 mo; > 6 mo: 63.1% | n/a | n/a | |
| Benbakhta, 2015 [13] | Morocco (n = 200) | Md: 65 days (=2.17 mo); IQR: 31–121 days; Ra: 3–579 days | Md: 20 days (=0.67 mo); IQR: 10–40 days; Ra: 1–433 days | Md: 25 days (=0.83 mo); IQR: 9–42 days; Ra: 0–368 days | n/a |
| Md: 50 days (=1.67 mo); IQR: 29, 77 days; Ra: 5–535 days | |||||
| Md: 120 days (4.0 mo); IQR: 81–202 days; Ra: 14–860 days | |||||
| El-Shinawi, 2013 [14] | Morocco (n = 45) | <1 mo: 46.7% 1 to <6 mo: 37.8% 6 to <12 mo: 0% >12 mo: 15.6% |
n/a | n/a | n/a |
| Ermiah, 2012 [15] | Libya (n = 200) | Md: 4 mo (max. 24) <3 mo: 46% 3–6 mo: 14% >6 mo: 40% |
Md: < 1 mo <1 mo: 84.5% 1–6 mo: 4.5% >6 mo: 11.0% |
n/a | n/a |
| Md: 7.5 mo (max. 25 mo) <3 mo: 30% 3–6 mo: 14% >6 mo: 56% | |||||
| Landolsi, 2010 [16]∗ | Tunisia (n = 160) | Mean: 11.6 mo; Md: 8 mo | n/a | n/a | |
| Mousa, 2011 [17] | Egypt (n = 163) | Me: 6.2 mo; Md: 2.3 mo | Presentation to arrival at TCC: Me: 6.8 wk; Md: 2.5 wk | n/a | Me: 1.5; Ra: 0–4 (does not mention traditional or spiritual healers) |
| Stapleton, 2011 [9] | Egypt (n = 343) | Md: <1 mo | n/a | n/a | n/a |
| Sub-Saharan Africa | |||||
| Clegg-Lamptey, 2009 [18] | Ghana (n = 66) | Me: 46 wk (=10.7 mo) Md: 34 wk (=7.9 mo) Ra: 1 wk, 5 y |
n/a | Previous medical consultation: 39.4% | |
| Ezeome, 2010 [19] | Nigeria (n = 162) | <1 mo: 26.4% 1–3 mo: 28.3% >3 to 6 mo: 17.6% >6 mo: 27.7% |
<1 mo: 17% 1–3 mo: 10.6% >3 to 6 mo: 16% >6 mo: 56.4% |
n/a | |
| <1 mo: 5.6% 1–3 mo: 4.3% >3 to 6 mo: 17.3% >6 mo: 72.8% | |||||
| Ibrahim, 2012 [20] | Nigeria (n = 201) | Me (SD): 12.12 (5.18) mo Ra: 1 wk to 96 mo <1 mo: 4.5% 1–3 mo: 13.9% >3 to 6 mo: 32.8% >6 to 12 mo: 30.8% >12 mo: 17.9% |
n/a | n/a | n/a |
| Marcus, 2013 [21]∗ | South Africa (n = 103) | <3 mo: 17.5% 3–6 mo: 30.1% >6 mo: 52.4% |
n/a | n/a | n/a |
| Otieno, 2010 [22]∗ | Kenya (n = 166; 98.8% females) | From first symptoms to presentation at Kenyatta National Hospital (late stage only) <30 d: 6.62% 31–90 d: 20.4% >90 d: 73.08% |
n/a | n/a | |
| Pace, 2015 [23] | Rwanda (n = 144) | Md: 5 mo (IQR: 1–13) | Md: 5 mo (IQR: 2–14) | n/a | <5 HCP visits: 44% ≥5 HCP visits: 56% (does not mention traditional or spiritual healers) |
| Md: 15 mo (IQR: 8–32) | |||||
| Price, 2012 [24] | Cameroon (n = 50) | n/a | >3 mo: 42% >6 mo: 32% |
n/a | Consulted ≥4 HCP: 46% (including traditional and spiritual healers) |
| >6 mo: 60% | |||||
| Toure, 2013 [25] | Cote d'Ivoire (n = 350) | <6 mo: 9.1% 6–10 mo: 12% 10–14 mo: 78.9% Weighted mean: 10.7 mo |
n/a | n/a | |
| Quantitative and qualitative studies | |||||
| Dye, 2010 [26] | Ethiopia (n = 69; 98.1% females) | n/a | n/a | n/a | >2 HCP visits: 73.2% (including traditional or spiritual healers) |
| Ly, 2002 [27] | Mali (n = 44; 43 females) | 1–12 wk (=2.8 mo): 63.6% 13 (=3.0 mo) to 48 wk (=11.2 mo): 36.4% Weighted mean: 3.4 mo |
n/a | n/a | >3 HCP: 50% (only conventional HCP included) |
| From symptoms to first appointment at the study (diagnostic) hospital: Ra: 8 wk (=1.87 mo) to 72 wk (=16.8 mo) | |||||
| Qualitative studies | |||||
| Ekortarl, 2007 [28] | Cameroon (n = 9 BC cases; 11 subjects with other types of cancer) | n/a | n/a | n/a | n/a |
| Mbuka-Ongona, 2012 [29] | Botswana (n = 11) | Time from first symptom to presentation at study hospital (PMH): Me: 3 y; Ra: 1–10 y |
n/a | n/a | |
| Pruitt, 2015 [30] | Nigeria (n = 31) | n/a | n/a | n/a | |
BC = breast cancer; CI = confidence interval; HCP = health care provider; IQR = interquartile range; Md = median; Me = mean; n/a = not reported in the original publication; Ra = range; TCC = Tanca Cancer Center.
∗
Study recruited only patients with advanced breast cancer (see Table 1).