Table 2.
Breast Cancer Pathway Steps and Sample Quotes
| Step | Substep | Data sample |
|---|---|---|
| Step 1: Initial symptom recognition and appraisal | Type of symptom and way of discovery | “I was there one day and I examined my breast and I realized that there is a lump at the top.” (P21) |
| “When I woke up in the morning, I wore a white nightie the previous night and I realized there was blood where my breast touched the fabric.” (P19) | ||
| Initial symptom interpretation | “I felt the lump so I kept touching it. My mind went there…. [assuming it was due to breast cancer].” (P8) | |
| “Whenever I am about to have my menses, my breasts will swell up and become bigger… When I observed this change… I reasoned that it could be related to my menses. I did not perceive it serious.” (P11) | ||
| Symptom disclosure | “I showed it to three of my sisters…. It looked as if the breast was tilted…One of my sisters advised me to take it straight to [a district hospital] in the morning if I have insurance.” (P12) | |
| “There was a nurse in our house and…when I told her, she told me to wait for a while because it could be the result of the ‘sure’ [deodorant] I am using, so I should stop using it.” (P18) | ||
| Step 2: Initial management before seeking orthodox medicine | Traditional herbal medicine | “I considered the lump as one of the usual breast problems. So, I started treating it with herbal medications.” (P9) |
| Over-the-counter medication | “My children…bought me some medication from the chemist to stop the breast pains.” (P32) | |
| Faith healing | “I initially thought the breast heaviness was due to evil witches bedeviling me. So I went to my personal priest…and resorted to prayers.” (P26) | |
| Wait and see | “I found the lump in August, I thought it was just an ordinary lump…. Hence I waited until around October but monitored the symptom alongside.” (P6) | |
| Step 3: Decision to seek orthodox medicine | Additional symptoms | “Since it started being painful I had to do away with the herbal treatment and report to the [hospital].” (P24) |
| Alternative therapy failure | “When the lump appeared, we started treating it with herbal medications and it went down a bit and it reappeared a little worse…When the herbal medication did not work we brought it to [hospital].” (P9) | |
| Advice and pressure from social network | “The moment I told them [friends about symptoms], they said ‘be quick and take it to the hospital because you don't play around with diseases affecting the breast….’ And I rushed to the hospital.” (P7) | |
| Step 4a: Reach first health facility | “And when we went there [district hospital] the doctor declared it to be a lump so we should go and take a scan and he will take it (the lump) out for me.” (P17) | |
| “I went to see the doctor [district hospital] and he told me that those who used to work on these kind of cases are no longer working at the hospital. So he called another doctor at [tertiary hospital] and informed him that he is sending a patient to him…I started coming here [tertiary hospital].” (P30) | ||
| Step 4b: Reach second health facility | “I went to the hospital [regional facility], and they told me ‘No, it is not anything’ so I should go home…Three weeks' time, I went to [another facility] … for review. And when they checked, they said the thing [lump] was no longer there. And me too, I just relaxed and stayed at home.” (P16) | |
| Step 5: Diagnostic evaluations | “Well, when I came to [tertiary hospital] he [doctor] gave us some tests and we took a very big picture [scans]. He also requested another test at [private lab]. I have even been to that place two times. And all the documents associated with these are there. And I can't even count the numerous other tests I've done over here.” (P5) | |
| “He [doctor] took a sample of the breast…then he asked that I take a scan of the breast. He also asked me to go to [private lab] where they put the breast in a machine (mammogram].” (P11) | ||
| Step 6: Get diagnosed with breast cancer | “I did the breast scan mammogram and the tissue biopsy…and I went for the results and it they told me it was cancer.” (P8) | |
| Step 7: Discussion at tumor board | “Following the diagnosis, we were scheduled for a meeting [tumor board] in two weeks. The doctor explained that everyone involved [at the tumor board] will bring their opinion …it is important for me to sit in during deliberations… However, the same doctor later told us not to come for the meeting due to my long distance, so he will represent me.” (P4) | |
| Step 8: Evaluations before starting treatment | “He requested I go for a lab test… they examined a lot of tissues They examine your blood; they check the blood to know if you can take the thing [chemotherapy].” (P23) | |
| Step 9: Start treatment | “I did four chemotherapy cycles before I was operated on. Then another four after operation.” (P12) |