Abstract
Introduction: Incidence of breast cancer has been increasing in Kerala over the past decade and has overtaken cervical cancer. Early detection and treatment can completely cure breast cancer. Delay of more than 3 months results in poor prognosis. Nevertheless, delayed help seeking is seen among the majority of women who come to clinics. Patient delay can occur at three levels (delay due to not disclosing to another person, delay in consulting a doctor and delay in starting treatment).
Objectives: To study the pattern of delay in help seeking behavior among female breast cancer patients and to find out reasons for delay.
Methodology: Study was conducted in the female wards of Surgery and Radiotherapy Departments, in a tertiary care centre in South Kerala. 60 patients were interviewed and data collected using semi-structured questionnaire.
Results: The study was conducted in 60 patients who were diagnosed as breast cancer and were under treatment in a tertiary care centre in South Kerala. The mean age was 50.15 years (9.725). 73.3% were rural residents, 43.3% APL, 63.3% housewives, 83.3% married. 26.7% knew about screening, of which 56.2% knew mammogram and 81.2%, self-breast examination. Of the latter, 83.3% practiced it while others did not, due to ignorance. Lump was the commonest symptom detected, in 75%. 50% reported at early stage. 55.6% of those who sought help at first symptom reported to their husbands. 51.7% had delay of more than 3 months, 5.0%, less than 3 months and 43.3% had no delay. The median help seeking delay in disclosing to another person was 8.0 months (6.0-24.0), in consulting a doctor, 6.0 months (2.0-19.5) and in starting treatment, 1.5 months (1.0-3.0). Median total delay was 11.0 months (6.0-31.5).
Conclusion: In spite of Kerala having high female literacy, the majority of women delayed due to ignorance and lack of awareness about disease itself and screening practices. Ironically, many who are aware do not take proper steps to detect breast cancer early. Programmes targeted at increasing the awareness among women are necessary so that they present early and have a better chance of survival.
Keywords: Breast cancer, Delay, Awareness, Help seeking, Breast cancer in Kerala.
References
- Chintamani A., Khandelwal, R., Tandon, M., Bamal, R., Jain, S., Narayan, N., Srinivas, S. &, Kumar, Y. 2011. Patient and provider delays in breast cancer patients attending a tertiary care centre: a prospective study Department of Surgery and Vardhman Mahavir Medical College, Safdarjang Hospital, New Delhi. JRSM Short Rep. 2011 Oct. 2(10): 76. doi: 10.1258/shorts.2011.011006. Epub 2011 Oct 10.PMID:22046495[PubMed].
- Dubayova, T., van Dijk, J.P., Nagyova, I., Rosenberger, J., Havlikova, E., Gdovinova, Z., Middel, B. & Groothoff, J.W. 1998. The impact of the intensity of fear on patient’s delay regarding health care seeking behavior: a systematic review. J. Public Health, 55(5): 459-68. doi: 10.1007/s00038-010-0149-0. Epub 2010 May 14. PMID:20467882 [PubMed - indexed for MEDLINE] PMCID:PMC2941081.
- Facione, N.C., Giancarlo, C. & Chan, L. 2000. Perceived risk and help-seeking behavior for breast cancer: A Chinese-American perspective. Cancer Nurs., 23(4): 258-67. PMID:10939173 [PubMed - indexed for MEDLINE]
- Grunfeld, E.A., Ramirez, A.J., Hunter, M.S. & Richards, M.A. 2002. Women’s knowledge and beliefs regarding breast cancer. Br. J. Cancer, 86(9): 1373-8. PMID: 11986766 [PubMed - indexed for MEDLINE]
- Grunfeld, E.A. & Kohli, N. 2010. Beliefs about breast cancer and help-seeking intentions for the disease among women in India. King’s college, London Women Health, 50(4): 327-41. doi:10.1080/03630242.2010.498752. PMID:20711947[PubMed-indexed for MEDLINE]
- Heisey, R., Clemons, M., Granek, L., Fergus, K., Hum, S., Lord, B., McCready, D.R. & Fitzgerald, B. 2011. Health care strategies to promote earlier presentation of symptomatic breast cancer: perspectives of women and family physicians. Oncol., 18(5): e227-37. PMID:21980254 [PubMed] PMCID:PMC3185904.
- Hunter, M.S., Grunfeld, E.A. & Ramirez, A.J. 2003. Help seeking intentions for breast cancer symptoms: a comparison of the self regulation model and the theory of planned behavior. Br. J. Health Psychol., 8(3): 319-33. PMID:14606976[PubMed- indexed for MEDLINE]
- Jayalekshmi, P., Gangadharan, P. & Mani, K.S. 2006. Cancer in women in Kerala--a transition from a less-developed state. Asia J. Cancer Prev., 7(2): 186-90.
- Karla Unger-Saldaña Infante-Castañeda, C. 2009. Delay of medical care for symptomatic breast cancer: A literature review. Salud Publica Mex., 51 Suppl 2: 270-85. Review. PMID:19967283 [PubMed - indexed for MEDLINE] Facultad de Medicina de la Universidad Nacional Autónoma de México, Mexico City.
- Mor, V., Masterson-Allen, S., Goldberg, R., Guadagnoli, E. & Wool, M.S. 1990. Pre-diagnostic symptom recognition and help seeking among cancer patients. Community Health, 15(4): 253-66. RI 02912 Brown University Center, Providence.
- Montazeri Ali, Ebrahimi, M., Mehrdad, N., Ansari, M. & Sajadian, A. 2003. Delayed presentation in breast cancer: a study in Iranian women. BMC Women’s Health. 3(1): 4. PMID:12846932 [PubMed - as supplied by publisher]
- Norsa'adah, B., Rahmah,A., Rampal, K.G. & Knight A. 2012. Understanding barriers to Malaysian women with breast cancer seeking help. Asia Pac. J. Cancer Prev., 13 (8): 3723-30.
- O' Mahony, M., Hegarty, J. & McCarthy, G. 2011. Women's help seeking behaviour for self-discovered breast cancer symptoms. Eur. J. Oncol. Nurs., 15(5): 410-8. doi: 10.1016/j.ejon.2010.10.011. Epub 2010 Nov 19.PMID:21094088 [PubMed - indexed for MEDLINE]
Corresponding Author
Dr. Praveen P
Department of Internal Medicine,
T.D. Medical College, Alappuzha, Kerala, India
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
DOI: https://dx.doi.org/10.18535/jmscr/v6i3.118
