• Ayesha Khan Ayub teaching hospital
  • Khalid Khan Ayub Teaching Hospital
  • Ali Raza Ayub Teaching Hospital
  • Zaheer ud Din Qureshi Ayub Teaching Hospital
  • Babar Sultan Ayub Teaching Hospital
  • Fahad Ali Khan Ayub Teaching Hospital


Background: Delay in the diagnosis of carcinoma breast has important prognostic, clinical and medico-legal implications. This study assesses the frequency and causes of patient delay in women with breast cancer presenting to a breast clinic run by a specialist surgical unit in a tertiary care hospital.  Methods: For this study all women, aged between 16–90 years, who presented with primary breast carcinoma of any histological type, diagnosed between June 2016 to September 2017 were eligible. Structured interviews were administered during the first visit with a confirmed diagnosis or the first hospitalization due to carcinoma breast, and the frequencies of the factors for delay analysed. Results: 84% of the patients presenting with primary carcinoma breast present with a significant patient delay, of which older patients who are illiterate, poor, coming from rural areas and unaware of carcinoma breast as a disease, among other factors, have a higher tendency to delay consultation. Conclusion: Healthcare advice-seeking behaviour in women suffering from breast cancer in Pakistan is alarming with a vast majority of patients presenting late leading to delayed treatment and probable worse outcomes and survival.Keywords: carcinoma breast; self-delay; late diagnosis; patient delay; breast cancer

Author Biographies

Ayesha Khan, Ayub teaching hospital

General surgery resident, surgical A unit, Ayub teaching hospital.

Khalid Khan, Ayub Teaching Hospital

Head of Surgery and Allied, Ayub teaching hospital.

Ali Raza, Ayub Teaching Hospital

General surgery resident, surgical A unit, Ayub teaching hospital.

Zaheer ud Din Qureshi, Ayub Teaching Hospital

Associate Professor Surgery, Ayub Teaching Hospital

Babar Sultan, Ayub Teaching Hospital

Associate Professor Surgery, Ayub Teaching Hospital

Fahad Ali Khan, Ayub Teaching Hospital

resident Surgeon, Ayub Teaching hospital


Tartter PI, Pace D, Frost M, Bernstein JL. Delay in diagnosis of breast cancer. Ann Surg 1999;229(1):91–6.

Smith EC, Ziogas A, Anton-Culver H. Delay in surgical treatment and survival after breast cancer diagnosis in young women by race/ethbicity. JAMA Surg 2013;148(6):516–23.

Hansen RP, Vedsted P, Sokolowski I, Sondergaard J, Olesen F. General practitioner characteristics and delay in cancer diagnosis. A population-based cohort study. BMC Fam Pract 2011;12:100.

Caplan LS, Helzlsouer KJ. Delay in breast cancer: a review of the literature. Public Health Rev 1993;20(3-4):187–214.

Caplan Lee. Delay in Breast Cancer: Implications for Stage at Diagnosis and Survival. Front Public Health 2014;2:87.

Barros FA, Uemura G, Soares de Macedo JL. Interval for access to treatment for breast cancer in the Federal District, Brazil. Rev Bras Ginecol Obstet 2013;35(10):458–63.

Ozmen V, Boylu S, Ok E, Canturk NZ, Celik V, Kapkac M, et al. Factors affecting breast cancer treatment delay in Turkey: a study from Turkish Federation of Breast Diseases Societies. Eur J Public Health 2014;25(1):9–14.

Black AR, Woods-Giscombé C. Applying the Stress and ‘Strength’ Hypothesis to Black Women’s Breast Cancer Screening Delays. Stress Health 2012;28(5):389–96.

Chintamani, Tuteja A, Khandelwal R, Tandon M, Bamal R, Jain S, et al. Patient and provider delays in breast cancer patients attending a tertiary care centre: a prospective study. JRSM Short Rep 2011;2(10):76.

Bodapati SL, Babu GR. Oncologist Perspectives on Breast Cancer Screening in India - Results from a Qualitative Study in Andhra Pradesh. Asian Pac J Cancer Prev 2013;14(10):5817–23.

Bourdeanu L, Luu T, Baker N, Swain-Cabriales S, Chung CT, Mortimer J, et al. Barriers to Treatment in Patients With Locally Advanced Breast Cancer. J Natl Compr Canc Netw 2013;11(10):1193–8.

Quaife SL, Forbes LJ, Ramirez AJ, Brain KE, Donnelly C, Simon AE, et al. Recognition of cancer warning signs and anticipated delay in help-seeking in a population sample of adults in the UK. Br J Cancer 2014;110(1):12–8.

Partridge AH, Hughes ME, Ottesen RA, Wong YN, Edge SB, Theriault RL, et al. The Effect of Age on Delay in Diagnosis and Stage of Breast Cancer. Oncologist 2012;17(6):775–82.

Sheppard VB, Isaacs C, Luta G, Willey SC, Boisvert M, Harper FW, et al. Narrowing Racial Gaps in Breast Cancer Chemotherapy Initiation: The Role of the Patient-Provider Relationship. Breast Cancer Res Treat 2013;139(1):207–16.

Landolsi A, Gahbiche S, Chaafii R, Chabchoub I, Ben Fatma L, Hochlef M, et al. Reasons of diagnosis delay of breast cancer in Tunisian women (160 patients in central region of Tunisia). Tunis Med 2010;88(12):894–7.

Memon ZA, Shaikh AN, Rizwan S, Sardar MB. Reasons for patient’s delay in diagnosis of breast carcinoma in Pakistan. Asian Pac J Cancer Prev 2013;14(12):7409–14.

Yau TK, Choi CW, Ng E, Yeung R, Soong IS, Lee AWM. Delayed presentation of symptomatic breast cancers in Hong Kong: experience in a public cancer center. Hong Kong Med J 2010;16(5):373–7.

Yusoff N, Taib NAM, Ahmad A. The health seeking trajectories of malaysian women and their husbands in delay cases of breast cancer: A qualitative study. Asian Pac J Cancer Prev 2011;12(10):2563–70.

Ceballos-García GY, Giraldo-Mora CV. Autobarreras” de las mujeres al diagnóstico y tratamiento oportuno del cáncer de mama. Aquichán 2011;11(2):140–57.

Lim JNW. Empirical comparisons of patient delay and help seeking models for breast cancer: fitness of models for use and generalisation. Asian Pac J Cancer Prev 2011;12(6):1589–95.

Ukwenya AY, Yusufu LMD, Nmadu PT, Garbaa ES, Ahmed A. Delayed treatment of symptomatic breast cancer: The experience from Kaduna, Nigeria. S Afr Surg 2008;46(4):106–10.

Taib NA, Yip CH, Low WY. Recognizing symptoms of breast cancer as a reason for delayed presentation in asian women - the psycho-sociocultural model for breast symptom appraisal: Opportunities for intervention. Asian Pac J Cancer Prev 2011;12(6):1601–8.

Fedewa SA, Ward EM, Stewart AK, Edge SB. Delays in adjuvant chemotherapy treatment among patients with breast cancer are more likely in African American and Hispanic populations: A National cohort study 2004-2006. J Clin Oncol 2010;28(27):4135–41.

Goodson WH 3rd. Moore DH 2nd. Causes of Physician Delay in the Diagnosis of Breast Cancer. Arch Intern Med 2002;162(12):1343–8.

Shyyan R, Masood S, Badwe RA,Errico KM, Liberman L, Ozmen V, et al. Breast cancer in limited-resource countries: diagnosis and pathology. Breast J 2006;12(Suppl 1):S27–37.

Jassem J, Ozmen V, Bacanu F, Drobniene M, Eglitis J, Lakshmaiah KC, et al. Delays in diagnosis and treatment of breast cancer: a multinational analysis: Eur J Public Health 2014;24(5):761–7.

Afzelius P, Zedeler K, Sommer H, Mouridsen H, Blichert-Toft M. Patient's and doctor's delay in primary breast cancer. Acta Oncol 1994;33(4):345–51.

Ramirez AJ, Westcombe AM, Burgess CC, Sutton S, Littlejohns P, Richards MA. Factors predicting delayed presentation of symptomatic breast cancer: a systematic review. Lancet 1999;353(9159):1127–31.

Arndt V, Sturmer T, Stegmaier C, Ziegler H, Dhom G, Brenner H. Patient delay and stage of diagnosis among breast cancer patients in Germany--a population based study. Br J Cancer 2002;86(7):1034–40.

Piñeros M, Sánchez R, Cendales R, Perry F, Ocampo R. Patient delay among Colombian women with breast cancer. Salud Publica Mex 2009;51(5):372–80.

Pakseresht S, Ingle G, Garg S, Sarafraz N. Stage at diagnosis and delay in seeking medical care among women with breast cancer, Delhi, India. Iran Red Crescent Med J 2014;16(12):e14490.

Gangane N, Anshu, Manvatkar S, Ng N, Hurting AK, San Sebastian M. Prevalence and risk factors for patient delay among women with breast cancer in rural India. Asia Pac J Public Health 2016;28(1):72–82.

Binns C, Low WY, Lee MK. Breast cancer: an increasing public health problem in the Asia Pacific region. Asia Pac J Public Health 2013;25(5):364–7.



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