Assessing Delay Patterns in Diagnosis and Care Among Breast Cancer Patients in Ethiopia

Abstract

BACKGROUND: In Ethiopia, breast cancer patients often present with advanced-stage disease, leading to high mortality. This study aimed to quantify diagnostic and treatment intervals and identify their association with stage at presentation. AIM: The aim of this study is to determine the role of specific types of delay on the stage of disease presentation for breast cancer. METHODS AND RESULTS: A multicenter cross-sectional study was conducted at Ethiopia's two largest tertiary oncology centers. Data from 205 histologically confirmed breast cancer patients were analyzed using multivariable logistic regression and random forest machine learning to evaluate the impact of various time intervals on disease stage. The median total delay was 5.05 months, with more than half of patients exceeding a six-month interval from symptom onset to treatment initiation. Primary delay (patient interval) was the dominant contributor, accounting for over 77% of the total variance in delay. Total delay > 6 months was independently associated with a 4.26-fold higher odds of advanced-stage (Stage III/IV) presentation (AOR 4.26, 95% CI: 2.07-8.77, p < 0.001). Lack of awareness was the primary reason for delay (77.8%), while complementary medicine use and absence of pain were not significantly associated with prolonged total delay. CONCLUSION: The majority of delays occur during the pre-clinical phase. Reducing primary delay through targeted community awareness and improved symptom recognition is critical to achieving earlier diagnosis and reducing breast cancer mortality in Ethiopia.