Factors associated with diagnostic delays in lung cancer in East Africa: The role of symptoms and passive smoking

Abstract

Background: Screening for lung cancer often relies on symptom presentation and diagnostic imaging, yet many symptoms are non-specific, leading to potential misdiagnoses and delays. Methods: Adults (≥18 years) with biopsy-confirmed lung cancer were enrolled from cancer clinics in Uganda and Tanzania. Logistic regression analyzed factors associated with diagnostic delays stratified by HIV status. Results: From 2022, 528 potential lung cancer cases were screened; 227 (43.0%) were confirmed. The median age was 59 years (IQR: 49-68), with a majority of females (55.0%) and (7.9%) infected with HIV-1. Out of the 18 HIV-1 infected individuals, only two had detectable viral loads. Current and passive smokers comprised 26.4% and 18.5% of the cohort, respectively. Adenocarcinoma was the most common type (50.2%), with advanced-stage presentation (III and IV) in 89.3% of cases. Diagnostic delay, defined as seeking care after 90 days from symptom onset, occurred in 30% (95% CI: 25.1%-37.2%). Significant factors included cough (OR=3.7, 95% CI: 1.23-11.41, P=0.020), hemoptysis (OR=1.5, 95% CI: 1.03-2.10, P=0.034), household smoking (OR=1.5, 95% CI: 1.03-2.25, P=0.036), and history of chest radiation (OR=1.9, 95% CI: 1.33-2.70, P<0.001). HIV status and socio-demographic characteristics were not statistically significant. Conclusion: A significant proportion of lung cancer patients experienced diagnostic delays, influenced by specific symptoms and passive smoking. Enhancing public awareness about key symptoms and the risks of passive smoking is crucial. Future interventions should focus on public health education and training for early symptom recognition among healthcare providers.