Abstract C105: Late-stage diagnosis of breast cancer and associated factors at rural hospitals in Ethiopia: A mixed-method study
Authors: Tesfaw Aragaw , Getachew Sefonias , Taylor Lesley , Kantelhardt Eva Johanna , Addissie Adamu 
Published: August 2020

Abstract
Background: A key factor for beneficial breast cancer (BC) outcome is detection at early stage; however, late-stage diagnosis of BC is a common problem in Africa. In Ethiopia the causes for late-stage presentation are not well studied, particularly in rural settings. Thus, the main aim of this study was to assess the magnitude of late-stage diagnosis of BC and its associated factors at six selected public hospitals in south and southwestern Ethiopia, where 80.6% of the population inhabits rural areas.
Methods: A hospital-based retrospective cross-sectional study was conducted from January 2013 to December 2017. A total of 426 BC patients' records were reviewed. Qualitative data were collected by in-depth interview from purposely selected health care providers and patients. Multiple logistic regression was used to identify factors associated with late-stage diagnosis of BC. P-value &lt;0.05 was used to determine level of significance.
Result: Of the 426 BC patients, 72.5% presented with late-stage disease (stage III and IV). The median age was 42.8 years (+/- 13.4 years). 93.4% of the cases were female. 73% (331/426) patients had longer than 3 months' delay to treatment. 89.9 % of the patients presented with a palpable mass and 42.3% presented with an active wound. Among all, 34.3% were referred to the regional centers by private and public health facilities, thus indicating a previous point of contact with a heath care provider. Almost one third (33.8 percent) were diagnosed with Grade III disease. Independent risk factors for late stage of presentation and diagnosis were the patient's own delay to care (AOR=1.87, 95% CI; 1.04, 3.38); living in a rural area (AOR=2.97, 95%CI; 1.66, 5.34); and delays within the health care system to refer (AOR=2.03, 95%CI; 1.09, 3.78). Females were at more risk than males (AOR=3.75 95%CI; 1.33, 10.54). Patients with breast masses (AOR=4.09, 95%CI; 1.66, 10.11), wounds (AOR=0.41, 95%CI 0.24, 0.72), and Grade III tumor (AOR=2.45, 95%CI; 1.27, 4.73) were also associated to late stage at presentation. The In-depth interview revealed that lack of awareness and knowledge to BC, use of traditional therapy, considering symptoms as “not serious,” and long waiting times to receive care at referred health facilities were the main reasons for late-stage presentation and diagnosis.
Conclusion: The study found that patient delay, rural residence, breast lump and wound, tumor grade, sex and a referral history were factors related to the high proportion of late stage at diagnosis. Hence, there is a need to increase patients' awareness to prevent delays in diagnosis and to strengthen the capacity of early detection, diagnosis and referrals within the health care system.
Citation Format: Aragaw Tesfaw, Sefonias Getachew, Lesley Taylor, Eva Johanna Kantelhardt, Adamu Addissie. Late-stage diagnosis of breast cancer and associated factors at rural hospitals in Ethiopia: A mixed-method study [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr C105.