Abstract IA33: Pathways to breast cancer care in South Africa
Authors: Moodley Jennifer 
Published: December 2017

Abstract
Breast cancer is a major public health burden and remains the commonest cancer among women worldwide. In 2012, 1.7 million women were newly diagnosed with breast cancer and 522 000 women died of the disease with the majority of cases (53%) and deaths (63%) occurring in low- and middle-income countries.
In South Africa (SA) breast cancer is the most commonly diagnosed cancer among women and accounts for 16% of all female cancer deaths. Similar to other developing countries, the majority of patients in SA present with late stage disease, which is associated with a poorer prognosis. SA does not have a national mammography-screening program. Typically women with breast symptoms self-present to primary health care facilities and are referred to secondary or tertiary level health facilities if further diagnostic work-up is required to diagnose breast cancer. Appropriate recognition of breast symptoms, improved access to health facilities and accurate investigation of symptomatic women are essential to down stage breast cancer.
Worldwide, the majority of cancers (85-90%) are diagnosed on the basis of symptomatic presentation despite cancer screening programs. Studies have shown that for symptomatic breast cancer, shorter time to presentation to a health care provider is associated with early stage disease, and better breast cancer survival. Further, a substantial proportion of late stage diagnosis of poorly differentiated breast cancer cases could be avoided if patients had presented within one month of detecting symptoms. Consequently, understanding breast cancer symptom awareness, and responses to symptoms by both patients and providers are important in developing interventions to promote timely breast cancer diagnosis.
For people with potential symptoms of cancer, the pathway to cancer diagnosis is complex. Internationally, research has shown that personal, disease and healthcare factors are associated with the timeliness of seeking care for symptomatic disease and can contribute to late stage presentation. Primary care providers also play a pivotal role in timely cancer diagnosis and referral. Understanding the influence of these factors on the pathway women follow to breast cancer diagnosis is vital to the development of interventions.
The Model of Pathways to Treatment provides a useful research framework to explore and understand patient's journeys to care as it takes into account the complex and dynamic nature of help-seeking behavior. The Model identifies five key events in the pathway to care viz. detection of bodily changes; perceived reasons to discuss symptoms with a health care provider; first consultation with a health care provider; diagnosis and start of treatment, and four important intervals between these events: the appraisal, help seeking, diagnostic and the pre-treatment intervals. Using the Model, this presentation will outline what is currently known about patient pathways to breast cancer care in SA and what further research is required to develop targeted interventions to promote timely diagnosis of breast cancer.
Citation Format: Jennifer Moodley. Pathways to breast cancer care in South Africa [abstract]. In: Proceedings of the AACR International Conference: New Frontiers in Cancer Research; 2017 Jan 18-22; Cape Town, South Africa. Philadelphia (PA): AACR; Cancer Res 2017;77(22 Suppl):Abstract nr IA33.