Factors affecting delay in the presentation of breast cancer symptoms among women in Gaza, occupied Palestinian territory: A cross-sectional survey

Objective: To identify factors related to women's delay in presenting with breast cancer symptoms to improve earlier diagnosis in the occupied Palestinian territory (oPt). Design: Cross-sectional Setting: Two government cancer hospitals. Participants: A consecutive sample of 130 Palestinian women living in Gaza with newly diagnosed breast cancer were approached in the waiting rooms of cancer hospitals in Gaza between 1 January and 31 December 2017. 120 women took part and returned the completed questionnaire. Primary and secondary outcome measures: Clinical information about breast cancer were collected from hospital cancer records. An interval of three months or more between women's self-discovery of symptoms and their first presentation to a medical provider was considered as a delay. Results: 94% (122/130) of women attending cancer hospitals in Gaza agreed to take part in the study. Their mean age was 51 years (range: 23-72), 33.6% (31/122) had a family history of breast cancer, and 74.5% (41/55) of those whose cancer stage was known had been diagnosed at stage III or IV. Around one half (62/122) said they had not recognised the seriousness of their breast changes but only 20% (24/122) of women delayed seeking healthcare by three months and more. Considering that the symptom was not serious (X2= 13.94, p> 0.05), and lack of pain (X2= 6.63, p> 0.05) were the only two factors statistically associated with later presentation. Lower socio-economic status, older age, lower education, and negative family history of breast cancer were not statistically associated with women's delay. Conclusions: Women's awareness about the seriousness of breast changes and the critical importance of seeking prompt diagnosis needs to be improved using context-relevant and evidence-based awareness campaigns. This should be accompanied with training of female nurses on promoting early detection and improvement in diagnostic facilities to ensure timely diagnosis of cancer in the oPt.Microsoft Word.Funding provided by: King's College LondonCrossref Funder Registry ID: http://dx.doi.org/10.13039/501100000764Award Number:This data was collected from two oncology centres in Gaza, occupied Palestinian territory