Diagnostic Interval: Experiences among Women with Breast Cancer in Malaysia
DOI:
https://doi.org/10.3889/oamjms.2021.7833Keywords:
Breast cancer, Diagnostic interval, Malaysia, WomenAbstract
BACKGROUND: The diagnostic pathway is critical for early breast cancer detection and prognosis improvement. Countries such as the United Kingdom, particularly England, have implemented faster diagnosis standards to ensure that patients receive a definitive diagnosis of cancer or are ruled out within 28 days of referral. However, there is a severe shortage of data on the experiences of breast cancer patients in Malaysia during the diagnostic interval.
AIM: This study aimed to explore what happened to the women during the diagnostic phase prior to confirmation of breast cancer.
METHODOLOGY: Purposive sampling was applied, and 14 participants were recruited from two government hospitals. The participants took part in in-depth, face-to-face, one-time, and audio-recorded interviews. All the interviews were subsequently transcribed verbatim and analyzed using narrative analysis.
RESULTS: The diagnostic interval for the women in this study was 1–3 months from first medical contact till diagnosis. Four themes were identified during the analysis for the diagnostic interval: 1) Women who are suspected of having breast cancer; 2) Women who experience false reassurance; 3) Woman who experience delayed referral; and 4) Women who experience inconclusive investigation results.
CONCLUSIONS: This study indicates that early warning signs of breast cancer may prompt doctors to take immediate action. However, unexpected delays may occur as a result of staffing and system issues in the healthcare system. Healthcare professionals should aggressively refer patients with typical symptoms and actively follow-up with patients who present with atypical symptoms in the community. Continuing education for healthcare professionals is necessary to improve diagnostic and referral procedures.Downloads
Metrics
Plum Analytics Artifact Widget Block
References
World Health Organization. Breast Cancer. Geneva: World Health Organization; 2021. Available from: https://www.who.int/news-room/fact-sheets/detail/breast-cancer [Last accessed on 2021 Jul 10].
National Breast Cancer Foundation. Breast Cancer Facts; 2021. Available from: https://www.nationalbreastcancer.org/breast-cancer-facts [Last accessed on 2021 Jul 10].
Breast Cancer Now. Facts and Statistics; 2021. Available from: https://www.breastcancernow.org/about-us/media/facts-statistics [Last accessed on 2021 Jul 10].
National Cancer Institute. Breast Cancer Risk in American Women; 2019. Available from: http://www.cancer.gov/types/breast/risk-fact-sheet [Last accessed on 2019 Jun 04].
Cancer Research UK. Breast Cancer Genes; 2019. Available from: http://www.cancerresearchuk.org/about-cancer/type/breast-cancer/about/risks/breast-cancer-genes [Last accessed on 2019 Jan 10].
Azizah AB, Hashimah B, Nirmal K, Siti Zubaidah AR, Puteri NA, Nabihah A, et al. Malaysian National Cancer Registry Report 2012-2016. 2019. Malaysia: Ministry of Health.
Scott S, Walter F, Webster A, Sutton S, Emery J. The model of pathways to treatment: Conceptualization and integration with existing theory. Br J Health Psychol. 2013;18(1):45-65. https://doi.org/10.1111/j.2044-8287.2012.02077.x PMid:22536840 DOI: https://doi.org/10.1111/j.2044-8287.2012.02077.x
Koo MM, von Wagner C, Abel GA, McPhail S, Rubin GP, Lyratzopoulos G. Typical and atypical presenting symptoms of breast cancer and their associations with diagnostic intervals: Evidence from a national audit of cancer diagnosis. Cancer Epidemiol. 2017;48:140-6. https://doi.org/10.1016/j.canep.2017.04.010 PMid:28549339 DOI: https://doi.org/10.1016/j.canep.2017.04.010
Malaysia Ministry of Health. Management of Breast Cancer. Malaysia: Ministry of Health; 2010.
WHO. Promoting Cancer Early Diagnosis. Geneva: WHO; 2021. Available from: https://www.who.int/activities/promoting-cancer-early-diagnosis [Last accessed on 2021 Dec 01].
Getachew S, Tesfaw A, Kaba M, Wienke A, Taylor L, Kantelhardt EJ, et al. Perceived barriers to early diagnosis of breast cancer in South and Southwestern Ethiopia: A qualitative study. BMC Womens Health. 2020;20(1):38. https://doi.org/10.1186/s12905-020-00909-7 PMid:32103774 DOI: https://doi.org/10.1186/s12905-020-00909-7
Provost S, Pineault R, Tousignant P, Roberge D, Tremblay D, Breton M, et al. Does the primary care experience influence the cancer diagnostic process? Int J Family Med. 2015;2015:176812. https://doi.org/10.1155/2015/176812 PMid:26504599 DOI: https://doi.org/10.1155/2015/176812
Susinos T. ‘Tell me in your own words’: Disabling barriers and social exclusion in young persons. Disabil Soc. 2007;22:117-2. DOI: https://doi.org/10.1080/09687590601141501
Riessman CK. Narrative Analysis. London: SAGE; 1993.
Riessman CK. Divorce Talk: Women and Men Make Sense of Personal Relationship. USA: Rutgers University Press; 1990.
Majeed I, Ammanuallah R, Anwar AW, Rafique HM, Imran F. Diagnostic and treatment delays in breast cancer in association with multiple factors in Pakistan. East Mediterr Health J. 2021;27(1):23-32. https://doi.org/10.26719/emhj.20.051 PMid:33538316 DOI: https://doi.org/10.26719/emhj.20.051
Maghous A, Rais F, Ahid S, Benhmidou N, Bellahamou K, Loughlimi H, et al. Factors influencing diagnosis delay of advanced breast cancer in Moroccan women. BMC Cancer. 2016;16:356. https://doi.org/10.1186/s12885-016-2394-y PMid:27268201 DOI: https://doi.org/10.1186/s12885-016-2394-y
Poum A, Promthet S, Duffy SW, Parkin DM. Factors associated with delayed diagnosis of breast cancer in Northeast Thailand. J Epidemiol. 2014;24(2):102-8 https://doi.org/10.2188/jea.je20130090 PMid:24335087 DOI: https://doi.org/10.2188/jea.JE20130090
Rasiah R, Yusof W, Nwagbara V. Performance of X-Ray and Fluoroscopy Machines in Public and Private Hospitals in Malaysia. Workshop, Healthcare Services in Malaysia: Are There Differences in the Practices, Performances and Charges Between Public and Private Hospitals; 2010.
Renzi C, Whitaker KL, Wardle J. Over-reassurance and undersupport after a ‘false alarm’: A systematic review of the impact on subsequent cancer symptom attribution and help seeking. BMJ Open. 2015;5(2):e007002. https://doi.org/10.1136/bmjopen-2014-007002 PMid:25652803 DOI: https://doi.org/10.1136/bmjopen-2014-007002
Lyratzopoulos G, Wardle J, Rubin G. Rethinking diagnostic delay in cancer: How difficult is the diagnosis? BMJ. 2014;349:g7400. https://doi.org/10.1136/bmj.g7400 PMid:25491791 DOI: https://doi.org/10.1136/bmj.g7400
Lyratzopoulos G, Abel G, McPhail S, Neal R, Rubin G. Measures of promptness of cancer diagnosis in primary care: Secondary analysis of national audit data on patients with 18 common and rarer cancers. Br J Cancer. 2013;108(3):686-90. https://doi.org/10.1038/bjc.2013.1 PMid:23392082 DOI: https://doi.org/10.1038/bjc.2013.1
Giess CS, Frost EP, Birdwell RL. Difficulties and errors in diagnosis of breast neoplasms. Semin Ultrasound CT MR. 2012;33(4):288-99. https://doi.org/10.1053/j.sult.2012.01.007 PMid:22824119 DOI: https://doi.org/10.1053/j.sult.2012.01.007
Ortiz-Rodriquez JM, Guerrero-Mendez C, Martinez-Blanco MD, Castro-Tapia S, Moreno-Lucio M, Jaramillo-Martinez R, et al. Breast Cancer Detection by Means of Artificial Neural Networks; 2018. Available from: https://www.intechopen.com/chapters/57365 [Last accessed on 2021 Dec 03]. DOI: https://doi.org/10.5772/intechopen.71256
Gandhi TK, Kachalia A, Thomas EJ, Puopolo AL, Yoon C, Brennan TA, et al. Missed and delayed diagnoses in the ambulatory setting: A study of closed malpractice claims. Ann Intern Med. 2006;145(7):488-96. https://doi.org/10.7326/0003-4819-145-7-200610030-00006 PMid:17015866 DOI: https://doi.org/10.7326/0003-4819-145-7-200610030-00006
Gbenonsi G, Boucham M, Belrhiti Z, Nejjari C, Huybrechts I, Khalis M. Health system factors that influence diagnostic and treatment intervals in women with breast cancer in Sub-Saharan Africa: A systematic review. BMC Public Health. 2021;21:1325. https://doi.org/10.1186/s12889-021-11296-5 PMid:34229634 DOI: https://doi.org/10.1186/s12889-021-11296-5
Shyyan R, Masood S, Badwe RA, Errico KM, Liberman L, Ozmen V, et al. Breast cancer in limited-resource countries: Diagnosis and pathology. Breast J. 2006;12 Suppl 1:S27-37. https://doi.org/10.1111/j.1075-122X.2006.00201.x PMid:16430396 DOI: https://doi.org/10.1111/j.1075-122X.2006.00201.x
Downloads
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2021 Wan Hasliza Wan Mamat, Nikki Jarrett, Susi Lund (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
http://creativecommons.org/licenses/by-nc/4.0