Determinants of patient and health system delays for women with breast cancer in Morocco, 2013

Background. - In Morocco, breast cancer is the first most common cancer in women. It is diagnosed in most cases at an advanced stage. Delay in diagnosis and access to treatment for breast cancer increases morbidity and mortality. The objective of this study was to determine the consultation delay (patient delay), diagnosis delay and access to treatment delay (health system delays) of women with breast cancer admitted at the National Institute of Oncology in Rabat. Factors associated with these delays were analyzed. Methods. - We conducted a cross-sectional study from December 2012 to May 2013 at the National Institute of Oncology in Rabat. Two hundred eligible and consenting women were interviewed using a structured and pre-tested questionnaire. Stages I and II were identified as " early stages" and III and IV as " advanced stages". Results. - In our population, 54% were diagnosed at an early stage of breast cancer and 46% at an advanced stage. The median total delay was 120 days (interquartile interval [IIQ] = 81-202 days). The patient delay (median = 65 days, IIQ = 31-121) was longer than the health system delay (median = 50 days, IIQ = 29-77). High risk for a long total delay (more than 4 months) was observed for women who were aged over 65 years (OR = 1.30, 95% CI 1.10-4.20), illiterate (OR = 4.50, 95% CI 2.10-6.20), rural residents (OR = 3.40, 95% CI 1.23-8.13), in a lower socioeconomic category (OR = 4.75, 95% CI 1.45-15.60), without knowledge about breast self-examination (OR = 5.67, 95% CI 2.65-12.15) and seen more than 2 times before diagnosis (OR = 7.70, 95% CI 2.88-20.50). A long total delay increased the risk of being diagnosed at an advanced stage (OR = 5.62, 95% CI 3.03-10.45). Conclusion. - Efforts should be directed to providing good information to the population at risk, better access to screening and continuing medical training to enable diagnosis and early treatment. (C) 2015 Elsevier Masson SAS. All rights reserved.