Breast cancer is the most common cancer in females around the world.
Annually, more than one million women are diagnosed with breast cancer
globally. In Oman, breast cancer is also the most common cancer in females and
its incidence has been rising over the years. Published studies have shown that
many Omani women have late stage breast cancer at presentation. Possible
reasons for this have not been explored. Although Oman has in place a mortality
registration database, no population-based mortality data from breast cancer are
available. Likewise, the only data available about survival rate of people with
breast cancer come from a hospital-based study.
The main aims of the research described in this thesis are:
1) To identify the extent of delay in breast cancer diagnosis in Oman.
2) To assess the relationship between delay and socio-demographic
characteristics, medical and obstetric history, nature of presenting
symptoms and women’s knowledge about breast cancer.
3) To identify reasons for delay in seeking medical help for self-detected
breast cancer symptoms in Omani women.
4) To calculate the population-based survival rate from breast cancer in
Aims 1, 2 and 3 were addressed by a study of 150 patients attending oncology
clinics in both the Royal Hospital and Sultan Qaboos University Hospital, who
were interviewed using structured questionnaires. Patient delay was defined as a
period of three months or more between an individual's first awareness of a sign
or a symptom of illness and the initial medical consultation.
In order to calculate survival rate, the National Cancer Registry records were to
be linked to mortality databases in Oman (Directorate General of Civil Status
and to the Parallel Mortality Database).
The final analysis of delay included 144 patients with breast cancer. The median
time taken by women in this sample between discovering the breast symptoms
and seeing a doctor was 14 days. 56.9% of the patients had a medical
consultation in less than a month after detecting symptoms, whereas 20.1 % had
a consultation within 1 to 2 months. 22.9 % of the patients delayed consultation
by ≥ 3 months. Of the socio-demographic characteristics examined in this study,
it was observed that older age, low educational level and employment status
were associated with patient delay. Practice of breast self-examination and
having a history of chronic disease were also predictors of delay. 44% of
patients had early stage disease (stage I/stage II) compared to 56% of patients
with late stage disease (stage III/stage IV). However, patient delay was not
associated with advanced stage cancer in this study.
The main reasons given for delay were: failure to recognise the symptoms to be
breast cancer, not seeing oneself at risk for breast cancer, fear and
embarrassment, use of alternative therapy and family and work commitments.
Due to ethical consideration, I was not able obtain data from Omani NCR and
therefore the linking to mortality databases was not possible.
This study is the first in Oman to investigate the extent of patient delay for
women with self-discovered breast symptoms and the factors that influence this
delay. The findings of this study indicate the need for public education aimed at
raising breast cancer awareness. Further, initiating a screening program in
Oman should be considered to help women achieve diagnosis of the disease in
its early stages.
Population-based cancer research should be encouraged in Oman, and efforts
should be taken to improve the quality and completeness of cancer data, which
are important in providing on-going monitoring of cancer.||