Prince Antonio Harrison, Kavitha Srinivasan, Binu VS, MS Vidyasagar, Suma Nair
Background: The incidence of Breast Cancer is increasing, particularly in previously low incidence areas such as Asia. In fact in India, it is considered the leading Cancer among women in certain metros such as Mumbai, Bangalore & Thiruvananthapuram. The risk factors responsible for the causation of breast cancer may be population specific. Moreover, there are inherent factors that aid in the late presentation of breast cancer patients to a hospital. Identifying these factors holds great promise in reducing the incidence, morbidity and mortality due to this disease.
Objectives: To study the socio-demographic and risk factors of breast cancer patients presenting to a tertiary care hospital and to determine the stage at presentation and factors contributing to delayed presentation.
Methods: This was a one is to four matched case control study with a sample of 315 individuals. The cases were enrolled in the order of their admission into the hospital during a four month study period. For each identified case an age matched control was recruited from the hospital. Cases and controls were personally interviewed by the investigator using a structured questionnaire and the data pertaining to treatment and diagnostic modalities were collected from the medical records.
Results: Most (46%) of the cases belonged to the 45 – 54 age group and only 8% were over the age of 60. Despite a high literacy status (80%), women in this study had poor awareness pertaining to breast cancer (63%). Considerable proportions of the cases were detected in stage III (46%) or stage IV (36.5%) of the disease when treatment options are limited and cure a distant probability. Nearly all the cases (98.4%) had accidently identified the breast lump and none of them had ever performed a breast self examination or undergone any screening procedure. First delivery at age > 30 years [OR = 2.27 (1.02 – 5.05) p < 0.05] showed a significant risk association. Menarche < 11 years [OR = 0.321 (0.106 – 0.971) p < 0.05] showed a beneficial effect. Nearly 88% of the cases approached more than one primary care practitioner prior to being referred to a cancer detection center, thereby delaying the process of diagnosis.
Conclusion: The risk factor for breast cancer determined by our study was first delivery over the age of 30. Delay in referral of cases was another significant finding which is of concern and needs to be addressed pragmatically. Considering the low awareness levels of the participants and nonexistent screening practices a targeted intervention to tackle this problem seems to be the need of the hour.
Study Limitations: Since the controls were hospital based, generalisability of these findings could be limited. Besides, women in this study were more literate and employed as compared to many in other parts of India. Various factors that affect delayed presentation such as fear of diagnosis and affordability were not studied.
