Reasons of diagnostic delay of breast cancer in Tunisian women (160 patients in the central region of Tunisia)

The diagnosis of breast cancer is, in Tunisia, still done at a late stage. To identify the principal obstacles against early diagnosis of breast cancer for patients consulting at advanced locally stage or with metastasis. We have asked 160 patients with breast cancer showing local T3 or T4 evolution or metastasis at the time of diagnosis, about reasons for the late diagnosis of their breast cancer. The average delay in consultation was 11.6 months and the average size of the tumor was 6.3 cm. The cause of delays in diagnosis was, in 92.5% of cases linked to the patient, and in 24% of case to medical personnel. Two many causes found in patients were: a none-attribution of the symptoms as cancer (35%), and the absence of self-examination of the breasts (23.5%). A comparison of patients according to the cause of delay demonstrated that the distance from a medical centre is more frequent in the case of medical delays, the level of education is lower in patients who fail to carry out self-examination, the more frequent relevant family history of patients who have not attributed the symptoms to cancer, and the relative distance from a medical centre is more pronounced in women in difficult financial circumstances. Changing patient behaviour by public health education, besides professional educational programs could help to ovoid diagnosis delay of breast cancer in Tunisia and improve its outcome.