A study, which I conducted during my undergraduate years titled “Patient and provider delays in breast cancer patients attending a tertiary care centre: a prospective study” was published in the Journal of Royal Society of Medicine. This study was conducted in a government hospital at New Delhi, where majority of the patients were from the rural background. Patient delays are a well known fact and more so in breast cancer due to the apprehension shared by many Indian ladies regarding the examination of their breasts. It was not surprising to see that there was an average delay of around 70-75 days was observed in these patients, after the onset of symptoms till the time of the first consultation.
Adding to these patient delays, 63% of these patients first contact after the onset of the symptoms was with an unregistered medical practitioner (quack), which led to further delay in the diagnosis of breast cancer. Another shocking fact was that an average of three consultations were required before the diagnosis of breast cancer was made.
These points clearly highlight why the incidence of locally advanced breast cancer in India is so high!! This along with the aggressive biology of our tumors (high incidence of triple negative tumors), spells doom for most of the patients.
What are the steps which can be taken to avoid these delays in diagnosis?
- Spreading awareness about breast cancer: With communicable diseases gradually being controlled in our country, cancer is the next big epidemic which India is going to face. Proper steps need to be taken now to ensure India is ready to face this next big challenge. Awareness about Breast cancer should be increased among Indian women and I feel that Obstetricians and Pediatricians have a huge role to play in this. They should educate ladies regarding breast cancer during their pregnancy and follow-up visits.
- Improving the literacy level: In our study, we observed that literate patients were more likely to consult a qualified doctor and the time lag between the onset of symptoms and the first consultation was less in them as compared to illiterate ladies.
- Educating Primary Care Doctors: Although patient delays were largely responsible for the late presentation but there were instances, where breast cancer were not detected by primary care doctors. Special sessions should be conducted for these doctors to make them more aware about the signs and symptoms of various cancers.
- Hunting down quacks: Quacks lead to unnecessary delays not only in the management of Breast cancer but also other illnesses and our government should take appropriate measures to end this menace.
I know it is easier said than done but with these measures we can certainly cut down the delays in the management of Breast Cancer in India.