Shimaa Mousa

Patterns of Seeking Medical Care among Breast Cancer Patients in Gharbiah, Egypt

AUTHORS: Shimaa Mousa, Ibrahim Seifeldin, Ahmed Hablas Eman Elbana, Amr Soliman

OBJECTIVES:
Breast cancer is the most common cancer among Egyptian women, accounting for 37.6% of female tumors in Egypt. The incidence rate in Egypt is 49.6 cases per 100,000 women, and these cases are commonly diagnosed at later stages. The objective of this study was to map and identify patterns in the medical care-seeking pathways of Egyptian breast cancer patients.

METHODS:
Interviews were conducted with newly-diagnosed breast cancer patients at the Tanta Cancer Center (TCC), the largest cancer center in the Nile delta region of Egypt. The study was conducted between February 2009-May 2009 and December 2009-August 2010. Patients were asked to describe their medical care pathway from the initial symptom experienced until their arrival at TCC.

PRELIMINARY RESULTS:
Data were collected from 150 women (through July 2010). Preliminary analyses found that 76% of the women reported a breast mass as the first symptom of breast cancer, and 70% reported an increase in mass size as the cause for seeking medical advice. The most commonly visited first provider/facility was a general surgeon (36%). Other commonly visited types of initial providers included: primary care/general hospitals (20%), TCC (13.3%), surgical oncologists (9.3%), medical oncologists (7.3%), and gynecologists (6.7%). Among patients who visited surgical oncologists and medical oncologists first, 78.6% and 100% reached TCC by the second provider visit, respectively, compared to 50% of general surgeons' patients, 26.7% of primary care providers' patients, and 20% of gynecologists' patients. By the third facility visit, 84% of all patients had reached TCC. In total, the average time between first symptom and arrival at TCC was 7.6 months (Median: 4 months, Range: 2 days - 38 months, SD: 8.8 months).

CONCLUSIONS:
General surgeons and primary care providers were commonly reported as the patients' initial contact with the Egyptian health care system. Furthermore, compared to patients who visited oncologists, a lower proportion of these patients reached TCC by the second visit. In order to ensure that breast cancer patients are immediately referred to the proper treatment facility, it may be important to target general surgeons and primary care providers when planning interventions aimed toward decreasing the number of facilities visited between the first symptom observed and arrival at TCC.

About Shimaa
Shimaa Mousa is originally from East Lansing, MI, and graduated from Michigan State University with a Bachelor's degree in Human Biology. She graduated from the University of Michigan School of Public Health in 2011 with a MPH in Epidemiology and a Certificate in Global Health.
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