Low awareness, poverty delay breast cancer diagnosis and treatment in Bangladesh: Study

More than half of breast cancer patients in Bangladesh start treatment more than four months after first noticing symptoms as low awareness, poverty and weak healthcare access delay diagnosis, a newly published study has found.

The study, titled "Understanding Delays in Breast Cancer Diagnosis in Bangladesh: A Facility-Based Cross-Sectional Study", was published in the international journal Health Science Reports on 28 June.

Conducted by researchers from the Biomedical Research Foundation (BRF), Independent University, Bangladesh (IUB), and the National Institute of Cancer Research and Hospital (NICRH), the study analysed data from 355 women treated at two major cancer care facilities in Dhaka.

The data were collected from April to September 2017.

Led by BRF scientist and IUB Professor Mohammad Sorowar Hossain, the study found that 55.7% of patients faced a total delay of more than four months from the onset of symptoms to the start of treatment.

It also found that 41% of participants delayed seeking medical care for more than three months after first noticing symptoms, while 24.3% faced delays within the healthcare system, including diagnosis, referrals and treatment initiation.

Infographics: TBS

The findings suggest that many women reach hospitals only after the disease has advanced.

Nearly half of the patients, 48.8%, had Stage II breast cancer when they sought medical help, while 44.1% were at Stage III. Stage III patients had the highest rate of patient delay (51.5%) and total delay (48.6%).

According to GLOBOCAN 2022 estimates, breast cancer was the most common cancer among women in Bangladesh, with 12,989 new cases.

Symptoms ignored

The study identified poor awareness, fear, embarrassment and financial hardship as major reasons behind delayed diagnosis.

About 79% of patients delayed seeking care because they believed their symptoms would disappear on their own.

Nearly 76% cited negligence, while 65.5% said financial hardship delayed their treatment.

More than 44% said they felt embarrassed to discuss breast problems or undergo breast examinations, while 38% delayed visiting a doctor because they feared being diagnosed with cancer or undergoing chemotherapy.

Women who felt uncomfortable discussing breast symptoms with their husbands were more than twice as likely to face delay, the study found.

Poverty and geography worsen delays

The study found strong links between delay, education, income and location.

Women with little or no education were more than twice as likely to face total delay compared with those who had secondary or higher education.

Patients from households earning less than Tk5,000 a month also faced a higher risk of delay.

Rural patients faced nearly three times the risk of total delay compared with urban patients, while Rangpur patients faced the highest risk, with Barishal used as the reference group.

Screening remains limited

Mohammad Sorowar told The Business Standard that one of the biggest reasons for delayed diagnosis is that many women ignore painless breast lumps, assuming they are temporary or linked to hormonal changes.

"Many women do not seek medical advice because the lump is painless. As a result, the opportunity to detect the disease at an early stage is often lost," he said.

He said awareness about where breast cancer screening services are available remains low, even among educated people.

Bangladesh also lacks enough trained healthcare workers to conduct primary breast examinations and assess whether patients need mammography or further tests, contributing to delays in both screening and treatment, he said.

The study says Bangladesh does not have organised breast cancer screening programmes and lacks a systematic referral system.

It also found that nearly 20% of patients first sought treatment from traditional healers, homeopathic practitioners or local pharmacies, believing their symptoms would improve without specialised medical care.

Sorowar said delays also occur when patients first visit primary-level facilities where proper diagnostic and referral services may not be available.

Early diagnosis can save lives

Sorowar said breast cancer treatment in Bangladesh has improved in recent years, and patients diagnosed at Stage I or Stage II can be treated successfully within the country.

"Early diagnosis increases survival chances, lowers treatment costs and reduces complications," he said.

The researchers recommended nationwide awareness campaigns, particularly in rural communities, organised screening programmes, training for nurses and primary healthcare workers, stronger referral systems and mobile screening services in remote areas.

They also recommended adding breast awareness and self-examination lessons to secondary school curricula, particularly for girls in grades nine and ten.