Barriers to early presentation of self-discovered breast cancer in Singapore and Malaysia: a qualitative multicentre study

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Lim, Jennifer N. W. ; Potrata, Barbara ; Simonella, Leonardo ; Ng, Celene W. Q. ; Aw, Tar-Ching ; Dahlui, Maznah ; Hartman, Mikael ; Taib, Nur A. (2015)
  • Publisher: BMJ Publishing Group
  • Journal: BMJ Open (vol: 5)
  • Related identifiers: doi: 10.1136/bmjopen-2015-009863, pmc: PMC4691764
  • Subject: Global Health | 1699 | PREVENTIVE MEDICINE | 1717 | QUALITATIVE RESEARCH | 1506 | 1704 | Research | 1725 | 1724

Objective: To explore and compare barriers to early\ud presentation of self-discovered breast cancer in\ud Singapore and Malaysia.\ud Design: A qualitative interview study with thematic\ud analysis of transcripts.\ud Participants: 67 patients with self-discovered breast\ud symptoms were included in the analysis. Of these,\ud 36% were of Malay ethnicity, 39% were Chinese and\ud 25% Indian, with an average age of 58 years (range\ud 24–82 years). The number of women diagnosed at\ud early stages of cancer almost equalled those at\ud advanced stages. Approximately three-quarters\ud presented with a painless lump, one-quarter\ud experienced a painful lump and 10% had atypical\ud symptoms.\ud Setting: University hospital setting in Singapore and\ud Malaysia.\ud Results: Patients revealed barriers to early\ud presentation not previously reported: the poor quality\ud of online website information about breast symptoms,\ud financial issues and the negative influence of relatives\ud in both countries, while perceived poor quality of care\ud and services in state-run hospitals and misdiagnosis\ud by healthcare professionals were reported in Malaysia.\ud The pattern of presentation by ethnicity remained\ud unchanged where more Malay delayed help-seeking\ud and had more advanced cancer compared to Chinese\ud and Indian patients.\ud Conclusions: There are few differences in the\ud pattern of presentation and in the reported barriers\ud to seek medical care after symptom discovery\ud between Singapore and Malaysia despite their\ud differing economic status. Strategies to reduce\ud delayed presentation are: a need to improve\ud knowledge of disease, symptoms and causes, quality\ud of care and services, and quality of online\ud information; and addressing fear of diagnosis,\ud treatment and hospitalisation, with more effort\ud focused on the Malay ethnic group. Training is\ud needed to avoid missed diagnoses and other\ud factors contributing to delay among health\ud professionals.
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