Análise do atraso da paciente no diagnóstico do câncer de mama – Paraíba

Abstract

Introduction: Breast cancer accounts for about 28% of the worldwide incidence of neoplasms per year, providing an estimated 59,700 new cases for the biennium 2018-2019. A study of 527 patients with breast cancer, conducted between 2005 and 2011, in Paraíba, revealed that 41% of women who arrived at the hospital with advanced tumor staging (III and IV). Late treatment is ultimately responsible for increased mortality, and this is a more present reality in developing countries. Late treatment may be associated with patient behavior (patient delay, PD) and / or be caused by the health system (system delay, SD). The present study focused on the PD. No study had been performed on the patient's delay in Paraíba. Objective: The present study aimed to identify factors that led to the delay of the patient in the diagnosis and treatment of breast cancer in the two reference centers for breast cancer in the state of Paraíba. Method: This was a cross- sectional study, where the Nominal Logistic Regression Analysis was used in order to obtain the odds ratio between the analyzed variables, with 103 breast cancer patients attended at the two largest centers of reference in oncology of the State of Paraíba. The PD was defined as an interval> 60 days between the discovery of symptoms by the patient and the first medical appointment. Results: Of the 103 patients analyzed, 33 (32.0%) presented patient delay. Women with low and medium schooling, respectively 1.22 (95% CI: 0.33-4.48) and 1.92 (95% CI: 0.53- 7.00), increased the chances of patient delay in comparison to women with high schooling. Not being in a stable relationship increased the chance of patient delay 2.04 (95% CI: 0.88-4.73) times compared to women who had stable relationships. Patients without a private health plan increased the odds of 1.90 (95% CI: 0.49-7.32) of patient delay when compared to women with private health insurance. Failure to perform / perform infrequently or sometimes home visits increased the odds of AP 6.25 (95% CI: 0.76-51.33) and 1.82 (95% CI: 0.14-23.25) p < 0.05 respectively, compared to women who always performed medical visits at their place of residence. Women who visited the basic health unit never / rarely 2.66 (95% CI: 0.96-7.36) or sometimes 2.76 (0.96-7.36) increased the chance of patient delay when compared to those who visited regularly. Patients who never underwent mammography and clinical examination of the breasts had 1.78 (0.57-5.53) and 1.47 (0.44-4.89), respectively, higher chances of patient delay in comparison to those who underwent mammography regularly. Statistical analysis did not indicate significant associations between patient delay and stage or tumor grade. Conclusion: Socioeconomic aspects presented results in agreement with the literature. Although the tumors were not discovered during medical examinations, mammography and clinical examination of the breasts were important factors that reduced patient delay, indicating that the prevention behavior of women is associated with other attitudes that favor greater agility in the search for diagnosis. The fact that women who performed medical consultations rarely or never in their place of residence suffered a significant PD indicates the existence of access barriers.