Time to pathologic diagnosis of suspicious breast lesions: An institution-based study in five Ethiopian hospitals

Most breast cancer (BC) patients in sub-Saharan Africa are diagnosed at advanced stages. The World Health Organization's Global Breast Cancer Initiative Pillar II has a benchmark to diagnose BC within 2 months of the first contact with a health care provider (HCP). In this study, we interviewed 345 women who received a diagnostic workup of a suspicious breast lesion (eventually diagnosed as benign or malignant) at five Ethiopian hospitals in 2022. We assessed the length of the diagnostic journey encompassing the pre-contact interval between the first experience of symptoms and the first HCP visit, and the post-contact interval between HCP visit and diagnostic pathology procedures. We used negative binomial regression models to identify factors influencing these time intervals. The median pre-contact interval was 2.8 months (interquartile range [IQR] 0.5-9.8). The median post-contact interval was 1.7 months (IQR 0.6-3.9). Regarding the post-contact interval, 55% of patients received their pathologic diagnosis within the recommended 2 months after the first HCP visit and met the Global Breast Cancer Initiative's benchmark. Increased travel times, limited social support, and consulting multiple HCPs before seeking pathology evaluation prolonged post-contact intervals. Older patients (>45 years) and those referred for pathology evaluation during the initial HCP visit experienced shorter post-contact intervals. Of all 345 women, 39% were diagnosed with BC. The relatively low proportion of women diagnosed within the recommended time frame makes it evident that increased awareness for BC, easily accessible diagnostic services, and specific training for HCPs are essential for the timely diagnosis of BC in Ethiopia.