Breast cancer presentation at a regional cancer centre

Breast cancer accounts for 20% of all female cancers in India and most patients present with advanced disease. Many factors may be responsible for the late presentation including the prehospital diagnostic and therapeutic approach towards breast lumps which may be malignant. To evaluate these factors we carried out a prospective investigation at the Institute Rotary Cancer Hospital of the All India Institute of Medical Sciences.

We studied 100 new patients with breast cancer seen in a special clinic over a 12-week period, excluding patients who did not have a palpable lump and those who had had an operation in another hospital more than six months previously.

Fifty-seven of the patients were from urban and 43 from rural areas. Only 20 patients were aware of breast cancer before the onset of their illness. They were mainly from an urban background, educated and had a family history of breast and other malignancies. The total duration of illness ranged from 1 week to 10 years (mean 11.3 months) and the time to first visit ranged from 1 day to 9.5 years (mean 6.7 months). The delay between the first contact with a doctor to the date seen in the Institute Rotary Cancer Hospital thus amounted to a mean of 4.6 months. The duration of illness as well as time to first visit was also significantly shorter in urban patients, those who were educated and those who were aware of the disease. Fine needle aspiration cytology was used in 50 patients and was diagnostic in 39. Thirty of the 100 patients had no diagnostic investigations. Of the 43 patients treated elsewhere, the operation had been inadequate in 17 and 27 of the 43 patients were found to have had faulty adjuvant therapy. Many patients did not carry their operation notes and histopathology reports and when these were available, they were often of poor quality. The use of staging investigations was incomplete so much so that in 22 patients the disease could not be staged at all because of poor records.

Breast cancer is seen in our hospital in an advanced stage because most patients are unaware of the disease. However, the treating physician also contributes to delay in the diagnosis, uses the diagnostic and staging investigations improperly, performs inadequate surgery and prescribes inappropriate adjuvant treatment. Record keeping is also of a poor quality. We need to provide more information to both patients and doctors about breast cancer.