Breast cancer : do the current policies mean anything?

Abstract

AIM :

Breast cancer remains one of the most prevalent malignancies globally with a high mortality rate. South Africa has a number of policies in place designed to ensure that minimum delays are experienced by patients from first symptom to initial treatment. This study was initiated to determine where the longest delays occurred during the patient's journey, from the first symptom to the first treatment. This information, combined with the existing policy, identifies shortfalls in the breast cancer diagnostic and treatment pathways that must be addressed.

METHODS :

A cross-sectional study was undertaken in the Department of Medical Oncology, University of Pretoria/Steve Biko Academic Hospital between April 2020 and August 2021, analysing six timelines from first symptom to first treatment in patients with newly diagnosed breast cancer. Data was obtained by the researchers from the patients on their first visit relating to the delays experienced from first symptom to final biopsy. Clinical information was obtained from the patients' source records once a treatment decision had been reached and treatment started where applicable.

RESULTS :

The longest delays experienced were between the patients' first visit to any medical facility to date of diagnostic biopsy. Delays due to COVID-19 were in the minority with 13/79 (16.4%) patients reporting having experienced COVID-19 related delays. Key Area 2 of the Breast Cancer Prevention and Control Policy makes provision for patients to be referred directly to a regional/tertiary/quaternary medical facility for further screening, diagnosis and treatment within 21-60 days from the first visit. In the study's cohort, a mean of four months from first visit to diagnostic biopsy was recorded. Overall delays of longer than 12 months due to non-representative biopsies (range 1-3) were recorded in three patients. Twenty-nine patients (36.7%) presented to three medical facilities prior to diagnostic biopsy with 10/79 (12.6%) and 1/79 (1.2%) presenting to four and five institutions, respectively, before the diagnostic biopsy.

CONCLUSIONS : The delays patients experienced highlights the lack of knowledge about the urgency and correct referral of suspected malignancy cases. Despite the number of promulgated policies relating to fast track systems via specialist breast units, fiscal and human capital deficiencies negatively impact the attempts to diagnose and treat patients timeously and increase survival.