Understanding Delays in Breast Cancer Diagnosis in Bangladesh: A Facility-Based Cross-Sectional Study.

Background and Aims: This study investigates factors contributing to delays in breast cancer diagnosis in Bangladesh and their impact on cancer staging. Early detection is crucial for effective treatment, yet many women in low- and middle-income countries (LMICs) are diagnosed at advanced stages, resulting in poorer outcomes. Methods: A cross-sectional study was conducted at two major cancer care facilities in Dhaka. Women aged 18 and older with suspected or confirmed breast cancer were included. Data were collected using a structured questionnaire on sociodemographic and clinical variables. Total delay, defined as the time from symptom recognition to treatment initiation, was categorized into patient delay (symptom recognition to first medical consultation) and provider delay (first consultation to treatment start). Multivariable logistic regression analyses identified factors associated with these delays. Results: Among 355 participants, 55.7% experienced total delays of over 4 months, with the highest delays in stage III cases (51.5%) due to patient delays. Key factors contributing to patient delay included low education (AOR: 1.43, 95% CI: 1.17-3.05), low monthly income (AOR: 3.41, 95% CI: 1.65-7.30), and absence of breast pain (AOR: 0.50, 95% CI: 0.26-0.96). Provider delays were significantly associated with rural residence (AOR: 3.07, 95% CI: 1.49-6.98) and the presence of nipple discharge (AOR: 2.92, 95% CI: 1.04-8.06). Total delays were most prevalent among patients from the Rangpur division (AOR: 5.87, 95% CI: 2.11-6.59), those residing in rural areas (AOR: 2.74, 95% CI: 1.40-5.52), and individuals with low education (AOR: 2.33, 95% CI: 1.09-5.11). Clinical factors such as breast pain (AOR: 2.34, 95% CI: 1.22-4.60) were also significantly associated with delay, along with discomfort discussing symptoms with a spouse (AOR: 2.16, 95% CI: 1.03-4.68). Additionally, nearly 80% of patients delayed seeking medical attention due to the belief that symptoms would resolve spontaneously, while 75% cited negligence and 65.5% reported financial barriers. Conclusions: Significant delays in breast cancer diagnosis in Bangladesh are driven by socio-economic factors and inadequate healthcare access. Increasing public awareness, especially in rural areas, and improving healthcare accessibility are essential to facilitate early detection. Expanding screening programs and training healthcare providers in early cancer detection are critical to improving patient outcomes.