Understanding delays in breast cancer diagnosis in Africa: Key insights and contributing factors

Abstract

Africa has the highest age-standardized breast cancer (BC) mortality rates, largely due to diagnostic delays. Therefore, this scoping review aims to identify individual-level factors that contribute to diagnostic delay of BC in African women. We conducted a global scoping review on cancer diagnostic delays in women, following PRISMA-ScR guidelines. In this scoping review, diagnostic delay is defined as the time from first symptom recognition to pathological diagnosis. Qualitative and quantitative studies involving cancer patients or healthcare professionals published between 2018 and November 28, 2023, were included. We searched PubMed/MEDLINE and Scopus, excluding non-English studies and those focused solely on screening. Two reviewers independently screened titles, full texts, and extracted data. Disagreements were resolved by discussion. Consultations followed Arksey and O'Malley's framework, with input from a general practitioner, psychologist, and epidemiologist. Factors were classified using Bronfenbrenner's ecological model to analyze BC diagnostic delays in Africa. Of 9699 studies, 128 were relevant; 30 focused on African BC patients. Delays were linked to microsystem factors: lack of awareness, fear, young age, low education, finances, mesosystem factors: family duties, limited access, delayed care, symptom disclosure, exosystem factors: traditional healers, mistrust, referral inefficiencies, and macrosystem factors: religious beliefs, education gaps, cultural norms. Diagnostic delays in women with BC in Africa are mainly due to low awareness, cultural beliefs, and reliance on traditional healers. Expanding current interventions and integrating them into healthcare systems, along with engaging religious leaders, is important. Future research should focus on culturally tailored strategies to improve early detection and outcomes.