Timeliness of Pathological Diagnosis for Suspicious Breast Lesions in Northern Tanzania.

Abstract

Background: Most breast cancer cases in sub-Saharan Africa are diagnosed at advanced stages. The World Health Organization's Global Breast Cancer Initiative (GBCI) emphasizes early diagnosis and recommends that women with suspicious breast lesions promptly consult a health care provider (HCP) and receive a pathologic diagnosis within 60 days of their initial visit.

Patients and methods: We interviewed 194 women undergoing diagnostic evaluation for suspicious breast lesions at a zonal referral hospital in northern Tanzania to assess diagnostic timeliness. Two intervals were examined: the pre-contact interval from first symptom recognition to the initial HCP visit, and the post-contact interval from the first HCP visit to the definitive pathological diagnosis. Negative binomial regression models were applied to assess factors influencing the duration of pre- and post-contact intervals.

Results: The median pre-contact interval length was 1.0 month (IQR: 0.2-4.7), and the median post-contact interval was 0.9 months (IQR: 0.2-5.5). Overall, 63% of women received a pathological diagnosis within 60 days of first HCP contact, meeting the GBCI benchmark. Consulting multiple HCPs was associated with longer post-contact intervals, whereas being married and referral for pathologic evaluation at initial HCP visit were associated with shorter intervals. Breast cancer was diagnosed in 28% of participants.

Conclusion: We observed comparatively short diagnostic intervals, with several modifiable factors influencing interval lengths. Targeted training of frontline HCPs and sustained breast cancer awareness efforts are particularly needed for women experiencing prolonged delays from symptom onset to diagnosis. Continued monitoring of diagnostic intervals is essential to sustain and improve diagnostic timeliness.