Women Going Forward in Survival (Mujeres Avanzando a la Sobrevida): A Prospective Breast Cancer Cohort Study in Honduras.

Abstract

Breast cancer mortality rates are disproportionately high in low- and middle-income countries. The primary reasons for high mortality rates are delays to diagnosis and treatment leading to late-stage presentation. Mujeres Avanzando a la Sobrevida is a prospective cohort study of two cancer centers in Honduras which aimed to map the current landscape of breast cancer in Honduras and understand delays in diagnosis and treatment. All women older than 18 years with newly diagnosed invasive breast cancer were included. Demographic, cancer, and treatment data were collected at pertinent time intervals for diagnosis and treatment. The Unger Saldaña Delay Survey was used to evaluate patients' perceptions of and reasons for delays in cancer care. A total of 184 patients with a median age of 53 years at diagnosis were enrolled; 85.0% had T2-T3 tumors. Sixty percent had stage III or IV cancer, and 70% had axillary node involvement. The mean time interval from the first symptom to the initial treatment was 386 days; from the first symptom to the first provider visit (patient interval) was 205 days; from first provider to biopsy (diagnostic interval) was 79 days; and from biopsy to initial treatment (treatment interval) was 98 days. Despite these delays, 74% of patients felt they sought care promptly. The most cited self-reported reason for these delays was patients' belief in self-improvement. Honduras faces significant delays in three critical intervals of breast cancer diagnosis and treatment. Targeted interventions are needed to enhance cancer awareness and health promotion among the population, provide specific cancer care training for clinicians, and design and implement straightforward navigation pathways for timely referrals.