Breast Cancer Incidence and Factors Affecting Delayed Presentation in a Rural Fiji Population: A Qualitative Study.

[BACKGROUND] Breast cancer disproportionately affects low- and middle-income countries with increased mortality rates compared to high income countries. For the Pacific island country of Fiji, numerous factors have been hypothesized for the high mortality rate. Delay in initial presentation is thought to be a major contributor. This delay is poorly understood.

[METHODS] A retrospective mixed-method study of patients who were diagnosed with breast cancer at Labasa Hospital in Fiji from 2018 to 2022 was conducted. Incidence and mortality rates were obtained from hospital records. Further demographic information and factors pertaining to delayed hospital presentation were obtained from qualitative patient interviews and reported using the Standards for Reporting Qualitative Research (SRQR) guidelines.

[RESULTS] There were 112 histologically confirmed cases of breast cancer at Labasa hospital with an increase in incidence over the study period from 13 to 24.3/100,000 (p < 0.05). Sixty-three patients were able to be interviewed with a mean age of 55.2 years (SD +/- 13.4). The median time from symptom onset to initial presentation was 86.9 weeks (IQR 20-96) and time from diagnosis to treatment was 3.4 weeks (IQR 1-2). Six major themes were identified as reasons for delayed hospital presentation: lack of knowledge, fear, healthcare system delay, preference for alternative treatment, financial/transportation difficulties, and lack of family support.

[CONCLUSIONS] Breast cancer incidence continues to rise in Fiji with substantial delays from symptom onset to initial presentation. Six major themes were identified as issues for delay in presentation.