Demographics and premorbid preferences
There were 423 respondents; we excluded three males leaving 420 females. The majority were the Yoruba tribe, only one required interpreter. The modal age decade was the fifth(table1). Most respondents (323 of 358(90%, 95%CI 87-93) [62 unspecified] preferred orthodox medical care before noticing their symptoms, but most did not utilize BC screening; only 6.0%(95% CI 4.0-9.0%) performed self-breast examination monthly(table1b) hence most lumps were detected inadvertently.
Comparative length of intervals
The PCI (median 106) was significantly longer than the HSI (median 42), Wilcoxon-Signed Rank test p= 0.0001.(paired t-test mean difference 140±442 days (95% CI 95-186). Most respondents disclosed early within 30 days (330(81 %, 95% CI 77-85) and consulted FHP within 60 days (230 (60%, 95% CI 53-63)). Most respondents had long PCI of >30 days.(1-7 days in 91(25%(95% CI 20-29), 1-30 days in 134 (36% 95% CI 31-41) and >30 days in 237 out of 377(64% 95% CI 59-68 ). The SCI was >90 days in 293 of 401 (73% (95% CI 68-77), 91-180 days in 70 of 401 (17% (95% CI 14-22) and >180 days in 226 of 401 (56% (95% CI 51-61) (Table2).
Pattern of disclosure and factors influencing API
Most respondents informed the first person (primary person) early, and the husband was the most common primary person. The primary person offered the correct advice often (table3b), and 276 of 399 (69.2%) acted in tandem with the advice received within 2weeks. Patronizing orthodox care, being married, and being younger were associated with early disclosure (table4) in the unadjusted logistic regression analysis. In the adjusted analysis combining age, premorbid preference, and marital status to predict early disclosure, only premorbid preference and marital status were significant.
Patterns of FHP attendance and factors influencing HSI
Most respondents (355 of 417(85% 95% CI 81-88) first sought orthodox medical care. The most common FHP was a general practitioner(fig 1). A total of 63 (15% (95% CI 12-19) first sought alternative care. The majority of respondents who were hospital goers before detecting their breast symptom still visited a hospital first for treatment (275 of 323 ( 85% 95% CI 81-89). The odds of visiting hospital first vs. switching to alternative care was 2.3(1.0-5.1) among this subgroup of patients.
Receiving correct advice( asking the patient to visit a hospital, to visit orthodox healthcare provider, or go for investigation) from person1 and patronizing hospital for other illnesses were both associated with short HIS (table4). There was a weak correlation between the length of API and the length of the help-seeking interval.
r = 0.13 (95% CI 0.03-0.23)
Factors influencing the length of the PCI
More respondents with big (>5cm) tumors received correct advice compared to those with small tumors (Risk difference 5.5% (95% CI 4.0-15). The probability of correct advice was higher among the doctor FHP compared to nondoctor FHP (Risk difference 8.4 (95% CI 3.2, 20). In the unadjusted analysis, receiving correct advice and having a big tumor were associated with short PCI. Only receiving correct advice was significant in the adjusted odds ratio (AOR) (table4).
Relationship between the component intervals and the SCI
The PCI strongly correlated with the SCI (r= 0.9, 95% CI 0.88- 0.92). Other intervals correlated weakly with the SCI. ( API r = 0.3 95% CI 0.22-0.40 and HSI r = 0.38, 95%CI 0.30-0.47).
There was a high probability of having a short SCI after traversing any component interval quickly (Table5). The odds ratio (OR) for a short SCI vs. long SCI among those who had short API was 6.5 (95% CI 2.6-16.7), among those who had short help-seeking was 11 (95% CI 5.4-2.1) and among those who had short primary-care was 8.3 (95% CI 5.0-14).
Among those who divulged reasons for the long help-seeking intervals, symptom misinterpretation or symptom accumulation was 92 (47%), socioeconomic reasons were 47 (24%), and ignorance was 6 (3.0%). Reasons for long primary-care intervals was misdiagnosis by a health care provider in 37 (25%) (Table 6).
Impact of interval length on the tumor size and risk of t-stage migration
The tumor size estimates of 13 among the 420 records were unreliable and excluded from the analysis of the growth in tumor size and risk of stage migration. Most tumors were estimated as early T-stage at detection, whereas most were locally advanced at the specialist clinic (table7). Mean difference in T-size was significant(. paired t-test mean difference 5.0±4.9cm (95% CI 4-5), median 3.0 vs. 8.0 Wilcoxon-Signed Rank test P= 0.0001).
There was a moderate correlation between the length of the total interval and the growth in tumor size ( r = 0.4). The average growth in the tumor size per month was estimated to be 0.4cm (95% CI in the first 12 months. The risk of stage migration within the first 12 months was lowest in the first month (table7). The overall risk that a lump would be locally advanced when detected inadvertently was 12%(95%CI 9-16), and the risk that it would migrate to the next T-stage before arriving in a specialist clinic was 64% (95% CI 59-69). The OR for stage migration in an SC interval of 31- 90 days vs. 1-30 days was 5 (95% CI 2.0-12), and the OR for stage migration in SC interval >90 days vs. 1-30 days was 16 (95% CI 7.0-38). Among patients who detected their tumors relatively early (estimated as T1 or T2), the hazard of progressing to advanced-stage increased with time. The hazard was lowest in the first 30days (3%), 17% in 60days, 31% in 90 days and 61% in 180 days.