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Journal of Oncology
Volume 2012, Article ID 121873, 8 pages
Review Article

A Systematic Review of Barriers to Breast Cancer Care in Developing Countries Resulting in Delayed Patient Presentation

1Program in Global Surgery and Social Change, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
2Department of Plastic and Oral Surgery, Children’s Hospital Boston, 300 Longwood Avenue, Enders 1, Boston, MA 02115, USA
3Duke University School of Medicine, 201 Trent Drive, Durham, NC 27715, USA
4Dana Farber Cancer Institute, Brigham and Women’s Hospital, 450 Brookline Avenue, Boston, MA 02115, USA

Received 11 April 2012; Accepted 17 June 2012

Academic Editor: Thomas E. Adrian

Copyright © 2012 Ketan Sharma et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. Within the developing world, many personal, sociocultural, and economic factors cause delayed patient presentation, a prolonged interval from initial symptom discovery to provider presentation. Understanding these barriers to care is crucial to optimizing interventions that pre-empt patient delay. Methods. A systematic review was conducted querying: PubMed, Embase, Web of Science, CINAHL, Cochrane Library, J East, CAB, African Index Medicus, and LiLACS. Of 763 unique abstracts, 122 were extracted for full review and 13 included in final analysis. Results. Studies posed variable risks of bias and produced mixed results. There is strong evidence that lower education level and lesser income status contribute to patient delay. There is weaker and, sometimes, contradictory evidence that other factors may also contribute. Discussion. Poverty emerges as the underlying common denominator preventing earlier presentation in these settings. The evidence for sociocultural variables is less strong, but may reflect current paucity of high-quality research. Conflicting results may be due to heterogeneity of the developing world itself. Conclusion. Future research is required that includes patients with and without delay, utilizes a validated questionnaire, and controls for potential confounders. Current evidence suggests that interventions should primarily increase proximal and affordable healthcare access and secondarily enhance breast cancer awareness, to productively reduce patient delay.