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Journal of Oncology
Volume 2013, Article ID 206367, 6 pages
Research Article

The Haiti Breast Cancer Initiative: Initial Findings and Analysis of Barriers-to-Care Delaying 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
4Clinique Bon Sauveur, Zanmi Lasante, Cange, Haiti
5University of Tennessee Health Science Center, 910 Madison Avenue, Memphis, TN 38163, USA
6Dana Farber Cancer Institute, Brigham and Women’s Hospital, 450 Brookline Avenue, Boston, MA 02115, USA

Received 14 March 2013; Revised 8 May 2013; Accepted 15 May 2013

Academic Editor: Sofia D. Merajver

Copyright © 2013 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. In Haiti, breast cancer patients present at such advanced stages that even modern therapies offer modest survival benefit. Identifying the personal, sociocultural, and economic barriers-to-care delaying patient presentation is crucial to controlling disease. Methods. Patients presenting to the Hôpital Bon Sauveur in Cange were prospectively accrued. Delay was defined as 12 weeks or longer from initial sign/symptom discovery to presentation, as durations greater than this cutoff correlate with reduced survival. A matched case-control analysis with multivariate logistic regression was used to identify factors predicting delay. Results. Of patients accrued, 90 (73%) reported symptom-presentation duration and formed the basis of this study: 52 patients presented within 12 weeks of symptoms, while 38 patients waited longer than 12 weeks. On logistic regression, lower education status (OR = 5.6, ), failure to initially recognize mass as important (OR = 13.0, ), and fear of treatment cost (OR = 8.3, ) were shown to independently predict delayed patient presentation. Conclusion. To reduce stage at presentation, future interventions must educate patients on the recognition of initial breast cancer signs and symptoms and address cost concerns by providing care free of charge and/or advertising that existing care is already free.