A review of the delay in diagnosis and management of breast lumps in the Theewaterskloof sub district in the Western Cape
Breast cancer is the most feared and common female malignancy in the world. About one in ten women in South Africa will be diagnosed during her lifetime with this disease. The outcome of breast cancer treatment is dependent on early detection and swift subsequent management. A lack of research exists in South Africa about diagnostic and treatment delay factors. A situational analysis is currently underway to improve the breast cancer service in the country. Even less is known about the delays in rural health care. This study examined the delay during the diagnosis and treatment of breast lumps in the Theewaterskloof (TWK) sub district in the Western Cape. The results were compared to Worcester hospital, the secondary referral centre of this district. Three hundred and twenty (322) patients from Caledon hospital and surrounding clinics in the TWK and 322 randomly selected patients from Worcester hospital surgical clinic, who presented during 2007-2010, were retrospectively studied. The mean breast lump diagnostic period at TWK was 45 days versus 16 days at Worcester. Breast cancer diagnostic times were 38 days and 19 days respectively. More alarming was the difference in breast surgery delay of 173 days versus 16 days at TWK Worcester hospital respectively. These time periods were compared to the tertiary institutions in the Western Cape and with international guidelines. Cytological adequacy i.e. Fine Needle Aspiration (FNA) and core needle biopsy between the institutions are also reported. In conclusion it is suggested that regular training in FNA is required to improve the cytological adequacy at TWK. Long delay in surgical waiting periods can be addressed by referring TWK breast cancer patients to Worcester hospital after diagnosis.