Delayed help-seeking for symptomatic breast cancer: reasons for delay among participants receiving treatment at a public healthcare facility in South Africa

We explored delayed help-seeking behaviour for symptomatic breast cancer among a sample of female patients attending an outpatient breast cancer clinic at a tertiary public hospital in the Western Cape. The objective of the research was to explore the perceived personal and structural barriers to help-seeking among women with breast cancer from this low-resource setting, as this information has not been documented. Purposive sampling was used to recruit 25 breast cancer patients. Patients participated in individual interviews that were audio-recorded and transcribed. We conducted a thematic analysis using both inductive and deductive coding. Participants’ limited knowledge of breast cancer, negative views of the healthcare system, and challenging life experiences, such as marital discord, perceived lack of support, and caring for sick loved ones, contributed to their help-seeking delays. We used a combination of the Common-Sense Model of Self-Regulation and Bronfenbrenner’s Ecological Systems theory to conceptualize and organize these findings. A general lack of breast cancer knowledge was a major contributing factor to help-seeking delays among participants in the study. This finding was surprising considering that several breast cancer awareness campaigns have been run both nationally in South Africa and internationally. We call attention to the need for accessible breast cancer information at primary healthcare and community levels.

The value of mammography in women with focal breast complaints in addition to initial targeted ultrasound

Purpose To determine the added value of mammography in women with focal breast complaints and the utility of initial targeted ultrasound in this setting. Methods Women with symptomatic breast disease who were evaluated by breast imaging (mammography/digital breast tomosynthesis and ultrasound) between January 2016 and December 2016 in the Radboud University Medical Centre were included. We retrospectively collected the following data: date of birth, indication of imaging, visibility on mammography/ultrasound, whether biopsy was taken, additional findings, BI-RADS-classification, pathology and follow-up results. Results A total of 494 women were included (mean age 46.5, range 30 to 93). In 49 women (9.9%), symptomatic breast cancer was diagnosed, all visible during targeted ultrasound. The negative predictive value of targeted ultrasound was very high (99.8%). Additional findings on mammography were significantly more often malignant when the symptomatic lesion was also malignant (3.8% vs 70%, P < 0.05). In only one patient with symptoms caused by a benign finding, an incidental malignancy was detected on mammography outside the area of complaint (detection rate 2.2/1000 examinations). Conclusions The contribution of mammography for cancer detection in women with focal breast complaints is very low when targeted ultrasound is performed. Additional findings are most common in patients with symptomatic breast cancer. Our results suggest that initial targeted ultrasound is a more appropriate initial tool for the evaluation of focal breast complaints. Mammography could be performed on indication only.

Pathogenic Variants in CHEK2 Are Associated With an Adverse Prognosis in Symptomatic Early-Onset Breast Cancer

PURPOSE Checkpoint kinase 2 ( CHEK2) is frequently included in multigene panels. We describe the associated outcomes among carriers of CHEK2 pathogenic variants in young patients with symptomatic breast cancer. PATIENTS AND METHODS Participants (N = 2,344) in the Prospective Outcomes in Sporadic Versus Hereditary Breast Cancer study had a diagnosis of primary invasive breast cancer at age ≤ 40 years. Summary statistics were used to compare tumor characteristics among CHEK2+ carriers with those who were CHEK2−. Kaplan-Meier curves were used to demonstrate overall survival (OS) and distant disease-free survival. RESULTS Overall, 53 of the 2,344 participants (2.3%) had a pathogenic CHEK2 variant. CHEK2+-associated tumors were significantly more likely to be grade 2, estrogen receptor and progesterone receptor–positive compared with CHEK2− tumors (grade 2, n = 28 of 52 [53.8%] v n = 803 of 2,229 [36.0%]; P = .029). CHEK2-associated tumors were significantly more likely to have nodal involvement (N1, n = 37 of 53 [69.8%] v 1,169 of 2,253 [51.9%]; P = .0098) and demonstrated a trend toward multifocality. A higher proportion of participants with CHEK2+ variants with invasive breast cancer were obese than were those with CHEK2− variant (28.3% v 18.8%; P = .039). Univariate and multivariable analyses revealed that OS and distant disease-free survival were significantly worse in CHEK2+ versus CHEK2− carriers (OS hazard ratio, 1.58; 95% CI, 1.01 to 2.48; P = .043). CONCLUSION This work highlights the adverse prognosis associated with breast cancer in carriers of CHEK2 pathogenic variants. It also identifies a potential association among obesity, family history, and breast cancer risk in young CHEK2 gene carriers.