Factors Associated with Late Presentation of Breast cancer in a Teaching Hospital in Port Harcourt, Nigeria


  • Solomon N. Elenwo Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt.
  • Rex Friday Ogoronte A. Ijah Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt.
  • Alexander A. Dimoko Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt.


Associated Factors, Late Presentation, Breast Cancer, Port Harcourt, Nigeria


Aim: The aim of this study was to investigate the socio-demographic and clinical factors associated with late presentation of breast cancer in Surgery Department of the University of Port Harcourt Teaching Hospital, from July 2016 to June 2019.

Background: Most breast cancer patients in developing countries are known to present late with advanced diseases. Patient and system delays have been described with a period longer than 12 weeks considered as prolonged delay. The reasons for delayed presentation / diagnosis are myriad, and some have been reported outside the African setting.

Materials and Methods: A five-year retrospective review of data from breast cancer patients was carried out. A minimum sample size of 60 was deemed adequate based on alpha level of 0.05, breast cancer prevalence of 25.7% in Nigeria and precision level ±5%. Data were analysed using the Statistical Package for Social Sciences (SPSS) version 20.0. Bivariate analysis employed Chi square/Fisher’s exact statistics in determining significant relationship between the dependent and independent variables.

Results: Forty-two (68.8%) out of 61 breast cancer patients presented with late stage disease. There was significant association between age category, attainment of menopause, history of breast feeding, and late presentation of breast cancer.

Conclusion: Our study showed that some socio-demographic and clinical factors are found among patients who presentation with breast cancer, and most of them are multiparous. Breast cancer occur among patients with relatively younger age than their western counterpart, and most of them were multiparous.

Author Biographies

Solomon N. Elenwo, Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt.

Department of Surgery, Consultant General Surgeon and Senior Lecturer

Rex Friday Ogoronte A. Ijah, Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt.

Department of Surgery, General Surgeon

Alexander A. Dimoko, Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt.

Department of Surgery, Consultant General Surgeon


Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. International journal of cancer. 2015;136(5):E359-E86.

Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA: a cancer journal for clinicians. 2011;61(2):69-90.

Ginsberg GM, Lauer JA, Zelle S, Baeten S, Baltussen R. Cost effectiveness of strategies to combat breast, cervical, and colorectal cancer in sub-Saharan Africa and South East Asia: mathematical modelling study. Bmj. 2012;344:e614.

Niëns LM, Nyarko KM, Zelle SG, Jehu‐Appiah C, Rutten FF. Equity in Ghanaian breast cancer treatment outcomes—a modeling study in Komfo Anokye Teaching Hospital. The breast journal. 2014;20(1):100-2.

Ngoma T, Mandeli J, Holland JF. Downstaging cancer in rural Africa. International journal of cancer. 2015;136(12):2875-9.

Ozmen V, Boylu S, Ok E, Canturk NZ, Celik V, Kapkac M, et al. Factors affecting breast cancer treatment delay in Turkey: a study from Turkish Federation of Breast Diseases Societies. The European Journal of Public Health. 2015;25(1):9-14.

Neal R, Allgar V. Sociodemographic factors and delays in the diagnosis of six cancers: analysis of data from the ‘National Survey of NHS Patients: Cancer’. British journal of cancer. 2005;92(11):1971-5.

Andersen RS, Vedsted P, Olesen F, Bro F, Søndergaard J. Patient delay in cancer studies: a discussion of methods and measures. BMC health services research. 2009;9(1):1-7.

Grunfeld EA, Hunter MS, Ramirez AJ, Richards MA. Perceptions of breast cancer across the lifespan. Journal of psychosomatic research. 2003;54(2):141-6.

Nosarti C, Crayford T, Roberts J, Elias E, McKenzie K, David A. Delay in presentation of symptomatic referrals to a breast clinic: patient and system factors. British journal of cancer. 2000;82(3):742-8.

Montella M, Crispo A, D'aiuto G, De Marco M, De Bellis G, Fabbrocini G, et al. Determinant factors for diagnostic delay in operable breast cancer patients. European journal of cancer prevention. 2001;10(1):53-9.

Richards M, Westcombe A, Love S, Littlejohns P, Ramirez A. Influence of delay on survival in patients with breast cancer: a systematic review. The Lancet. 1999;353(9159):1119-26.

Eniojukan J, Adepoju T. An Audit of the management and associated contextual correlates of clinical presentations of breast cancer in tertiary hospital in south west. IOSR Journal of pharmacy. 2015;5(6):11-21.

Kirkwood BR, Sterne JA. Essential medical statistics: John Wiley & Sons; 2010.

Adetifa F, Ojikutu RK. Prevalence and trends in breast cancer in Lagos State, Nigeria. African Research Review. 2009;3(5).

Maghous A, Rais F, Ahid S, Benhmidou N, Bellahamou K, Loughlimi H, et al. Factors influencing diagnosis delay of advanced breast cancer in Moroccan women. BMC cancer. 2016;16(1):356.

Akuoko CP, Armah E, Sarpong T, Quansah DY, Amankwaa I, Boateng D. Barriers to early presentation and diagnosis of breast cancer among African women living in sub-Saharan Africa. PloS one. 2017;12(2):e0171024.

Fedewa SA, Edge SB, Stewart AK, Halpern MT, Marlow NM, Ward EM. Race and ethnicity are associated with delays in breast cancer treatment (2003–2006). Journal of health care for the poor and underserved. 2011;22(1):128-41.

Ayeni OA, Norris SA, Joffe M, Cubasch H, Nietz S, Buccimazza I, et al. The multimorbidity profile of South African women newly diagnosed with breast cancer. International Journal of Cancer. 2020;147(2):361-74.

Jedy-Agba E, McCormack V, Olaomi O, Badejo W, Yilkudi M, Yawe T, et al. Determinants of stage at diagnosis of breast cancer in Nigerian women: sociodemographic, breast cancer awareness, health care access and clinical factors. Cancer causes & control. 2017;28(7):685-97.

Ebughe GA, Ugare GU, Nnoli MA, Bassey I-A, Nwagbara VJ, Udosen J, et al. Histological type and tumour grade in Nigerian breast cancer: Relationship to menarche, family history of breast cancer, parity, age at first birth, and age at menopause. IOSR J Dent Med Sci. 2013;7(5):58-63.

Popoola AO, Adewuya AO. Prevalence and correlates of depressive disorders in outpatients with breast cancer in Lagos, Nigeria. Psycho‐Oncology. 2012;21(6):675-9.

Fatiregun O, Sowunmi AC, Habeebu M, Okediji P, Alabi A, Fatiregun O, et al. Prevalence and Correlates of Unmet Supportive Needs of Nigerian Patients With Cancer. Journal of global oncology. 2019;5:1-9.

Erhabor O, Udomah F, Abdulrahaman Y, Zama I, Imoru M, Adias TC, et al. Randomized Clinical Trials on Breast Cancer in Nigeria and Other Developing Countries: Challenges and Constraints. Perioperative Inflammation as Triggering Origin of Metastasis Development: Springer; 2017. p. 123-59.

Felix CE, Ogbonna OS, Chinedum CF. Serum Immunoglobulins (IgG, IgM and IgA) in Nigerian Women with Breast Cancer. Open Journal of Immunology. 2018;8(03):81.

Ntekim AI, Folasire AM, Ali-Gombe M. Survival pattern of rare histological types of breast cancer in a Nigerian institution. The Pan African Medical Journal. 2019;34.

Adeniji AA, Dawodu OO, Habeebu MY, Oyekan AO, Bashir MA, Martin MG, et al. Distribution of Breast Cancer Subtypes Among Nigerian Women and Correlation to the Risk Factors and Clinicopathological Characteristics. World Journal of Oncology. 2020;11(4):165.

Song Q-K, Li J, Huang R, Fan J-H, Zheng R-S, Zhang B-N, et al. Age of diagnosis of breast cancer in china: almost 10 years earlier than in the United States and the European union. Asian Pacific Journal of Cancer Prevention. 2014;15(22):10021-5.

Sant M, Allemani C, Capocaccia R, Hakulinen T, Aareleid T, Coebergh JW, et al. Stage at diagnosis is a key explanation of differences in breast cancer survival across Europe. International journal of cancer. 2003;106(3):416-22.

Ugwu-Olisa OA, Nnamdi AS, Gregory NC, Festus I. Clinicopathologic study of breast lumps in Abakaliki, South Eastern Nigeria. Asian Journal of Medical Sciences. 2016;7(3):58-64.

Balekouzou A, Yin P, Pamatika CM, Bishwajit G, Nambei SW, Djeintote M, et al. Epidemiology of breast cancer: retrospective study in the Central African Republic. BMC Public Health. 2016;16(1):1-10.

Mensah S, Dogbe J, Kyei I, Addofoh N, Paintsil V, Osei Tutu L. Determinants of Late Presentation and Histologic types of Breast Cancer in Women Presenting at a Teaching Hospital in Kumasi, Ghana. 2015.

Fregene A, Newman LA. Breast cancer in sub‐Saharan Africa: how does it relate to breast cancer in African‐American women? Cancer: Interdisciplinary International Journal of the American Cancer Society. 2005;103(8):1540-50.

Najjar H, Easson A. Age at diagnosis of breast cancer in Arab nations. International journal of surgery. 2010;8(6):448-52.

Mathur D, Toriola A. Age at menarche in Nigerian athletes. British journal of sports medicine. 1982;16(4):250-2.

Umeora O, Egwuatu V. Age at menarche and the menstrual pattern of Igbo women of south-east Nigeria. African journal of reproductive health. 2008;12(1):90-5.

McDowell MA, Brody DJ, Hughes JP. Has age at menarche changed? Results from the National Health and Nutrition Examination Survey (NHANES) 1999–2004. Journal of Adolescent Health. 2007;40(3):227-31.

Yermachenko A, Dvornyk V. Nongenetic determinants of age at menarche: a systematic review. BioMed research international. 2014;2014.

Okonofua FE, Lawal A, Bamgbose J. Features of menopause and menopausal age in Nigerian women. International Journal of Gynecology & Obstetrics. 1990;31(4):341-5.

Yip C-H. Breast cancer in Asia. Cancer Epidemiology: Springer; 2009. p. 51-64.

Agarwal G, Pradeep P, Aggarwal V, Yip C-H, Cheung PS. Spectrum of breast cancer in Asian women. World journal of surgery. 2007;31(5):1031-40.

Youlden DR, Cramb SM, Yip CH, Baade PD. Incidence and mortality of female breast cancer in the Asia-Pacific region. Cancer biology & medicine. 2014;11(2):101.

Fan L, Goss PE, Strasser-Weippl K. Current status and future projections of breast cancer in Asia. Breast care. 2015;10(6):372-8.

Cui Y, Whiteman MK, Flaws JA, Langenberg P, Tkaczuk KH, Bush TL. Body mass and stage of breast cancer at diagnosis. International journal of cancer. 2002;98(2):279-83.

Altwalbeh D, El Dahshan M, Yassin R. Factors influencing delayed presentation of breast cancer among Saudi women. International Journal of Science and Research. 2015;1(4):967-74.

Surakasula A, Nagarjunapu GC, Raghavaiah K. A comparative study of pre-and post-menopausal breast cancer: Risk factors, presentation, characteristics and management. Journal of research in pharmacy practice. 2014;3(1):12.

Otieno E, Micheni J, Kimende S, Mutai K. Delayed presentation of breast cancer patients. East African medical journal. 2010;87(4):147-50.

Ibrahim N, Oludara M. Socio-demographic factors and reasons associated with delay in breast cancer presentation: a study in Nigerian women. The Breast. 2012;21(3):416-8.

Holland R, Hendriks JH, Mravunac M. Mammographically occult breast cancer: a pathologic and radiologic study. Cancer. 1983;52(10):1810-9.

Duijm L, Groenewoud J, Jansen F, Fracheboud J, van Beek M, de Koning H. Mammography screening in the Netherlands: delay in the diagnosis of breast cancer after breast cancer screening. British journal of cancer. 2004;91(10):1795-9.

Duijm LE, Groenewoud JH, de Koning HJ, Coebergh JW, van Beek M, Hooijen MJ, et al. Delayed diagnosis of breast cancer in women recalled for suspicious screening mammography. European journal of cancer. 2009;45(5):774-81.

Britton P, Duffy S, Sinnatamby R, Wallis M, Barter S, Gaskarth M, et al. One-stop diagnostic breast clinics: how often are breast cancers missed? British journal of cancer. 2009;100(12):1873-8.

Jassem J, Ozmen V, Bacanu F, Drobniene M, Eglitis J, Lakshmaiah KC, et al. Delays in diagnosis and treatment of breast cancer: a multinational analysis. The European Journal of Public Health. 2014;24(5):761-7.




How to Cite

Elenwo, S. N., Ijah, R. F. O. A., & Dimoko, A. A. (2022). Factors Associated with Late Presentation of Breast cancer in a Teaching Hospital in Port Harcourt, Nigeria. The Nigerian Health Journal, 22(1), 140–152. Retrieved from https://tnhjph.com/index.php/tnhj/article/view/516

Similar Articles

1 2 3 4 5 6 7 8 9 10 > >> 

You may also start an advanced similarity search for this article.