Factors Influencing Time to Treatment Initiation for Breast Cancer in Ethiopia

Abstract

Background: Breast cancer remains a major public health concern in Ethiopia, with timely access to care critical for improving outcomes. This study examined factors associated with delays in the breast cancer care pathway. Methods: This cross-sectional study collected data from 458 women with histologically confirmed breast cancer between July and September 2024 at three tertiary hospitals. Data were collected through structured interviews and clinical records. Five time intervals from symptom detection to treatment initiation were analyzed using the Model of Pathways to Treatment. Factors were categorized using Andersen's Behavioral Model, and Accelerated Failure Time (AFT) models were used to estimate time ratios (TRs) with 95% confidence intervals (CIs). Results: Rural residence (TR = 1.84; 95% CI: 1.20–2.80) and painless breast mass (TR = 1.94; 95% CI: 1.26–3.00) were linked to longer delays from symptom recognition to first healthcare contact. Low breast cancer literacy and consulting traditional healers before diagnosis were consistently associated with prolonged delays. Consulting ≥ 3 providers extended both intervals, from first healthcare contact to diagnosis (TR = 3.13; 95% CI: 1.96–4.98) and symptom detection to diagnosis (TR = 1.63; 95% CI: 1.02–2.62). Delays were also associated with first providers failing to suspect or refer for cancer. Longer diagnosis-to-treatment intervals were observed among unmarried women, low-income groups, and those using traditional healing post-diagnosis. Older women (≥ 60 years) experienced shorter delays in initiating treatment (TR = 0.62; 95% CI: 0.41–0.93). Conclusion: Delays in breast cancer care in Ethiopia are driven by individual, sociocultural, and systemic barriers. Multilevel interventions are needed to promote early detection and timely treatment.