1. Barriers to seeking diagnosis and treatment for breast cancer in a selected Philippine population Victoria M. Medina

2. Introduction Continuation of a previous study –Sample of randomly selected women, 70 women found positive for breast lump on clinical breast examination (CBE) –Only 46 women (66%) reported to the referral hospital even when the cost of diagnosis and treatment were shouldered by a third party –Non-compliers gave perfunctory answers like “I am afraid to know the results”, “it’s not necessary because I don’t feel any pain”, “I do not have time”

3. Objectives To determine the reasons for compliance and non-compliance to diagnosis and treatment in women offered free screening and treatment of breast cancer, after a positive finding on clinical breast examination. 3

4. Methods  Only 58 out of the 70 women positive for breast mass were located and interviewed  38 compliers and 20 non compliers  17 item questionnaire based on the health belief model (HBM)  3 subdomains  Perceived susceptibility  Perceived benefits  Perceived barriers

5.  A 6-item Likert scale was used for the responses. T-test was used to compare average scores on the Likert scale.  90 % level of significance  Logistic regression was done to determine independent factors affecting outcome. 5

6. Results 6

7. Table 1. Likert Scale Scores For Factors Affecting Compliance Using the Health Belief Model 7 Items Compliers (n=38) Mean + SD Non-compliers (n=20) Mean + SD P value Susceptibility2.62+1.983.15+2.320.22 Benefit5.89+0.4195.85+0.3520.55 Barriers Money-related3.88+2.313.77+2.300.81 Knowledge (lack of)2.72+2.133.65+2.470.05 Fear2.67+2.193.47+2.480.09 Time-related2.25+2.002.90+2.390.15 Institutional2.55+1.992.50+2.160.96 Shame1.54+1.401.75+1.810.52 Inconvenient1.45+1.183.00+2.510.015

8. Items Compliers (n=38) Mean + SD Non-compliers (n=20) Mean + SD P value Number of barriers3.92+1.125.40+1.470.00 8 Table 2. Comparison of the mean number of barriers identified

9. Table 3. Results of Logistic Regression, with Compliance as Dependent Variable. Logistic Regression Table 9 PredictorZp valueOdds Ratio95% CI Total fear-0.570.570.930.74-1.18 Total info1.830.071.230.99-1.53 Inconvenience1.980.051.531.00-2.32 Number of barriers2.500.012.171.18-3.97

10. Discussion Perceived susceptibility – Higher score in non-complier Perceived benefits – Both compliers and non-compliers agree to the benefits of early detection and treatment Perceived barriers – number of perceived barriers was significantly fewer among those non-compliers than compliers 10

11. Types of barriers Fear – Constant finding in several studies – Abnormal cancer screening findings and recalls for further investigation have the potential to generate psychological distress – Individuals who believe that getting cancer will severely limit their ability to function on a daily basis may be fearful of getting screened for cancer 11

12. Lack of knowledge – add to psychological distress due to the uncertainty this generates, and can impact negatively on compliance – some people especially those with high levels of anxiety to start with, may be further distressed with more information about the disease 12

13. Inconvenience – Echoes the findings of other studies – Weekday clinic schedules only 13

14. Limitations Small sample size and its consequence on statistical power 14

15. Conclusions Non-compliance to referrals may be due to perceived inconvenience, fear and lack of knowledge. Efforts should be made to reinforce breast cancer awareness, and women encouraged to consult for possible cancer related symptoms. 15

16. Thank you 16