Referral Patterns and Delays in the Care of Patients With Breast Complaints in Rwanda: A Cohort Study From a Tertiary Hospital

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PURPOSE Breast cancer (BC) outcomes are highly time-sensitive, yet delays in referral and treatment remain a major, often overlooked threat to survival in low- and middle-income countries. Understanding referral patterns may provide critical insights to address gaps in BC care delivery. This study examined referral patterns and delays related to breast complaints across the care continuum at a tertiary hospital in Rwanda. METHODS We conducted a retrospective cohort study of patients presenting with breast complaint(s) at Rwanda Military Referral and Teaching Hospital between January 2022 and June 2023. Electronic medical records and paper files were reviewed to extract preclinical and clinical data. Descriptive statistics were used. Chi-square and Fisher's exact tests assessed associations between patient characteristics and BC diagnosis. Multivariable logistic regression identified factors associated with time delays. Statistical significance was set at P < .05. RESULTS Among 297 participants, 96.3% were female. The most common chief complaint was breast mass (87.9%). Nearly one third (32.0%, n = 95) were diagnosed with BC. Of 91 participants with documented stage, 74.7% presented with late-stage disease, including 60.4% (n = 55) at stage III and 14.3% (n = 13) at stage IV. Median presentation delay was 240 days (IQR, 90-720), biopsy interval 9 days (IQR, 4-18), pathology interval 10 days (IQR, 7-14), and treatment interval 29 days (IQR, 15-74). The median time from symptom onset to treatment initiation among confirmed BC patients was 13 months (IQR, 5-25). Age at diagnosis was significantly associated with malignancy ( P < .001), with most malignant patients occurring among individuals age 31-50 years (51.1%, n = 47). CONCLUSION Substantial delays persist across the BC care continuum, particularly before diagnosis and treatment initiation.

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