Barriers to surgical treatment and diagnostic intervals among women with operable breast cancer in Benin: a retrospective study from two referral centers (2019-2023).

BACKGROUND

In Benin, breast cancer is a leading cause of cancer-related morbidity and mortality among women. Surgery is central to curative management, yet a substantial proportion of women with potentially operable disease do not ultimately undergo an operation. We assessed time-to-diagnosis intervals and factors associated with non-receipt of surgery among women with operable breast cancer managed in two referral hospitals in Cotonou between 2019 and 2023.

METHODS

We conducted a retrospective analytical study at the National University Hospital Hubert Koutoukou Maga (CNHU-HKM) and the University Hospital for Mother and Child Lagune (CHU-MEL). Eligible participants were women with de novo operable breast cancer at initial presentation. Sociodemographic, clinical, care-pathway, and tumor-related variables were extracted from medical records. Associations with receipt of surgery (yes/no) were explored using bivariate analyses and multivariable logistic regression, with statistical significance set at p < 0.05.

RESULTS

Among 1,362 breast cancer cases identified during the study period, 827 had usable medical records, of which 197 met the criteria for operable disease at diagnosis (operability rate: 23.8%). Data on surgical receipt were available for 187 patients, and 105 underwent surgery, yielding a surgical uptake rate of 56.1%. Mean age was 51.3 ± 13.7 years. The mean patient interval from symptom onset to specialist consultation was 252 days, and 83.3% of patients presented after more than 30 days. In multivariable analysis, lack of multidisciplinary tumor board (MTB) presentation (aOR 2.50; p = 0.004), detection of the tumor by someone other than the patient (aOR 5.67 ; p = 0.040), and tumor size > 5 cm (aOR 7.44; p < 0.001) were independently associated with non-receipt of surgery. Sociodemographic characteristics and measured diagnostic intervals were not independently associated with receipt of surgical treatment.

CONCLUSIONS

Strengthening MTB processes, promoting earlier symptom recognition and presentation, and reducing financial and psychosocial barriers could raise surgical uptake and improve outcomes for operable breast cancer in Benin.