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